Context
Spain’s public health governance was significantly challenged during the COVID-19 pandemic, revealing the need for a stronger institutional framework to manage health surveillance, intersectoral coordination, risk assessment and crisis preparedness. Until now, responsibilities were fragmented across various entities with limited coordination. Notably, the creation of a National Public Health Agency was a provision in the 2011 General Law of Public Health that was pending implementation.
Impetus for the reform
In the aftermath of the pandemic, a parliamentary special committee on the Social and Economic Reconstruction of the country, as well as the commissioned Evaluation on the Spanish health system response, recommended strengthening public health institutions and procedures, recognizing some weaknesses of the system and providing recommendations for enhanced responsiveness. Recommendation translated into specific funding as part of the EU Recovery and Resilience Plan.
Main purpose of the reform
The Law 7/2025, of 28 July, creates the National Public Health Agency (Agencia Estatal de Salud Pública, AESAP), an independent public agency attached to the Ministry of Health, to reinforce the protection of population health. The AESAP assumes technical responsibilities previously held by the Ministry of Health, making technical and scientific recommendations in surveillance and assessment of the health status of the population. The authority remains in the Ministry of Health in coordination with the ACs. The reform also entails increased infrastructure and human resources to accomplish these functions.
Content/characteristics
The AESAP assumes technical responsibilities previously held by the Ministry of Health, in coordination with the ACs, encompassing the surveillance, identification and assessment of the health status of the population. It is responsible for public communication on health risks, coordination of crisis preparedness and emergency response, and technical cooperation with regional public health services.
It also supports public administrations and civil society on health promotion, disease prevention, and addressing social determinants of health. The AESAP will participate in the design and evaluation of public health policies and promote research, training and innovation. It will also coordinate the State Network for Public Health Surveillance, and will assess health outcomes related to health services (in collaboration with ACs). These roles reinforce the state’s public health capacities without undermining regional competences.
Law 7/2025 also grants to the AESAP the authority to access and manage health data from ACs and other sources, reinforcing its legal capacity to collect and analyze public health information. This requires technical interoperability across the health information systems of the ACs and a new governance model for data sharing between administrations.
Implementation steps taken (or scheduled)
The law entered into force on 30 July 2025. Within six months, a royal decree will approve the AESAP’s statute, define its governance, and transfer relevant services and staff from the Ministry of Health, for example, those related to health alerts and emergency response or health policy evaluation. Coordination with ACs is foreseen via the Interterritorial Council, and a multilevel governance model is expected to be facilitated, pending the drafting and approval of the AESAP’s statute, through mechanisms for cooperation, data sharing and the promotion of collective intelligence.
Outcomes to date and any evaluation
As of July 2025, the reform has been enacted, and preparatory steps for implementation are underway. The forthcoming framework agreement between the Ministry of Health and the AESAP will establish mechanisms to assess accountability and performance.