- AIReF finds that Navarre has a more extensive primary care network than the national average, although 60% of its centres are more than 30 years old
- The hospital system makes good use of beds and has strong surgical capacity, but limited ICU bed availability
- It proposes a medium- and long-term master plan for healthcare infrastructure and a strategic plan for electromedical equipment to prioritise investment, modernisation, and monitoring and evaluation mechanismsAIReF finds that the Navarre Health Service had 16,059 professionals in 2023, 23% more than in 2016, with particularly strong growth in primary care
- It proposes strengthening strategic workforce planning in healthcare, introducing measures to reduce waiting times and lists, and reviewing the pay model to incorporate performance-related incentives
The Independent Authority for Fiscal Responsibility (AIReF) today published two studies on Navarre’s healthcare system, focusing on its healthcare infrastructure and human resources policy. Both studies assess the current state of the system, identify strengths and weaknesses, and propose measures to improve planning, effectiveness, and responsiveness to the population’s healthcare needs.
In the first study, AIReF analyses the infrastructure and equipment of the Navarre Health Service (Servicio Navarro de Salud-Osasunbidea), identifying strengths and shortcomings and proposing ways to better meet the current and future needs of the population.
The assessment highlights the lack of a consolidated strategic framework to guide investment planning, leading to fragmented management and decisions driven by immediate needs. Furthermore, the commissioning of new construction and refurbishment projects lacks systematic and objective criteria. In light of this situation, AIReF proposes developing a medium- to long-term master plan for healthcare infrastructure, setting out clear priorities and investment criteria aligned with the Navarre Health Plan.
In primary care, Navarre has a more extensive network than the national average, but it is characterised by the age of its facilities: 60% of centres are over thirty years old. In the hospital sector, Navarre stands out for its overall strong performance, efficient use of hospital bed capacity, and high surgical capacity, in contrast to the limited availability of intensive care beds, which is one of its main weaknesses. These shortcomings underscore the need to establish a planned investment framework that combines the renovation and modernisation of centres while ensuring equitable access across the region.
AIReF also proposes introducing monitoring and evaluation mechanisms to measure the operational efficiency of the public company Transporte Sanitario de Navarra-Bidean, which is expected to deliver benefits in team integration, operational control, and quality of care.
The assessment also highlights the lack of a specific procurement plan for electromedical equipment based on healthcare needs, as well as reliance on state or European programmes. It therefore proposes developing a comprehensive strategic plan, accompanied by a transparent prioritisation system and a unified inventory for monitoring purposes.
Comprehensive inventory and information systems
Regarding equipment, AIReF finds that Navarre has a strong starting point in high-tech equipment, although the growth of its stock over the past decade has been more moderate than the national average. At the end of 2022, 55% of the equipment was over 10 years old, exceeding international recommendations. In terms of use, utilisation rates are below the national average for CT scanners, MRI scanners, mammography equipment, PET scanners, gamma cameras, and SPECT scanners. This situation highlights the need for a comprehensive inventory and consolidated information systems to ensure more efficient and equitable use of available resources.
The study also highlights the lack of consolidated information systems for managing infrastructure, equipment, and staff. To address these shortcomings, it proposes implementing a centralised, unified system that ensures a single source of information, interoperability with financial, logistics and human resources platforms, process automation, and the use of predictive analytics tools, thereby improving decision-making and preventive management.
Lastly, in the area of clinical and management information systems, Navarre has three tools: ANDIA (integrated electronic health record), BARDENA (outcomes assessment) and SECA (management accounting). These systems represent progress, but they still operate separately. AIReF proposes integrating them into a cohesive digital ecosystem to strengthen process automation, predictive analytics and interoperability with the National Health Data Space, while also redesigning dashboards to provide key indicators.
Human resources policy
In the second study, AIReF analyses the human resources policy of Navarre’s healthcare system, which occupies a distinctive position because of Navarre’s special self-government regime, which gives it greater autonomy. This framework has enabled sustained growth over recent decades in both the budget and the healthcare workforce, as well as the development of its own legal framework through Regional Law 11/1992 and a process of granting civil servant status that standardised working conditions for healthcare staff. More recently, Regional Law 11/2023 introduced new specific supplements aimed at improving the attraction and retention of talent.
However, this quantitative progress coexists with several structural challenges. These include the fragmentation of responsibilities across different institutional bodies—the Department of Health, the Navarre Health Service-Osasunbidea (SNS-O) and the Department of the Interior, Civil Service and Justice—which reduces agility in human resources management; high levels of temporary employment, particularly in nursing; and a pay model in which fixed components predominate and performance plays only a limited role.
In terms of planning, the SNS-O had 16,059 professionals in 2023, 23% more than in 2016, with particularly strong growth in primary care and staff-to-population ratios slightly above the national average. However, the fragmentation referred to above reduces agility in staffing and leads to inconsistent prioritisation systems owing to the lack of a common instrument for planning, coordination and communication.
In addition, the system shows mismatches between funded and filled posts, as well as territorial disparities between basic health zones. It therefore proposes strengthening coordination mechanisms among the bodies involved by creating stable institutional channels, joint technical committees to plan key aspects (such as the timetable for public recruitment processes) and drawing up a joint medium- and long-term strategic human resources plan.
Measures to reduce waiting times and lists
The analysis of healthcare supply and demand points to a favourable picture in terms of pressure on the healthcare system, with primary care indicators for family medicine and paediatrics below the national average, and declining between 2016 and 2023. In hospital care, 81% of services recorded slight falls in the number of consultations per professional over the same period. However, waiting times have worsened significantly since the pandemic. In primary care, the percentage of consultations with a wait of more than four days rose between 2016 and 2023 from 9.3% to 16.8% in family medicine, from 13.5% to 15% in nursing, and from 2.4% to 4.4% in paediatrics. Over the same period, 73% of services recorded longer waits for first consultations and 80% saw a deterioration in surgical waiting times, although the average surgical waiting time remains below the national average.
Against this backdrop, AIReF proposes measures to reduce waiting times and lists on both the demand side—such as appropriateness protocols, digital tools and health education—and the supply side, through telemedicine, extended opening hours and schedule optimisation, supported by a territorial monitoring system to enable early detection of critical situations.
Temporary employment
Temporary employment remains a structural feature of healthcare employment in Navarre. In this region, it is particularly prevalent in nursing, reaching 65% in primary care and 66% in hospital care in 2023. Between 2016 and 2023, temporary employment fell in paediatrics by 24 percentage points, remained broadly stable in family medicine, and rose in nursing by 12 percentage points, with a general trend towards replacing cover contracts with interim staff. There are also territorial differences between basic health zones, with a positive correlation in nursing between temporary employment and population density.
Although recent public recruitment processes have helped to stabilise employment in some specialties, temporary employment remains high. AIReF therefore proposes consolidating a multi-year planning model for public recruitment processes, with clear timetables and priorities defined by category, in order to ensure a steady pace of recruitment rounds, improve coordination across processes, and anticipate future needs through predictive analytics tools.
Lastly, the study finds that Navarre’s pay model is characterised by the predominance of fixed pay and the limited weight of performance-related incentives. Although new specific supplements have been introduced in recent years and career progression has gradually been extended to different groups, variable pay still plays only a limited role. Against this backdrop, AIReF proposes reviewing the pay system to strengthen incentives linked to efficiency, quality of care and professional motivation.
