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Organisations and Structures in the Portuguese NHS

Component

Organisations and Structures in the Portuguese NHS

Organisations and Institutions that comprise the Health System

The next scheme represents the relationships between the various bodies, organisations and institutions that comprise the health system.

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The health care delivery system in Portugal consists of a network of public and private health care providers; each of them is connected to the Ministry of Health and to the patients in its own way. The key relationships are shown in the below scheme, with the Ministry of Health coordinating all health care provision and the financing of public health care delivery.

Organisations and Structure for the NHS

The scheme below defines the Organisational Chart of the Ministry of Health:

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A brief introduction of each structural part is described below:

Minister of Health

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The core function of the Minister of Health is:

  • The regulation, planning and management of the NHS;
  • Regulation, auditing and inspection of private health services providers, whether they are part of the NHS or not.

The two-state secretaries have responsibility for the first level of coordination, under delegation by the Minister of Health.

Direct Administration

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Secretariat-General for Health, SGH (Secretariado-Geral da Sa├║de, SGS)
The SGH provides and gives:
Ôłĺ Technical and administrative support to the other sections of the Ministry coordinates their work and provides assistance to staff within various government offices;

Ôłĺ Support to other institutions, services and bodies not integrated within the NHS, concerning internal resources, legal advice, information and public relations.

Inspectorate-General of Health-related Activities, IGHA (Inspe├ž├úo-Geral das Atividades em Sa├║de, IGAS)

General Directorate for Health, DGH (Dire├ž├úo-Geral da Sa├║de, DGS)

General Directorate for Intervention on Addictive Behaviours and Dependencies, DGIABD (Servi├žo de Interven├ž├úo nos Comportamentos Aditivos e nas Depend├¬ncias, SICAD)

Indirect Administration

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Central Administration of the Health System, CAHS (Administra├ž├úo Central do Sistema de Sa├║de, ACSS)
The CAHS is responsible for:
Ôłĺ The management of financial and human resources, facilities and equipment and systems of the NHS;
Ôłĺ The implementation of health policies, regulation and planning, along with Regional Health Administrations (RHAs), namely in health service contracting.

National Authority on Drugs and Health Products, INFARMED (Autoridade Nacional do Medicamento e Produtos de Sa├║de)

Institute for Protection and Assistance in Illness, ADSE (Instituto de Prote├ž├úo e Assist├¬ncia na Doen├ža, ADSE)

Regional Health Administrations, RHAs (Administra├ž├Áes Regionais de Sa├║de)
The RHAs are responsible for the implementation of national health policy regionally and coordinating all levels of health care.

The NHS, although centrally financed by the Ministry of Health, has had a strong regional structure since 1993 comprising five health administrations across Portugal: North, Centre, Lisbon and the Targus Valley, Alentejo and the Algarve.

Regional Health Administrations

Five health administrations across Portugal: North, Centre, Lisbon and the Tagus Valley, Alentejo and the Algarve.

A health administration board, accountable to the Minister of Health, manages the NHS in each region. The management responsibilities of these boards are a mix of strategic management of population health, supervision and control of hospitals, and centralised direct management responsibilities for NHS primary care.

They work in accordance with principles and directives issued in regional plans and by the Ministry of Health. Their main responsibilities are the development of strategic guidelines; coordination of all aspects of health care provision; supervision of hospitals and primary care management; establishment of agreements and protocols with private bodies; and liaison with government bodies, religious charities (for example Miseric├│rdias), other private non-profit-making bodies, and municipal councils.

They are also in charge of the development of a long-term care network.

Portuguese Institute for Blood and Transplantation (Instituto Portugu├¬s do Sangue e da Transplanta├ž├úo)

National Institute of Health, Doctor Ricardo Jorge (Instituto Nacional de Sa├║de Doutor Ricardo Jorge, INSA)

National Institute for Medical Emergencies, NIME (Instituto Nacional de Emerg├¬ncia M├ędica, INEM)

Hospitals belonging to the Public Administrative Sector (Hospitais do Sector P├║blico Administrativo)

Public Enterprise Sector

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Shared Services ÔÇô Ministry of Health, SSMH (Servi├žos Partilhados do Minist├ęrio da Sa├║de, SPMS)
The SSMH provides specific shared health-related services in matters of purchasing and logistics, financial management, human resources, information and communication systems, and other supplementary and subsidiary activities to organisations that are part of the NHS, irrespective of their legal nature, as well as to bodies and services of the Ministry of Health and any other organisations, as long as they carry out specific activities in the health field.

Local Health Units (Unidades Locais de Sa├║de)

Hospital Centres and other Public Enterprise Hospitals (Centros Hospitalares e Hospitais)

Bodies related to health care that does not belong to the MinistryÔÇÖs administration, either directly or indirectly

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National Health Council, NHC (Conselho Nacional de Sa├║de)
The NHC is the consultative body for the Ministry of Health, which is responsible for issuing recommendations and advice on measures to enforce the implementation of health policy objectives.

Health Regulatory Agency, HRA (Entidade Reguladora da Sa├║de)

Social Security

Institute of Employment and Training

Systems/ National Health Plan

The National Health Plan continues the vision established in the previous plans, e.g., health gains by integrating sustained efforts in all society, and the use of strategies based on citizenship, equity and access, quality and policies 0.

