Abstract
In Portugal, the need for health educational campaigns to reduce antibiotic misuse, and the implementation of handwashing and hygiene measures to reduce cross-transmission have become national priorities. The implementation of the e-Bug Project in our country has been conducted by the Directorate-General for Health as the beneficiary entity of the Project, in partnership with the Ministry of Education. The involvement of the operational structures of both ministries in the development of the Project has been guaranteed from the beginning. We have translated and produced 6000 junior and senior e-Bug packs, and started to distribute them to science teachers, health education coordinators and school health teams from all over the country, who were identified as stakeholders and registered as e-Bug users in an e-learning platform from the Ministry of Education. Portugal is deeply interested in the long-term sustainability of the e-Bug Project. Portuguese schools and the Portuguese e-Bug team will continue to support this initiative to benefit the health education of Portuguese children.
Introduction
In Portugal, antimicrobial overuse and misuse have been associated with increasing percentages of antibiotic resistance among defined pathogenic bacteria. Moreover, cross-transmission of these pathogens in closed environments in the community, such as day-care centres and schools, has been observed and is believed to contribute significantly to the dissemination of antibiotic-resistant pathogens.1–3
The immunization of the paediatric population with pneumococcal conjugate vaccine has not led to the expected reduction in resistance rates, because serotype substitution has occurred, with new serotypes having similar resistance profiles. High antibiotic use and high levels of cross-infection in day-care centres have also been important in maintaining high resistance rates.4,5
The need for health educational campaigns to reduce antibiotic misuse and the implementation of handwashing and hygiene measures have become national priorities.
Educational system
Education in Portugal is compulsory for children from 6 to 15 years of age and is divided into three consecutive cycles. A first cycle of 4 years (6–9/10 years of age) is followed by a second cycle of 2 years (10–11/12 years of age) and then a third cycle of 3years (13–14/15 years of age).6,7
In the science curriculum of the sixth year/second cycle (11–12 year olds), the focus is on: the role of microorganisms in ecological systems (good and bad bugs) and how they can cause disease (bacteria, viruses and other pathogens); the importance of health protection and the prevention of disease (e.g. vaccines and health education campaigns); and the importance of personal hygiene (handwashing and respiratory hygiene included).
In the science curriculum of the ninth year/third cycle (13–15 year olds), there is development of previous learning. This includes: how individual habits contribute to the quality of life; the importance of individual and collective health; how identification of risk behaviours may lead to research and problem solving; and environmental, social and economic factors for human well-being.
More than 6000 public schools throughout the country are grouped in ∼1200 organizational units called Groups of Schools that share common resources and management. In each of these Groups, there is a teacher responsible for the coordination of health education projects [the Health Education Coordinator (HEC)].
National Health System
The National Health System is coordinated by the Ministry of Health, and local services are implemented by five Regional Health Administrations and 71 Groups of Health Care Centres (ACES). Among other tasks, they develop a National School Health Programme in order to provide disease prevention and health education support to schools within each area. For that purpose, in each one of the ACES there is a School Health Coordinator (SHC) and a School Health Team.
In 2007, the Ministry of Education and the Ministry of Health agreed a protocol for health education, aiming to promote and launch national health education programmes in public schools.
Partners and stakeholders
In Portugal, the beneficiary entity of the e-Bug Project is the Directorate-General for Health (DGS), and so the involvement and commitment of the National Health System was guaranteed from the beginning. The SHCs from each one of the 71 ACES were identified as important stakeholders of the Project. From the beginning, the Project team worked with the Directorate-General for Innovation and Curricular Development (DGIDC), which is part of the Ministry of Education, and is responsible for the national curriculum of basic education and the implementation of health education projects in public schools. The DGIDC was invited to participate as a partner in the development and implementation of the Project. Technicians from the DGIDC collaborated in the reviewing of the packs, and identified the science teachers and the HECs as important stakeholders from the education sector. The partnership between the Ministry of Health and the Ministry of Education was the key for the successful implementation of the e-Bug Project in Portugal.
Implementation of e-Bug in Portugal
After translation and review, 6000 Portuguese packs (3000 each for the second and third cycles of education) were produced by the DGS. The DGIDC and the Ministry of Education are committed to financing the production of 3000 further packs, if and when they are needed. The implementation plan was designed through the collaboration of the Ministries of Health and Education, and aimed to publicize and distribute the packs to stakeholders and to support implementation in local settings (Figure 1).
Implementation plan for the e-Bug project in Portugal.
The plan consisted of several phases, which included a first announcement of the e-Bug Project, the publicizing of e-Bug to schools and stakeholders, a formal launch session for invited stakeholders, the placement of e-Bug in a learning platform for schools, the distribution of e-Bug packs to stakeholders and schools, the registration of e-Bug users, and finally, the evaluation of e-Bug's dissemination and use.
First announcement of e-Bug Project
The first public presentation of e-Bug in Portugal occurred in the national session of the European Antibiotic Awareness Day (EAAD), held in Lisbon on the 18 November 2008, chaired by the Director-General for Health. The associate Portuguese partner presented the Project, and emphasized the importance of this educational tool as part of the efforts to reduce antibiotic use and bacterial resistance.
Promotion of e-Bug to schools and stakeholders
For promotional purposes, an exhibit with a poster advertising and explaining the Project was produced. The exhibit was used in the 2008 and 2009 EAAD sessions, and also in other events organized either by the Ministry of Health or by the Ministry of Education, including a National Health Promotion Meeting, held in Lisbon on 10 July 2009 that was attended by 600 teachers from all over the country.
Formal launch of e-Bug
A formal launch of e-Bug for invited stakeholders was held on 11 September 2009, at the Gulbenkian Foundation Auditorium in Lisbon.
The session was chaired by the Director-General for Health and by the Director-General for Innovation and Curricular Development. More than 300 stakeholders from all over the country attended, including science teachers, HECs, school directors and regional education directors. The National Health System was represented by SHCs and regional infection control coordinators. The programme included a presentation of the e-Bug Project, Portuguese packs and web site, and implementation plans. In this meeting, packs were distributed to participants who were also invited to register as e-Bug users.
e-Bug in a learning platform for schools
To support local implementation of the Project all over the country, a ‘discipline’ called e-Bug was created in September 2009 in the Moodle Platform of DGIDC (e-learning platform from the Ministry of Education for education projects and programmes).8 Teachers were invited to register on the platform as e-Bug users. Registration allows them to receive the packs, exchange experiences online with other registered teachers, and get online news and support from the e-Bug Portuguese team and from local and regional coordinators.
Distribution of e-Bug packs
In this first year, the packs were sent directly to online-registered e-Bug users and to interested groups of schools by the Ministry of Education (through DGIDC) and also to all school health teams by the Ministry of Health (through DGS). Distribution and registration are still running, and this process will be evaluated at the end of the school year.
Evaluation questionnaire
At the end of school classes (mid-July 2010), an evaluation questionnaire was sent to all e-Bug users, asking for their opinion of the strengths and weaknesses of e-Bug, and its added value to teachers and pupils. The questionnaire also asked for suggestions to improve the e-Bug packs and web site.
Future of e-Bug
e-Bug is an important health educational tool that was designed and translated for the benefit of Portuguese school children for years to come. The involved entities, DGS and DGIDC, are interested in its long-term sustainability in Portuguese schools and the e-Bug Portuguese team will continue to support this on behalf of the health education of Portuguese children.
Funding
This work was supported by DG SANCO of the European Commission (2005211).
Transparency declarations
This article is part of a Supplement sponsored by the European Commission Health and Consumer Protection Directorate-General DG SANCO (grant number 2005211).
