What is Governance?

Despite the complexities and multidimensionality inherent to governance, there is a consensus that it encompasses a set of processes and tools related to decision-making with different responsibilities and implications for the different actors. Thus, health governance involves the collaboration of other sectors, including the private sector and civil society, with the ultimate purpose of enhancing positive results.

Interest in the study of health governance has gained traction in the last decade, which has helped harmonize its conceptual meaning and how it can be an ally, creating conditions for improving the health and well-being of citizens. The configuration of the health governance function is influenced by the complex and changing context, which is assumed today as a much more decentralized system with multiple actors and levels of authority.

Strengthening the capacity needed to perform governance functions effectively can be supported in different ways, such as by strengthening transparency and accountability, establishing or improving various consultation mechanisms or establishing or improving regulation.

Diabetes in the world

Before the emergence of COVID-19, 6% of  the world’s population (420 million people) lived with diabetes. This number is 4 times higher than in 1980 and is expected to increase to 570 million by 2030 (WHO Global Diabetes  Compact).  The number of individuals with diabetes and other chronic diseases will continue to increase with the aging of the population, as well as the presence of risk factors for diabetes (mainly obesity and sedentary lifestyle).

Prevalence in Europe and in Portugal

In the European Union, around 32.3 million adults were diagnosed with diabetes in 2019. In Portugal the prevalence of diabetes is high (above the average of EU countries in 2019), reaching 9.8% of the population aged 20 to 79 years (OECD/European  Union, 2020).

The impact on the economy

The economic weight of diabetes is substantial. Health expenditure allocated to diabetes treatment and preventing complications is estimated at around €150 billion in 2019 in the EU, with the average expenditure per diabetic adult estimated at around €3,000 per year (International Diabetes Federation, 2019).

In Portugal, according to the Report of the National Program for Diabetes: Challenges and Strategies 2019, published by the Directorate-General for Health (DGS), the costs of diabetes exceeded, in 2018, 740 million euros.

Why is governance in diabetes important?

To ensure that better health outcomes are achieved in this population, governance must be sustainable, effective and agile enough to meet the needs of individuals. Thus, governance in diabetes is the core  of the systematic development, implementation and coordination of different processes and tools that have a direct impact on the delivery and quality of health.

It is time to harness the wealth of knowledge about governance of health systems, lessons learned from relevant national and international experiences, and the high financial and organizational investment of the Portuguese government over the past decade.

One of the objectives of this initiative is to strengthen health governance by providing a roadmap and a showcase of resources and instruments that can be useful to improve health care, with emphasis on the practical and political experiences of diabetes care in Portugal.