This chapter explores the diverse roles and contributions of different units within the Department of Health and the Basque Government in general, illustrating a multifaceted approach to promoting community health. It provides information of the different programmes that are supported by the Department and the role of the district units in supporting community health.
Community Action to Strengthen Health Equity in the Spanish Basque Country
Abstract
Community action for health within the DHBC demonstrates a commendable commitment to enhancing public health through various innovative initiatives. Despite the evident fragmentation, the department has made significant strides in fostering community action across multiple units.
The activities of the DHBC cover a wide range of areas. The DHBC is headed by a Health Counsellor, whose mission is to direct, co‑ordinate and control its subordinate bodies, establish strategic objectives and liaise with the Basque Government. Supporting the Health Counsellor are two Vice‑counsellor’s Offices (Viceconsejerías): the Health Vice‑counsellor and the Finance and Administration Vice‑counsellor. The Decree 116/2011 on Organic and Functional Structure of the Department of Health, defines the areas of competence and missions of the various Directorates and other administrative bodies attached to the DHBC (see Figure 4.1).1 The Finance and Administration Vice‑counsellor’s Office, responsible for managing financial and human resources and contracting services with Osakidetza; consists of three directorates: Legal, Economic and General Services; Health Insurance and Contracting; and Pharmacy.
The Health Vice‑counsellor’s Office is primarily responsible for implementing the Basque Health Plan and maintaining adequate collaboration with other departments in the socio-health area. The office oversees four directorates: Public Health and Addictions; Health Planning, Management and Evaluation; Research and Innovation; and Social and Health Policies Integration. The Health Counsellor also co‑ordinates with several affiliated bodies, including the healthcare service Osakidetza.2 The DHBC has several offices throughout the Basque territory.
Note: This is a simplified scheme, arrows indicate hierarchical dependency.
Source: Decree 116/2021, of 23 March, (2021[1]), https://www.legegunea.euskadi.eus/eli/es-pv/d/2021/03/23/116/dof/spa/html/webleg00-contfich/es/.
The Directorate for Public Health and Addictions (DPHA) plays a relevant role in the co‑ordination, supervision, monitoring and evaluation of activities undertaken and in collaboration with other agents at a provincial and local levels (see Box 3.1). According to Article 9 of the Decree 116/2021, the duties of DPHA include:
Drafting proposals for health objectives in the Basque Health Plan, developing strategies for their implementation, creating monitoring indicators, and drafting of evaluation reports.
Developing health protection policies, particularly programmes related to food and environmental health, including the analysis of physical, chemical or biological risks. This also encompasses activities in health promotion, prevention, and protection, and responses to public health alerts and risks.
Conducting epidemiological surveillance and analysis of health and its determinants, preventing diseases, promoting health initiatives, developing programmes for health information and education, and promoting actions to generating social, environmental and economic conditions conducive to public and individual health environments.
Defining a comprehensive Basque policy on addictions and promoting interdepartmental and interinstitutional actions in this field. This includes supporting programmes aimed at preventing drug addiction with family, community, educational and work environments.
Strengthening community action by actively involving communities in the design, implementation and evaluation of community processes that address their health needs. This aims to achieve greater control over health determinants and improve their quality of life.
While the work with community is primarily carried out by the Health Promotion unit, other units, such as Health Protection and Addictions, also play a role. At the local level, district units of DPHA (Comarcas) are engaged in designing and implementing community action projects. In addition to the DPHA, the Directorate for Integration of Social and Health Policy and the Pharmacy Directorate also play a role in fostering community action.
The DPHA operates with a central office and additional units in each province’s capital (sub-directorates of public health based in Vitoria-Gasteiz, Bilbao, and Donostia-San Sebastián) to co‑ordinate actions at the provincial level. Additionally, there are nine district offices across the Basque territory. The district units of DPHA aim to provide public health services locally in close co‑ordination with local agents. The Basque territory is divided into nine district units of DPHA: Araba (attached to Alava), Encartaciones/Margen Izquierda, Interior, Uribe‑Kosta, Gernika-Lea Artibai (attached to Bizkaia), and Tolosa, Alto/Bajo Deba, Urola, and Bidasoa (attached to Gipuzkoa).