The National Health Plan has the mission of 0:
Ôłĺ Asserting the values and principles that support the identity of the Health System, namely the National Health Service, and to strengthen the coherence of the system around them;
Ôłĺ Clarifying and consolidating common understandings that facilitate the integration of efforts and of the agents in the achievement of gains and value in health;
Ôłĺ Framing and articulating the various levels of strategic and operational decision-making around the objectives of the Health System;
Ôłĺ Creating and sustaining an expectation of the development of the Health System through guidelines and proposals for action;
Ôłĺ Being a reference and enabling the monitoring and evaluation of adequacy, performance and development of the Health System.

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. For obtaining more information about The National Health Plan consult this link 0.

Provider Services

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Primary Health Care 0, 0
Primary health care is the central pillar of the health system, assuming important functions of health promotion, prevention and care of the disease, continuity of care and articulation with other health services.

In recent years, the network of primary health care in the NHS has been reinforced and expanded through the creation of the groups of primary care centres (Agrupamentos de Centros de Sa├║de, ACES), who is primarily responsible in the public sector for providing primary health care. Each ACES has organisational independence and is composed of several units, which are integrated into at least one primary care centre.

The ACES coordinate primary care provision but do not have financial autonomy, which belongs to the corresponding RHA. The ACES mission is to guarantee the primary care provision to the population of a given geographic area.

So What?

A series of health care reforms, initiated in 1995/1996, have been carried out with a view to increasing accessibility, improve continuity of care, increase professionals motivation and improve quality, which has had a direct impact in primary health care provision, including:
Ôłĺ Implementation of local health units (since 1999);
Ôłĺ Development of information systems (mainly since 2007);
Ôłĺ Implementation of the Family Health Units (2007);
Ôłĺ Reconfiguration and autonomy of primary care centres, by creating the ACES (Decree-Law No. 28/2008, of 22 February 2008);
Ôłĺ Restructuring of public health services (2009).

In the area of primary health care provision, both ACES and ULS are made up of the following functional unit types:
Ôłĺ Family Health Units (Unidade de Sa├║de Familiar, USF)
Ôłĺ Personalised Health Care Units (Unidade de Cuidados de Sa├║de Personalizados, USCP);
Ôłĺ Community Care Units (Unidade de Cuidados na Comunidade, UCC);
Ôłĺ Public Health Units (Unidade de Sa├║de P├║blica, USP);
Ôłĺ Shared Assistance Resource Units (Unidade de Recursos Assistenciais Partilhados, URAP).

Each of these functional primary care units is based on a multi-professional team with organisational and technical autonomy.

Family Health Unit (Unidade de Sa├║de Familiar, USF): a unit of health care, individual and family, based on a multidisciplinary team of doctors, nurses and clinical secretaries and that develops its activity with organisational, functional and technical autonomy, integrated into a network logic with the others units 0.

Personalised Health Care Units (Unidade de Cuidados de Sa├║de Personalizados, USCP): it has a structure similar to that USF, although in a more traditional model of personalized care, which still has to guarantee the accessibility of the users and the continuity of care0.

Community Care Units (Unidade de Cuidados na Comunidade, UCC): provides home and community health and psychological and social support, especially to the most vulnerable people, families and groups, most at risk or with physical and functional dependence or illness requiring close monitoring. Acts in health education, network integration, family support, the implementation of mobile intervention units and the RNCCI (Rede Nacional de Cuidados Continuados Integrados), through the integrated continuous care team. The UCC team is made up of nurses, social workers, doctors, psychologists, nutritionists, physiotherapists, speech therapists and other professionals.0

Public Health Units (Unidade de Sa├║de P├║blica, USP): acts as health observatory for the geographic area in which it is integrated, namely to develop public health information and plans, to carry out epidemiological surveillance, to manage intervention programs in the context of prevention, promotion and protection of the health of the general population or specific groups, and to collaborate, in accordance with their respective legislation, in the exercise of the functions of health authority. The USP team is made up of public health doctors, public health or community health nurses and environmental health technicians, also integrating, permanently or temporarily as deemed necessary, others professionals in the area of public health 0.

Shared Assistance Resource Units (Unidade de Recursos Assistenciais Partilhados, URAP): provides consulting and assistance services to other functional units and organises functional links to Hospitals. The URAP team is made up of doctors from various specialities other than general and family medicine and public health, as well as social workers, psychologists, nutritionists, physiotherapists, oral health technicians and other professionals not totally affected by other functional units 0.

Hospital Health Care

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The Hospital Health Care is part of health services aimed at ensuring the provision of specialised ambulatory care, inpatient care and emergency care with the objective of providing the population of a given geographic area with curative medical care.

At the end of 2017, the NHS comprised a total of 49 hospital institutions, as shown in the following chart, corresponding to the distribution of NHS hospital institutions by legal status.

Number of NHS hospital institutions in 2017

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Integrated Long-term Care

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The Integrated Long-term Care is focused on the overall recovery of the person, promoting their autonomy and their functionality, within the framework of their dependency situation.

The National Network for Integrated Long-Term Care (NNILTC) has as main objectives the provision of health care and social support in a continuous and integrated way to people who, regardless of age, are in a situation of dependency and loss of autonomy.

The NNILTC is present throughout the continental territory, with different types of home care and inpatient care, and includes public, private and social sector institutions that provide integrated care in the field of health and social action to people in situations of dependency or loss of autonomy whose situation does not require hospital admission but requires different care from those provided in acute care units.

References

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