Choosing the most adequate NP

Table 4. Kruskal-Wallis tests and associated multiple comparisons tests results with p<0.05 (2-sided), for quantitative variables of G7, G8, G9 by selected cluster partitions

priority potential for HIA (color green), cluster 2 with medium priority (color yellow) and cluster 3 with low priority (color red).

Furthermore, it is then possible to identify the NPs included in each cluster and granting each NP the color of the cluster it belongs to (table 6). Additionally, NPs may then be ranked by the 9 priority criteria (columns of table 6). Hence, assigning a color code to this ranking scheme in tables 5 and 6 helps us to easily identify the more and least advanced clusters and subsequently NPs.

One of the most essential features to be a NP candidate for HIA in our research is having a broad regional range, because of our equity concerns. That immediately limits our HIA candidates to a list of 12 NPs (listed at top of table 6), all green coded in group G9. Since a NP with a red code (low priority) in any of the areas is instantly rejected as a contender, a shortlist of 5 NPs is obtained (orange highlight). The NP for Cerebro-Cardiovascular Disease (PNDCV) is the only NP with a green code both in G1 Legal Context and G5 Link to health problems and gains (associated to the second and third more important criteria) and is thus indeed the adequate program to consider for an HIA with an equity focus and health systems impact concern.

In Table 7 we summarize the analysis of profiles of clusters that include the PNDCV throughout the groups of variables in our study. Groups of variables are ranked according to the priority criteria stated in the introduction of this chapter and recapped in the

“Features for being a potential priority for HIA” column. The clusters that include PNDV seem to agree well with the stated criteria, especially in what concerns the first two priorities embodied in groups G9 and G5. Hence, clusters with the PNDV seem to be better placed for selection that other clusters and within these groups the PNDV seems indeed to be the more adequate for HIA selection than other NPs.

Table 5. Color ranking priorities for HIA of clusters for each variable group and respective priority criterion

Groups of Variables ranked by

importance for our research

Features for being a potential priority for HIA

Chosen partition (number of

clusters)

Cluster

1 2 3 4 5 6

G9 Range of regional implementation

Having a regional span as extended

and in depth as possible 3 + ^{+- -}

G5 Link to health problems and gains

Showing a concern to monitor health gains, health systems needs and

effectiveness gains 5 + ^{+- +-}

G1 Legal Context Being a high-priority NP according to the National Health Plans 2004-2010

and 2012-2016 4 +- + ^+-

G3 Products

Having a practice of generating a variety of different products to the health professionals, specific groups of the population and the population in general (guidelines, published information, online presence, events, etc)

4 + +- ^{- -}

G8 Characterization

% of total specific aims/projects achieved

Considering the monitorization and evaluation of the way the aims are being achieved, including resources allocation

4 + +- ^{- -}

G4 Management Listing its planning documents, general aims and linking them to

specific aims and/or projects’ aims 4 + +-

G7 General aims, specific aims and associated projects

Presenting an adequate number of

aims and projects 6 - +- ^{+ -}

bold Cluster including PNDCV + High priority

+ - Medium priority - Low priority

Not adequate for comparison: one National Health Program cluster Non-existent: the chosen partition includes a lower number of clusters

Table 6. National Programs ranked by priority criterion according to color ranking priorities for HIA of clusters for each variable group of previous table