Decree 116/2011 establishes the Directorate for Public Health and Addictions, responsible for co‑ordinating and supervising material, economic, and human resources assigned to public health and addictions, as well as managing processes related to health promotion functions. The Deputy Director of Public Health and Addictions performs the following functions:
Implementing public health and addictions programmes and activities, including necessary health inspection and control actions.
Formulating proposed objectives for the Health Plan, developing implementation strategies, monitoring indicators, and preparing evaluation reports.
Co‑ordinating the district units of DPHA.
Resolving administrative‑sanitary authorisations for the operation of activities, industries, and food establishments.
Receiving applications and processing files related to Public Health and Addictions.
Note: The term district units of DPHA stands for Comarcas de Salud Pública. For historical and demographic reasons, the geographical organisation of the DHCB described here is not exactly the same as the geographical organisation of the Basque Health Service Osakidetza. In fact, there are some small differences in the geographical areas covered by Osakidetza’s “health zones” and the DHBC’s District Health Centres. It should be noted that geographical zones also exist for the pharmaceutical system.
3.2.1. The Health Promotion unit concentrates on developing concepts and securing funding for projects related to community action for health
Over the past decade, the Health Promotion unit has been actively engaged in promoting community action in co‑operation with Osakidetza. The Health Promotion unit staff at both the central level and in the Subdirectorates (see Box 3.1) has undertaken various initiatives to foster community action for health. Key activities include the development of frameworks and guides for community action as well as the creation of an online platform to document community projects for health. The unit also directly sponsors projects through funding lines that fully or partially incorporate a focus on community action. In the past, the unit was also responsible for training on community action in the health districts.
Dissemination and outreach
The Health Promotion unit has taken steps to support community action by developing two guides aimed at enhancing community health through structured, participatory processes. Each guide reflects a comprehensive understanding of the complexities involved in public health promotion within diverse community settings.
The first guide, titled “Methodological guide for approaching health from a community perspective” (Guía metodológica para el abordaje de la salud desde una perspectiva comunitaria), was developed with support from Osakidetza in 2016. In 2020, the second guide, titled “Guide for Participation Generating Well-being and Health” (Guía para una participación generadora de bienestar y salud), was released. This guide focusses on integrating health perspectives into community action to strengthen well-being of local population. Developed through collaborations with the Proyecto de Intervención Comunitaria Intercultural, the Municipality of Hernani, and Innobasque‑Basque Innovation Agency, it underscores the importance of diversity, autonomy, and relationships in community action.3 Both guides are designed to provide guidance for staff within the DHBA, health centres and municipality to promote community action for health.
Additionally, the department has published guides supporting specific participatory projects, such as transforming school playgrounds (Patios escolares) and creating safer school pathways (Eskolabidea). These guides highlight stages from planning to evaluation, ensuring successful community action and health improvement.
To support the dissemination of community health actions, the Health Promotion unit has launched the Euskadi Aktiboa project – a platform that uses geolocation to highlight and enhance community health projects and organisations. Community initiatives can be included following registration and submission. With a user-friendly search feature, the platform facilitates the exploration of health initiatives by location, type, and status. As of 17 January 2024, the database boasts 337 active entries, highlighting the wealth of community action across the Basque Country’s regions and various demographics.
Grants
The Health Promotion unit offers four types of grants and subsidies for organisations, individuals and programmes contributing to community action for health. Table 3.1 provides an overview of the four types of grants available in 2022.4 Each type of grant has an allocated budget (e.g. EUR 250 000) used to fund projects that align with the grant’s scope and meet eligibility criteria. Each grant has a maximum financing for a single project (e.g. EUR 5 000). Funding details include limits per project and entity, with payments structured around project milestones and regulatory, administrative and fiscal compliance.
