Postgraduate training in Andorra

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Background

Andorra does not have a medical school or faculty of health sciences. This means that all students wishing to pursue health-related degrees are obliged to do so in other countries.

Most attend schools in nearby Catalonia (Spain) or in France, seldom in more distant countries. The Andorra Nursing School collaborates with nursing schools and teaching hospitals in Catalonia on mental-health or midwifery specialization. The country also has a vocational school, offering studies leading to assistant-nurse specialities related to working with the elderly. On obtaining degrees in these areas, students are eligible to attend the Nursing School to qualify as nurses.

Andorra considers that continuing-education courses should be based on established needs, run by accredited centres and professionals, and have the potential to facilitate job and curricular incentives for health professionals.

Delivery

Andorra follows a mixed model in the delivery of postgraduate training (hereafter, “continuing education”), which includes opportunities offered in neighbouring countries (France and Spain). Andorra’s hospital holds monthly professional- development courses and these are often carried out bilaterally with Spain or France.

The Our Lady of Meritxell Hospital makes it possible for all health professionals employed there to pursue continuing medical education and training in neighbouring countries. In general terms, Andorra’s Health Care Service makes it possible for all categories of health-care workers, including desk officers and administrative personnel, to receive training in dealing with the public.

Initiatives

Andorra has recently established a shared medical-record system, which aims to provide the country with the information needed to develop a continuing-education plan. The plan should define the necessary learning material and teaching staff, and specify the venues of future courses, meetings, etc.

It will be a valuable instrument in enabling Andorra to make agreements with teaching centres abroad, thus facilitating the mobilization of teachers rather than students.

Postgraduate training in Andorra

Data

No data on postgraduate training are available since the Andorran health-care needs have not yet been established. The trend seems to be towards focusing on training in long-term care due to the challenges of chronic diseases and an ageing population.

It is expected that Andorra’s recently launched shared medical- record system will provide the country with useful information on population needs. Since all health professionals are required to input all relevant information emanating from patient visits, the system will reveal priority areas for postgraduate-training.

Role of postgraduate training in reducing brain drain

Andorra has put several mechanisms in place to reduce brain drain. Nationals of and residents in Andorra who have been working abroad may practise on return to the country upon validation of their degrees and the inclusion of their data in the Registry of Health Professionals and Health Care Facilities in the Ministry of Health. Other nationals wishing to practise in Andorra must have validated degrees and offers of employment in an existing health facility. If they meet these requirements, they have – in accordance with the country’s foreign investment laws – the possibility of establishing new health facilities. In Andorra, physicians also have the right to set up private practice.

An agreement exists with the Social Security Fund, establishing the amounts for all medical services delivered. The Fund reimburses patients 75% of ambulatory-care costs and 90%

of hospital and emergency costs, thus covering the main part of these expenses. For nurses, an agreement exists between the Andorran and Catalan Nursing Schools whereby Andorran graduates can specialize in midwifery in Catalonia, and Catalan graduate nurses can benefit from practical training at the Our Lady of Meritxell Hospital in Andorra.

Challenges and enablers

Nursing schools and universities need to play an enabling role in the continuing education of health workers for which they can provide the teaching infrastructure. Short and intensive courses, co-organized by Andorran and foreign organizations, could also help strengthen continuing education.

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Postgraduate training in Andorra

Cross-country collaboration

Bilateral collaboration between Andorra and other small countries is contributing to meeting the country’s postgraduate-training needs. In March 2019, the Ministry of Health of Andorra, the Andorran Health Care Service and the Ministry of Health of Monaco joined forces in organizing a workshop on geriatric orthopaedics in Andorra. This type of collaboration is possible thanks to the WHO Small Countries Initiative (1), which brings countries together in seeking solutions to challenges in several areas of public health.

References

1. Small Countries Initiative. In: World Health Organization Regional Office for Europe [website]. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/about-us/networks/small-countries-initiative, accessed 29 February 2020).

WHO support needed

Andorra would welcome WHO support in organizing international workshops on recognized needs, for example, a course for health professionals and policy-makers on the use of evidence available in health-information systems as a basis for decision-making.

WHO/EURO:2020-1298-41048-55728