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29 July 2025 | Policy Analysis
Spain creates a National Public Health Agency to strengthen public health governance
6.2. Future developments
6.2.1. Draft law on the National Agency for Public Health
Law 33/2011, of 4 October 2011, on Public Health and the conclusions of the Spanish National Parliament on the Social and Economic Reconstruction of the Kingdom of Spain in 2020 (Congreso de los Diputados, 2020) set up the need to create a national public health agency. In turn, the Recovery, Transformation and Resilience Plan established the reforms and investments necessary for the renewal and expansion of the capacities of the SNS, specifically for public health through the implementation of the three strategic and operational instruments provided for in Law 33/2011: the Public Health Strategy, the Public Health Surveillance Network and the National Agency for Public Health. The Draft law to create the Agency was submitted to parliament in 2024 (BOCG, 2024).
The National Agency for Public Health is designed to have countrywide responsibility in: a) surveillance, identification and assessment of the health status of the population and its determinants, as well as of associated problems, threats and risks, paying special attention to social inequalities in health; b) provision of public information of and communication on health status and potential risks; c) coordination of preparedness and response action for health crises and emergencies; d) coordination with the public health services and the health care services of the ACs and the cities of Ceuta and Melilla; e) reinforcement of the capacities, guidance and support for public health action and the evaluation of public health interventions, particularly policies on health determinants and inequalities.
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.
References
Law 7/2025, of 28 July, establishing the State Agency for Public Health (https://www.boe.es/boe/dias/2025/07/29/pdfs/BOE-A-2025-15652.pdf)
Law 33/2011, of 4 October, General Law on Public Health (https://www.boe.es/buscar/pdf/2011/BOE-A-2011-15623-consolidado.pdf)
Report of the Commission for Social and Economic Reconstruction 2020 (https://www.congreso.es/docu/comisiones/reconstruccion/153_1_Dictamen.pdf)
EVALUACOVID-19: Evaluation of the performance of the Spanish national health system in the COVID-19 pandemic (https://www.sanidad.gob.es/areas/alertasEmergenciasSanitarias/alertasActuales/nCov/documentos/EVALUACION_DEL_DESEMPENO_DEL_SNS_ESPANOL_FRENTE_A_LA_PANDEMIA_DE_COVID-19.pdf)
Recovery, Transformation and Resilience Plan (Component 18, Reform 2) (https://www.lamoncloa.gob.es/temas/fondos-recuperacion/Documents/05052021-Componente18.pdf)
6.2.2. Draft laws aiming to improve the foundational principles of the National Health System
Two relevant draft laws are currently in parliamentarian discussion; thus, 1) the draft law on the Universality of the SNS (Draft Law, 2024a) that seeks to widen health care coverage in those population subgroups still under-covered, and to amend the current distinction between the core, supplementary, accessory and complementary benefits, gathering benefits in a single package, and cancelling the possibility for the regions to offer complementary benefits, as well as the prohibition of new co-payments. Works in the parliamentary commission debating this bill are expected to be finalized this term; and 2) the draft law for the consolidation of equity and cohesion, accepted for amendments in the parliament of the nation (Draft Law, 2024b).