The two top grants outlined in Table 3.1 prioritise community-driven health initiatives but can only fund a limited number of qualifying projects due to the constrained budget. The first grant, although open to all types of community action actors, predominantly targets local government units rather than non-governmental organisations. The two bottom grants have a broader scope and can include community health actions, particularly targeting non-profit social initiative organisations, and could be used more broadly for expanding community action.
Note: Only includes grants with full or partial degree of community action, 2022.
Source: Government of the Basque Country (2024[2]).
Following a public call for applications, submissions are evaluated using a points-based system, which varies by grant category and criteria. For instance, the local health promotion grant evaluates applications based on technical project description (40 points), participatory level (40 points), and equity perspective (20 points), requiring a minimum of 50 total points to proceed, including at least 15 points for the project’s technical description. Similarly, the grant for student physical activity promotion has unique criteria, emphasising the technical project description, educational and local community involvement, and attention to inequalities, with specific minimum scoring thresholds for consideration.
3.2.2. The Addictions unit relies extensively on community action for health
The Addictions unit addresses a wide range of addictions, ranging from substance abuse (e.g. alcohol and illegal drugs) to behavioural issues (e.g. gambling and social media addiction). The primary objectives of the unit include creating health-promoting environments aimed at reducing substance use and addictive behaviours; implementing initiatives targeting families, schools, workplaces, and broader communities; and supporting prevention and health promotion programmes, particularly by enhancing family and school competencies.
The Addiction unit provides grants to local entities and non-profit organisations to implement projects that contribute to community health actions, particularly focussing on schools and families.5 Currently the unit offers three types of grants (see Table 3.2).The first two grants, which, together, account for the largest part of the DPHA’s budget size, support a broader array of community action projects with relatively generous funding limits. One grant caters to local government bodies, while the other is designated for non-government organisations, thereby broadening the range of potential recipients for addiction prevention efforts. The third grant focusses on funding trained personnel for community-based initiatives, addressing concerns over insufficient human resources and expertise at the local level. The small number of rejected applications for these grants indicates that the available funding aligns closely with current demand.
Project budgets are capped according to the specific grant rules, and there are specific criteria for prioritising applications. The eligibility criteria for allocating grants, following the public application process, are similar to those used by the Health Promotion unit. For example, projects can score up to 100 points, with specific allocations such as a maximum of 12 points for the technical quality of the project plan and up to 11 points based on the number of directly or indirectly benefited individuals. These scores not only determine eligibility but also influence the funding amount designated for each project. Each type of grant has a predefined budget (approximately EUR 500 000) and requires some form of co-payment. Disbursements are milestone‑based, contingent upon achieving project milestones and adhering to fiscal and administrative regulations.
Note: Only includes grants with full or partial degree of community action, 2022.
Source: Government of the Basque Country (2024[2]), www.euskadi.eus/gobierno-vasco/tramites-servicios/.
3.2.3. District units of the DPHA are leading and implementing many programmes promoting community action
Most staff working in the district units of DPHA conduct health promotion activities (which are out of their scope of mandate, see Chapter 4, Section 4.2.1). They possess long-standing experience in leading and promoting multisectoral and multi‑agent community action projects, co‑ordinating with other institutional actors such as Osakidetza or municipalities. The implementation of such projects requires a wide range of skills such as communication or leadership, and specific knowledge of addressed issues. Examples of the projects in which district staff has a leading or important role are:
“Alimentación saludable en población mayor”: This project aimed to describe the nutritional situation of older adults in the Basque Country. The analysis, conducted in the Bidasoa and Uribe OSIs, involved professionals from Osakidetza (Bidasoa and Uribe), the Sub-directorate of Public Health of Gipuzkoa, Public Health Uribe‑Kosta, the municipality of Irún, third sector representatives, research institutions, and representatives of older adults who participate in the design of the project (see Chapter 6 for further information).
