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Health systems in transition
Portugal
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RHAs, supporting public health units within the ACES;
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local health authorities consisting of a public health unit based in ACES;
•
public health doctors and sanitary technical staff;
•
GPs, responsible for health promotion as part of their work, including
family planning, antenatal services and screening programmes.
In 2008, the creation of the ACES restructured the organization of primary
care and public health. The Decree-Law No. 28/2008, of 22 February 2008
established the regimen for the creation, organizational structure and financing
of the ACES (see sections 2.3 and 5.3). These groups are formed by a set of
teams, including PHCUs, FHUs, community care units (
Unidades de Cuidados
na Comunidade
) and public health units (
Unidades de Saúde Pública
). Each
unit contains a team of physicians, nurses, health ancillary technicians, among
others, and works together with the primary care centres and the other units
belonging to the same ACES. In 2009, the public health units were restructured
to improve coordination with both the RHAs and the ACES. In the same year,
a new public health surveillance system was created.
Public health doctors (medical doctors who have completed a 4-year
postgraduate medical training in public health) are responsible for the
epidemiological surveillance of the health status of the population and also
for activities such as health promotion and disease surveillance. However, in
many primary care centres, these responsibilities are transferred to GPs due to a
shortage of public health doctors. Public health doctors’ responsibilities include:
•
surveillance and control of communicable diseases;
•
surveillance of water quality;
•
environmental health surveillance (with municipalities);
•
ensuring compliance of local services (including health facilities) with
health safety standards;
•
environmental inspections of workplace and work conditions;
•
building safety and housing inspection (with municipalities).
Public health doctors currently have a low status within the NHS and there
are problems with recruitment. Until now, their tasks have included acting
as health inspectors and occupational health officers, which are both heavily
bureaucratic and meant working under old directives. The aim of the latest
policies set out in the National Health Plan is to link the development of local