National Program

G9 Range of regional implementa

tion

G5 Link to health problems and gains

G1 Legal

Context G3

Products

CharacterizatiG8 on % of total

specific aims/projects

achieved

Management G4

G7 General aims, specific

aims and associated

projects

PNDCV CL1 CL1 CL2 CL2 CL2 CL2 CL2

PNV CL1 CL1 CL3 CL1 CL1 CL1 CL3

PNPCDO CL1 CL3 CL2 CL1 CL1 CL1 CL3

PNSO CL1 CL2 CL1 CL1 CL1 CL1 CL3

PCO CL1 CL3 CL1 CL2 CL2 CL2 CL2

ASCJR CL1 CL1 CL1 CL1 CL1 CL1 CL1

PNCI CL1 CL1 CL1 CL1 CL1 CL1 CL1

PNIVIH/SIDA CL1 CL2 CL1 CL3 CL1 CL1 CL3

PNPCD CL1 CL2 CL3 CL3 CL1 CL1 CL3

PNSR CL1 CL2 CL3 CL4 CL1 CL3 CL6

PNSE CL1 CL2 CL3 CL3 CL3 CL2 CL2

PNLCT CL1 CL3 CL3 CL3 CL4 CL2 CL2

PNSM CL2 CL1 CL1 CL3 CL1 CL1 CL2

PNCA CL2 CL1 CL3 CL2 CL3 CL1 CL1

PNCP CL2 CL1 CL1 CL3 CL1 CL1 CL6

PNCD CL2 CL1 CL1 CL3 CL3 CL1 CL3

PNPRA CL2 CL1 CL1 CL3 CL4 CL1 CL1

PNEP CL2 CL2 CL3 CL1 CL1 CL1 CL1

PNPCDPOC CL2 CL3 CL1 CL3 CL3 CL1 CL1

PNSV CL2 CL2 CL1 CL3 CL2 CL1 CL1

PNIIDSEV CL2 CL3 CL3 CL3 CL2 CL2 CL1

PNIVCLG CL2 CL3 CL4 CL1 CL1 CL1 CL1

PNSA CL2 CL5 CL1 CL2 CL1 CL2 CL1

PNCDT CL3 CL1 CL2 CL1 CL1 CL1 CL4

PNRPLA CL3 CL2 CL2 CL1 CL3 CL1 CL5

PNCDR CL3 CL3 CL1 CL1 CL1 CL1 CL1

PNPA CL3 CL3 CL1 CL2 CL1 CL1 CL3

PNSPI CL3 CL2 CL1 CL2 CL2 CL1 CL1

PNAS CL3 CL4 CL1 CL4 CL1 CL1 CL1

PNDR CL3 CL2 CL1 CL4 CL1 CL4 CL3

bold PNDCV

Potential National Programs for HIA + High priority

+ - Medium priority - Low priority

Not adequate for comparison: one National Program cluster

Table 7. Summary profile of the cluster including the PNDCV for each variable group and to the respective priority criterion

Group of

Variables Features for being a

potential priority for HIA Cluster including PNDCV

NPs Profile’s essential features

G9 Having a regional span as extended and in depth as possible

ASCJR, PNDCV, PNIVIH/SIDA, PNPCDO, PCO, PNLCT, PNPCD, PNCI, PNSE, PNSO, PNSR, PNV

PNs with the highest national coverage in all the 4 aspects analyzed.

G5 Showing a concern to monitor health gains, health systems needs and

effectiveness gains

PNDCV, PNCI Infecções Associadas aos Cuidados de Saúde, PNVacinação, ASCJR jovens em risco, PNCAsma, PNCPaliativos,

PNCDToxicodependências, PNSMental

PN’s where general aims include concerns of effectiveness gains and organization/response from health systems.

G1 Being a high-priority NP according to the National Health Plans 2004-2010 and 2012-2016

PNDCV, PNPCDOncologicas, PNCDToxicodependentes, PNRPLAlcóol

PNs mainly created before the National Health Plan 2004-10, from IDT and ACS, mainly financed by Social Games, considered high-priority in the National Health Plans 2004-10 and 2012-16.

G3 Having a practice of generating a variety of different products to the health professionals, specific groups of the population and the population in general (guidelines, published information, online presence, events, etc)

PNDCV, PNPAcidentes, PNSAmbiental, PNSAsma, PNSPIdosas, PCObesidade

PNs always with an Implementation Plan, that frequently have “alternative”

products such as Training documents, Other information materials and Other products. PNs that might look for ways of informing the public and health professionals different from the

“traditional” ones and perhaps more effective.

G8 Considering the monitorization and evaluation of the way the aims are being achieved, including resources allocation

PNDCV, PCObesidade, PNIIDSEV Determinantes Saúde Estilos de Vida, PNSVisão, PNSPIdosos

PNs that register more frequently than those in other an Analysis of proposed actions, but less frequently an assignment of resources, budgets and execution reports, operationalization and delivering indicators, evaluation through goals and an integration analysis with existent systems.

G4 Listing its planning documents, general aims and linking them to specific aims and/or projects’ aims

PNDCV, PCObesidade, PNIIDSEV Determinantes Saúde Estilos de Vida, PNLCTuberculose,

PNSAmbiental, PNSEscolar

PNs that tend not to have specific aims directly linked with general aims.

G7 Presenting an adequate

number of aims and projects PNDCV, PNSMental, PNSEscolar,

PNLCTuberculose, PCObesidade

PNs with higher median number of general aims, intermediate median number of specific aims, lower median number of projects by specific aim, higher median number of projects by specific aim. These PNs may thus be more realistic when setting their aims and consequently present a higher success rate in achieving the proposed aims.

4. Discussion