”Apoyo a personas cuidadoras” in the municipality of Irún: This initiative aimed to provide technical and psychological support to carers and prevent risks associated with caring activities in the home. The promoting group was led by professionals from Osakidetza (OSI Bidasoa) and the Irún district unit of DPHA including representatives from the Sub-Directorate of Public Health (Gipuzkoa), municipal social services of Irún, and other institutions (Municipality of Irún, 2024[3]).
“Ttipi-ttapa” in municipality and district of Tolosa: The project, initiated by the DHBC, creates walking routes to boost community action and local stakeholder involvement. This initiative, leveraging local community participation, fosters social cohesion, intergenerational exchange, and inclusivity for those with diverse abilities. Organizing a route demands collaboration among three institutions: a sports technician from the municipality to design and guide the walk, supported by public health technicians from the local unit of DPHA, and volunteers from a local school (Department of Health of Basque Country, 2024[4]).
“Salud para tod@s” in Gordexola: The programme, led jointly by staff from Osakidetza and the local unit of DPHA, consists of a range of health-related educational classes open to the local population. Co‑ordination with the local municipality ensures promotion and venue provision, while community associations contribute by suggesting the topics and helping with identifying instructors, ensuring the program’s relevance and accessibility. A unique partnership with the local football club helps to achieve an unusually high male participation rate of 40%.6
“Judimendi Neighbourhood Association” in Vitoria-Gasteiz: The association, located in a district of Vitoria-Gasteiz, benefits from the dedicated leadership of three women: a technician from the local unit of DPHA, a nurse from Osakidetza, and a volunteer from a local faith-based organisation. Their collaborative efforts, complemented by partnerships with municipal authorities, have broadened the association’s reach into various fields, addressing diverse community needs and engaging multiple social groups. Most of the organised activities relies on the volunteer commitment of its members, with the technician from the local unit of DPHA and Osakidetza nurse (Judimendi Neighbourhood Association, 2024[5]).
3.2.4. Health Protection unit has also significantly promoted community action for health
While the primary focus of the Health Protection unit lies away from community action, some of its activities are closely linked to community health and can be considered under the broad definition of community action for health. This section outlines these activities.
The Health Protection unit has a wide‑ranging mandate in food safety and nutrition, involving staff at central government and district levels. Health protection professionals are responsible for ensuring compliance with food industry standards and managing health risks associated with meat consumption, adhering to slaughterhouse standards. Additionally, they are involved in various aspects of environmental health, including water safety, air quality and chemical products. Recognising the close link between diet and health, the DHBC has promoted the development of healthy eating initiatives, which are under the responsibility of this unit. These initiatives aim to implement actions and objectives aligned with the Health Plan, adopting the health in all strategy as the overarching framework for action.
In 2017, the Health Protection Unit published a guide “Healthy Eating Initiatives in Euskadi” to support various health eating initiatives and identify clear, achievable lines of work in areas such as food production, distribution, management, consumption and healthy eating awareness (Department of Health of Basque Country, 2017[6]). The guide proposes objectives and actions to contribute to the collective effort to promote and establish healthier and more balanced eating habits. The Healthy Eating Initiative was launched with a three‑year timeframe to achieve concrete objectives in 1000 days. These objectives include reducing sugar and salt consumption, increasing fruit and vegetable consumption among young people, and promoting multi-stakeholder collaboration. In addition, the guide outlines five strategic lines, the first of which focusses on creating an information and expert knowledge system. A project within this strategic line involves mapping of health and nutrition assets of the Basque Country and sharing this mapping through a geolocation platform aiming to make resources and initiatives promoting healthy eating visible to the entire population.
