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03 August 2023 | Country Update
The Portuguese Government strengthens planning of human resources for health -
11 May 2023 | Country Update
The 2030 National Health Plan has been approved
2.5. Planning
The DGH has been responsible for the design, implementation and follow-up of the National Health Plan (see sections 2.3 and 5.1). The Plan sets the main guidelines, strategies and goals for the whole country for a given period of time and it involves a large number of players, including policy-makers, academics, health professionals and members from civil society. The current 2012–2016 National Health Plan was recently extended until 2020 (DGS, 2015b). The National Health Plan comprises strategic guidelines and goals regarding a minimum set of health system activities to be put into effect by the Ministry of Health. The current Plan sets four main axes: health citizenship, equity and adequate access to health care, health quality and healthy policies. The indicators guiding the Plan’s monitoring and evaluation are:
- annual reduction of premature (before age 70 years) mortality until 2020;
- increase in healthy life years by at least 30% for both men and women;
- reduce the use and exposure to tobacco smoke in the population 15 years or older; and
- control the incidence and prevalence of overweight and obesity in school-age population.
A formal national health strategy and health care policy with quantified goals and targets were defined for the first time in 1998, for the period 1998–2002. A revised version of this policy document was produced in 1999 involving a broader range of social partners and stakeholders. It was made public by the Ministry of Health under the title “Health: a Commitment” (“Saúde: Um Compromisso”) (Ministry of Health, 1999). In fact, this structuring tool was a true commitment of the administration to the citizens.
Legislation from 1988 gave the Ministry of Health total control over the procurement and installation of high-technology equipment both within the NHS and in the private sector. The legal guidelines for installing expensive equipment (big-ticket technologies), which established ratios of equipment per inhabitant, were abolished in 1995. However, the principle of prior authorization by the Ministry of Health for equipment within the NHS was retained. In 1998 a national list of health equipment was published (Ministry of Health, 1998), describing the distribution of specific items of equipment and services throughout the country, regional variations in equipment, the amount of equipment in public and private facilities, and the age of equipment. It was not primarily intended as a tool for determining the distribution of equipment, but rather it aimed to enable planners and hospitals to identify areas where there were gaps in service provision.
In 2001, the Ministry of Health issued formal guidelines for the development of Regional Master Plans for NHS hospitals and primary health facilities. The intent was to turn the Regional Master Plans into core instruments for the harmonious and integrated development of NHS infrastructures at national level. However, few developments have been made to accomplish the stated objectives.
The Portuguese Constitution specifies that the economic and social organization of the country must be guided, coordinated and disciplined by a national plan. The national plan must ensure, for example, the harmonious development of the different sectors and regions, the efficient use of productive resources, and the equitable allocation of resources among the population and between regions. As the NHS does not have its own central independent administration, the Ministry of Health carries out most of the planning, regulation and management functions of the NHS, which are centralized in the ACSS.
Box2.2 describes the evaluation of priority-setting and planning.
Box2.2
As part of the process of reform of the Portuguese NHS, framed by the 2019 Basic Health Law, a governmental dispatch (Dispatch number 7985/2023 of 3 August) has been issued to clarify the cooperation and joint working mechanisms between the Competence Center for Planning, Policies and Forecast of the Public Administration, the Central Administration of the Health System, the Executive Directorate of the National Health Service, and the Shared Services of the Ministry of Health, to improve planning and strategic management of Human Resources for Health (HRH), namely in the NHS. The mechanisms include:
- a set of exploratory studies, based on available data by the Ministry of Health, to frame the planning and strategic management of HRH, at national and international level;
- the diagnosis of the current situation of HRH, with the identification of prospective lines to be deepened and improved in the near future;
- the implementation of the Inventory of Human Resources in Health;
- the development of the HRH information system.
The 2030 National Health Plan (Plan Nacional de Saúde (PNS), 2030), an essential instrument of health governance which sets out the strategic guidelines for health policy with a view to reducing inequalities and increasing the population’s well-being throughout the life cycle, was approved.
This PNS 2030 is based on the identification of the population’s main health needs and expectations, establishing as major goals: the reduction of inequalities; the promotion of the development of healthy behaviours; the minimization of the consequences of climate change and other environmental determinants on health; the reduction in an integrated manner of the burden of communicable and non-communicable diseases; and keeping under control health problems at risk of increasing, emerging or re-emerging.
The PNS 2030 is aligned with the United Nations 2030 Agenda for Sustainable Development and resulted from of a widely participated process, involving the technical and scientific support of experts, the participation of more than 100 organizations both inside and outside the health sector, and the contribution of 114 entities and citizens who participated in the public consultation.
More information (in Portuguese), here: