ENHA EU Manifesto: A Manifesto for Health Equity in the EU


Mandatory screening and access for high quality nutritional care

Monitor our progress through our annual national dashboards
Aníbal Marinho ONCA Coordinator Portugal

Contact Aníbal for inquiries on Portuguese campaign activities and for publishing of your Good Practice on this website. portugal@nutritionalcare.eu

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  • Celia Lopes

    ONCA Spokesperson Portugal

Portuguese ONCA campaign

Portugal officially joined ONCA campaign in December 2016 with the objective of implementing the ONCA united vision locally:

‘Optimal nutritional care for all through mandatory systematic screening and outpatient equitable access for high quality nutritional care and medical nutrition’


Disease-related malnutrition in Portugal

Despite all previous efforts, for the last 30 years, disease-related malnutrition (DRM) has been a serious public health problem in Portugal, which led to high socioeconomics costs for both patients and the healthcare system:

  • Screening was not mandatory / performed as standard procedure;
  • Low DRM awareness and recognition of medical nutrition value among healthcare professionals, patients/caregivers, politicians and national authorities;
  • Lack of clinical nutrition education in medical schools;
  • Limited access to medical nutrition for outpatients.

It is estimated that 2 in 4 adult patients in Portuguese hospitals are at risk of malnutrition or are already malnourished – exceeding the European average of “1 in 4 adult patients” – and that almost 115.000 outpatients are currently requiring nutritional support with medical nutrition.


The Portuguese Malnutrition Awareness Week


It’s a credible multi-stakeholder platform with international visibility where 18 countries are fully aligned in one unique mission and good practices sharing.

ONCA helped to engage with health authorities, medical societies, patient associations and other relevant stakeholders. Currently, ONCA campaign involves PEN society, 12 patient association alliance “Nutrition for all”, MoH, health authorities, medical societies, payers, national industry group and it’s growing: every new stakeholder tackled engages and embraces ONCA.

National Stakeholder Map

ONCA dashboards were used to compare our reality with other European countries within MoH.

PT Dashboard November 2017

A clinical evidence & health economics dossier was developed and presented to MoH, Parliamentary Health Committee and other relevant stakeholders. The dossier includes strong arguments which allowed a strong political commitment.

It was possible to show our political stakeholders the dimension of this global campaign by hosting the Optimal Nutritional Care for All Conference in 2018:

  • Around 400 delegates from 18 European National Alliances
  • Relevant attendees/speakers:
    • MPs (Members of Portuguese Parliament)
    • MEPs (Members of European Parliament)
    • Representatives of Parliamentary Health Committee
    • Head of Health Authority
    • Heads of all relevant Medical Societies
  • Media coverage

ONCA Conference 2018 in Sintra


In summary, due to the effective implementation of a local campaign by taking ONCA credibility to the political level, it was possible to achieve so far:

  • More than 50 hearings with MoH & other relevant political and medical stakeholders
  • White paper signed by National Patient Associations Alliance
  • Mandatory electronic nutritional screening available at all public hospitals for adults and paediatrics (with KPIs)
  • Publication of “National Policy for effective screening implementation” by MoH & Directorate-General of Health
  • DRM at political and social agenda:
    • Political commitment
    • Media coverage
    • Involvement of patient associations
  • Publication of legal framework for home hospitalization
  • Publication of legal framework for outpatient access for the dietary management of Cow’s Milk Allergy (CMA)
  • PEN Society (APNEP) awarded with MNI Grant 2019

Ongoing and planned activities

  • Publication of “Directorate-General of Health Technical Standard” (for adults) which defines discharge algorithms of outpatient access for medical nutrition
    • Legal framework definition is ongoing
  • Launch of the first Portuguese Malnutrition Awareness Week
  • Dissemination and deployment of “National Policy for effective screening implementation”
  • Training of HCP responsible for nutritional screening
  • Monitor malnutrition national data analysis along with MoH