The Healthy Eating Initiative established governance mechanisms to co‑ordinate and facilitate projects. A commission was formed to provide strategic guidance, bringing together the departments of health, education, economics (industry and agriculture areas), tourism, the Basque Institute of Labour Safety and Security (Osalan), and Osakidetza. This was complemented by a forum where private and public organisations and citizens could make proposals. One significant project under this initiative was the “360‑degree update of school canteens”, which aimed to rethink school menus to increase the consumption of fruit, vegetables and fish while reducing fried foods. On the supply side, the initiative also targeted workplace canteens, promoted healthy options in vending machines, and collaborated with producers to reduce salt in products. To address the demand side, initial projects included sessions with young people and multidisciplinary teams to promote ownership of healthy eating, and training of health workers in nutrition. Additionally, campaigns using both traditional and social media were conducted to raise awareness and create a network of agents to promote healthy eating messages.
A more targeted strategy to prevent child obesity was published in 2019, encompassing actions in several areas, including the community (Departament of Health of Basque Country, n.d.[7]). The rationale behind this strategy is that the community plays a crucial role in promoting healthy lifestyles, and public authorities should promote healthy environments in towns and villages to encourage physical activity in a safe and accessible way. The strategy had a three‑year target for increasing fruit and vegetable consumption, physical activity and the proportion of local authorities prioritising childhood obesity prevention. Specific co‑operation with municipalities was a key aspect, aiming to prevent childhood obesity through actions such as the creation of a reference person (a health or sports technician) and establishing working groups at municipal or district level to discuss ways to improve physical activity. Additionally, the strategy promoted urban projects and safe mobility for children through cycle paths, access to sports, and other solutions. Finally, the strategy included specific actions such as co‑operation with the media to develop communication strategies adapted to children and adolescents.
3.3.1. The Pharmacy Directorate could play a more important role in community action
The Directorate of Pharmacy actively collaborates with pharmacists and other relevant stakeholders in health prevention and promotion initiatives. Within the strategic vision of the DHBC, integrating pharmacists into the health system is a key objective. This integration is facilitated by a regulatory framework that ensures all pharmaceutical establishments and services, while privately owned, fall under the authorisation and oversight of the DHBC. Health promotion initiatives run by the Directorate of Pharmacy and sponsored by the DHBC follow a structured process. This process begins with organising a pilot programme in a limited geographical area, such as aa municipality, followed by a comprehensive evaluation of the pilot results, including cost-benefit analyses. Successful initiatives are then extended to other municipalities/districts.
Although many of the programmes sponsored by the Directorate of Pharmacy do not strictly fall under the category of community action, they significantly contribute to health promotion and disease prevention efforts. These initiatives highlight the scope for action in this field by the DHBC in collaboration with pharmacies. One notable initiative is the Methadone Maintenance Programme, conducted in collaboration with the Basque Pharmacists’ College. Through this initiative, individuals suffering from drug addiction can benefit from supervised treatment with methadone, leveraging the proximity of pharmacies to citizens to improve access to vital treatment services. Pharmacies also play a crucial role in preventing HIV by providing quick tests to detect the virus.7 Additionally, ongoing initiatives and pilot projects include monitoring diabetic medication, projects for asthma patients, integrating community pharmacies into Osakidetza, promoting the appropriate use of benzodiazepines, and initiatives to prevent suicides.
A notable funded initiative more closely related to community action is “Home Pharmacy” (Farmacia a domicilio). This initiative significantly contributes “Home Care Services” (Servicios a domicilio), targeting individuals with disability or in need of some degree of long-term care, enabling them to remain in their own homes. The Home Pharmacy initiative aims to provide access to medicines and ensure proper adherence to treatment. Pharmacies collaborate closely with professionals from social services (home assistants) and/or family caregivers, addressing all aspects of medication procurement, storage, and administration. Other pharmacy initiatives involving elements of community action are detailed in Box 6.1.
3.3.2. The Directorate for Social and Health Policies Integration has all the governance tools to allocate more prominence to community action
The Directorate for Social and Health Policies Integration8 focusses on people‑centred care which requires co‑ordinated action combining health and social care. According to Law 12/2008, of 5 December, on Social Services, “Socio-healthcare shall comprise the set of care aimed at people who, due to serious health problems or functional limitations and/or risk of social exclusion, require simultaneous, co‑ordinated and stable health and social care, in accordance with the principle of continuity of care”. Achieving integrated social and healthcare requires agreements between the Directorate of Social and Health Policies Integration and the provinces, as the latter hold the competences for specialised social services. The directorate promotes a co‑ordinated approach, including co-financing from the DHBC. It finances a network of resources for people with long-term care needs, disability and mental health issues, often managed by NGOs, which include day care and sheltered housing facilities.
The current strategy of the Directorate for Social and Health Policies Integration incorporates concepts related to a community participatory approach, although it does not explicitly mention “community action”. In June 2021, the Directorate for Social and Health Policies Integration published a strategy for social and healthcare in the Basque Country for 2021-2024. One area with potential for community action is social and health prevention, which includes plans for designing a Co‑ordinated Framework for Social and Health Prevention and the Instrument for the Detection of Social and Health Risk. Those plans could potentially promote a community participatory action approach, though this is not explicitly stated in the strategy.
Another relevant area is socio-healthcare (atención sociosanitaria), which includes promoting, monitoring and raising awareness of the needs of individuals in vulnerable situations through relevant instruments and collaboration on actions that improve the quality of life for target socio-health groups, such as individuals with mental health and addiction issues, rare diseases, or those in end-of-life situations. While these activities could be conducted through a community action, the strategy does not clearly specify it as the preferred tool to achieve these objectives.
There is a stronger emphasis on community action in the area of mental health as demonstrated in the Mental Health Strategy 2023-2028, jointly undertaken by Directorate for Social and Health Policies Integration and Osakidetza. This strategy includes several “priority actions” that have links with community action. Notably, the priority action four focusses on community-based recovery care, while priority action six supports associations of families and individuals with mental health problems to create support groups (foreseen in 2026). Additionally, priority action eight emphasises citizen participation in the design, planning and evaluation of programmes by associations (foreseen in 2028). The promotion of a recovery approach and peer support is planned for 2026. Several associations of people with mental health issues and their families which receive support from the Directorate are already active in peer support, suicide prevention, and training to promote self-care, reduce stigma, and raise awareness.
3.3.3. Osakidetza has developed its own strategy for a community approach for health, allocating dedicated staff to this activity
Osakidetza has adopted a strategy for approaching health from a community perspective, initially focussing primarily on primary healthcare.9 This strategy, resulted from the emphasis on community in Osakidetza’s Strategic Plan (Osakidetza, 2023[8]). It addresses the social determinants of health and underscores the need for a multidisciplinary and intersectoral approach to tackle health inequalities and improve health outcomes. The strategy aims to promote community approaches for health, favour the creation of new initiatives, and co‑ordinate existing ones. To this end, the Strategy identifies the community as a key stakeholder and sees community action – defined as the effective involvement of communities in priority-setting, decision making and policymaking – as an effective way to support health priority-setting and strategy implementation. The strategy is structured around four key lines of action: (i) governance; (ii) mapping of initiatives; (iii) promoting a community approach at the three levels (individual, addressing the social determinants of health, group-based through activities to promote self-care and empowerment, and collective, through intersectoral approaches in the community); and (iv) dissemination. A line of action within the strategy focusses on promoting community action through several concrete initiatives:
Establishing a “community notebook” at each primary healthcare centre to increase the visibility of community activities, designed with an intersectoral and multidisciplinary approach.
Facilitating health promotion activities and promoting inter-sectoral relationships in health centres, encouraging collaborative work and community processes.
Providing training and support for health centre professionals to join local networks.
In April 2023, Osakidetza established a new structure featuring “community nurses” dedicated to health promotion and community processes. Community nurses are assigned to Integrated Health Organisations (Organización Sanitaria Integrada, OSI), each covering several primary care units. Within each primary care unit, there is a community action reference person who acts as a liaison between the health centres and the community nurses, communicating the needs and suggestions of primary care centres. Community nurses, in consultation with the community liaison officer in the integrated care units, are currently mapping existing initiatives involving the community (and could therefore be considered community action interventions). They will also be responsible for advising primary care professionals on initiating health promotion activities and community processes. In the future, community nurses will create networks for multidisciplinary and intersectoral work within Osakidetza and with external community agents.
In April 2024, Osakidetza released two complementary documents: “Strategy for approaching health from a community perspective”, providing theoretical basis for promoting a community approach in primary care units (Osakidetza, 2024[9]); and “A pathway to a citizen health empowerment strategy”, designed as a reference space for all citizens to address their health and empowerment needs and expectations (Osakidetza, 2024[10]).
While the DPHA has a mandate for fostering health promotion, Osakidetza also includes health promotion as a part of its healthcare provision mandate. Health promotion is inherently multidimensional, requiring collaboration among multiple agents for effective deployment. It is evident that the various dimensions of health promotion need co‑ordinated efforts, and a clearer definition of the mandates for each stakeholder is necessary. While the institutional structure developments mark significant progress, there is a need for a broader reconsideration of how Osakidetza’s new strategy aligns with the DPHA’s broader mandate. A more comprehensive strategy co‑ordinating the contribution of various community action actors is essential for effective implementation.
Community action for health extends beyond the DHBC. Various units across the government of the Basque Country play a role in promoting population health and well-being through community-based initiatives. This section highlights selected examples of such initiatives implemented outside the DHBC, illustrating the inherently interdisciplinary nature of community action. These examples stresses the importance of co‑ordinated efforts across government directorates to ensure that all relevant stakeholders contribute to the development and implementation of a future strategy for community action for health and well-being.
The first example is the Esukadi Lagunkoia initiative. It was developed by the Matia Institute under the auspices of the Basque Country’s Department of Equality, Justice, and Social Policies, and aims to explore the potential of the older people to enhance community well-being and environment in the Basque municipalities, aligning with the WHO’s Age‑friendly Environments Programme (Euskadi lagunkoia, 2024[11]). Its goals include fostering elderly participation, encouraging community engagement, establishing a network of supportive initiatives, and adapting environments to improve life quality for all citizens. The initiative provides guides for forming promoter groups and assessing community assets, with additional resources for action planning and rural area adaptation underway. An important component, Farmacia Lagunkoia, partners with the Basque Pharmacist’s Council to integrate pharmacies into the community support network, focussing on the older people’s needs. This involves connecting pharmacies with municipal resources, social services, and health centres, with pilot studies underway to evaluate strategies for creating age‑friendly pharmacy spaces.
Another example is Mugimen, a collaborative project designed to foster an active Basque society by integrating initiatives aimed at promoting physical activity and reducing sedentary lifestyles (Mugiment, 2024[12]). Launched by the DHBC, in collaboration with the Directorate for Physical Activity and Sports and the Directorate for Educational Innovation, the project engages a wide network including Provincial Councils, various municipalities within the community, and other organisations committed to advancing physical activity. This approach underscores a comprehensive effort to improve public health through enhanced engagement in physical activity across the region.
Urretzindorra is a project, supported by the Department of Equality, Justice, and Social Policies, aims at enhancing social inclusion and integration among immigrants and refugees through personalised mentorship. This approach facilitates their entry into local social networks by connecting newcoming families with small children to local elderly residents, who assume the role of “new grandparents”. This intergenerational bonding not only aids in the social integration of immigrants but also helps in the fight with loneliness among older people, which has a direct impact on their mental health and well-being.
References
[1] Decree 116/2021, of 23rd of March (2021), “Establishing the organisational and functional structure of the Department of Health”, BOPV (País Vasco) 65, https://www.legegunea.euskadi.eus/eli/es-pv/d/2021/03/23/116/dof/spa/html/webleg00-contfich/es/.
[7] Departament of Health of Basque Country (n.d.), Estrategia de Prevención de la Obesidad Infantil en Euskadi, https://www.euskadi.eus/estrategia/prevencion-de-la-obesidad-infantil-en-euskadi/web01-a2osabiz/es/ (accessed on 15 July 2024).
[4] Department of Health of Basque Country (2024), Rutas saludables. Ttipi-ttapa, https://www.euskadi.eus/rutas-saludables-ttipi-ttapa/web01-a3osakom/es/ (accessed on 14 March 2024).
[6] Department of Health of Basque Country (2017), Iniciativas para una Alimentación saludable en Euskadi, https://www.euskadi.eus/contenidos/informacion/alimentacion_iniciativas_prog/es_def/adjuntos/plan-alimentacion-saludable-anexo.pdf.
[11] Euskadi lagunkoia (2024), Project website, https://euskadilagunkoia.euskadi.eus/inicio/ (accessed on 28 February 2024).
[2] Government of the Basque Country (2024), Procedures website, http://www.euskadi.eus/gobierno-vasco/tramites-servicios/ (accessed on 2024 February 2024).
[5] Judimendi Neighbourhood Association (2024), , https://judimendikoak.wordpress.com/ideas/ (accessed on 15 July 2024).
[12] Mugiment (2024), Project website, https://mugiment.euskadi.eus/inicio/ (accessed on 2024 February 26).
[3] Municipality of Irún (2024), Apoto a Personan cuidadoras, https://www.irun.org/es/tramites/8-apoyo-a-personas-cuidadoras?idt=538 (accessed on 15 July 2024).
[10] Osakidetza (2024), Herritarren osasunean ahalduntzeko estrategia bateranzko bidea, https://osaraba.eus/infoberriak/wp-content/uploads/2024/05/Estrategia_Un-camino-hacia-una-estrategia-de-empoderamiento-en-salud-de-.pdf.
[9] Osakidetza (2024), Osasuna ikuspegi komunitariotik lantzeko estrategia, Lehen Mailako Arreta, https://www.osakidetza.euskadi.eus/contenidos/informacion/osk_trbg_planes_programas/eu_def/adjuntos/Estrategia-abordaje-salud-E-.pdf.
[8] Osakidetza (2023), Plan Estratégico 2023-2025, https://www.osakidetza.euskadi.eus/contenidos/informacion/osk_trbg_planes_programas/es_def/adjuntos/osakidetza-plan-estrategico-23-25_es.pdf.
← 1. Unless stated otherwise, references to laws, regulations and institutions should be intended as references to the Basque legislation and institutions.
← 3. Several other guides on the topic of community action exist. This section only mentions those where the DHBC has had a direct participation.
← 4. The report provides the data up to 2022 due to the unavailability of full budget information for 2023.
← 5. Institutional co‑ordination following the in the Law on Comprehensive Care for Addictions and Drug Addictions is regulated through the Support and Assistance Body established in Decree 25/2018, of 18 February.
← 6. Source: Interviews conducted during the fact-finding mission between 20 and 24 November 2024.
← 7. On 26 November 2023, an HIV prevention programme was implemented in 60 pharmacies, facilitating the access to HIV testing for the entire population, and positioning neighbourhood pharmacies as a valuable complement to the resources of Osakidetza. This has been evidenced by the programme’s success in conducting 32 694 rapid HIV tests since its launch in 2009.
← 8. The Spanish term “atención sociosanitaria” has not a straightforward translation in English. In this document, the Departamento de Atención Sociosanitaria is referred to as the Directorate for Social and Health Policies Integration, reflecting its role within the DHBC.
← 9. The strategy is in line with the overall Primary Care Strategy and the sub-strategy of Empowering Citizens in Health and the Osakidetza 2023‑2025 Strategic Plan, which aims to give people a more active role in their health and to develop healthy communities through active participation.