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:
Minister of Health
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.
Secretariat-General for Health, SGH (Secretariado-Geral da Saúde, SGS)
The SGH provides and gives:
− Technical and administrative support to the other sections of the Ministry coordinates their work and provides assistance to staff within various government offices;
− 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 (Inspeção-Geral das Atividades em Saúde, IGAS)
The Inspectorate-General of Health-related Activities is responsible for the audit, supervision, and disciplinary function in the health sector, both in NHS institutions and services and in private institutions.
General Directorate for Health, DGH (Direção-Geral da Saúde, DGS)
− Plans, regulates, directs, coordinates and supervises all health promotion, disease prevention and health care activities, institutions and services, whether or not they are integrated into the NHS;
− Is responsible for public health programmes, quality and epidemiological surveillance, health statistics and studies.
General Directorate for Intervention on Addictive Behaviours and Dependencies, DGIABD (Serviço de Intervenção nos Comportamentos Aditivos e nas Dependências, SICAD)
The DGIABD promotes the reduction of both legal and illegal drugs consumption, the prevention and treatment of addictive behaviours, and the decrease of dependencies.
Central Administration of the Health System, CAHS (Administração Central do Sistema de Saúde, ACSS)
The CAHS is responsible for:
− The management of financial and human resources, facilities and equipment and systems of the NHS;
− 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 Saúde)
− Regulates and supervises the pharmaceuticals and health products sector, following the highest standards of public health protection;
− It aims to ensure that all healthcare professionals and patients have access to safe, efficient and quality pharmaceuticals and other health products.
Institute for Protection and Assistance in Illness, ADSE (Instituto de Proteção e Assistência na Doença, ADSE)
ADSE is a public institute of participatory management, integrated in the indirect administration of the State, with the double responsibility of the Ministry of Health and the Ministry of Finance, endowed with administrative and financial autonomy and own assets.
The purpose of ADSE, I.P.’s mission is to protect its beneficiaries – workers with public employment legal relationship and retirements, and their families – in the areas of health promotion, disease prevention, treatment and rehabilitation.
Regional Health Administrations, RHAs (Administrações Regionais de Saúde)
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
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 Misericórdias), 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 Português do Sangue e da Transplantação)
The Portuguese Institute for Blood and Transplantation:
− Assures quality and safety regarding donation, analysis, processing, storing and distribution of human blood and blood components, as well as human organs, tissues and cells;
− Regulates, at a national level, the pharmaceuticals related to transfusions and assures stock levels of blood and blood components are available when needed.
National Institute of Health, Doctor Ricardo Jorge (Instituto Nacional de Saúde Doutor Ricardo Jorge, INSA)
This institute is a reference laboratory of the Portuguese health system, incorporating the functions of the national observatory and national reference laboratory in the Portuguese health sector.
It is responsible for conducting, coordinating and promoting health research at the Ministry of Health. It also has the objective of producing evidence for policy and action in public health.
National Institute for Medical Emergencies, NIME (Instituto Nacional de Emergência Médica, INEM)
NIME is the body of the Ministry of Health responsible for coordinating the operation, in the territory of mainland Portugal, of an Integrated Medical Emergency System, in order to guarantee to the victims of accidents or victims of sudden illness the prompt and correct health care.
The main tasks of the NIME are to provide relief at the scene, the assisted transport of the victims to the appropriate hospital and the articulation between the several actors in the system.
Hospitals belonging to the Public Administrative Sector (Hospitais do Sector Público Administrativo)
These are public institutions without an enterprise status and continue to be managed by civil service rules.
Public Enterprise Sector
Shared Services – Ministry of Health, SSMH (Serviços Partilhados do Ministério da Saúde, 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 Saúde)
Organisational model created to improve coordination between primary care and hospitals, through vertical integration of different levels of care. There are eight local health units in Portugal: Matosinhos, Northern Minho/Viana do Castelo and Northeast/Bragança (North); Guarda and Castelo Branco (Centre); and Southeast/Portalegre, Southern/Beja and Coastal/Santiago do Cacém Alentejo (Alentejo).
Hospital Centres and other Public Enterprise Hospitals (Centros Hospitalares e Hospitais)
The Hospital Centres and other Public Enterprise Hospitals include hospitals that are ruled as Public Entreprises (EPEs). Among them, there are hospitals that were grouped into Hospital Centres and others that remained as individual institutions. The rationale behind the creation of Hospital Centres was to improve efficiency through better coordination between institutions providing hospital care in the same geographical area. Both Hospital Centres and Hospitals are public enterprises, meaning that hospital boards have some level of autonomy and management accountability, compared with hospitals from the public administrative sector.
Bodies related to health care that does not belong to the Ministry’s administration, either directly or indirectly
National Health Council, NHC (Conselho Nacional de Saúde)
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 Saúde)
The HRA is an independent body responsible for the regulation of the health care sector. Its functions include the supervision of health care institutions regarding operating requirements, patients’ access to health care and defence of patients’ rights, quality of health care provision, economic regulation, and promotion of competition in the health care sector.
Besides these entities, there other, belonging to other ministries that will be relevant, the Social Security (Segurança Social).
The Social Security belongs to the Ministry of Labour, Solidarity and Social Security. The Social Security is a system that aims to ensure citizens basic rights and equal opportunities, as well as to promote social welfare and cohesion for all Portuguese citizens or foreigners who work or reside in the territory 0.
Institute of Employment and Training
The Institute of Employment and Training belongs to the Ministry of Economy. The IEFP is the national public employment service. Its mission is to promote the creation and quality of employment and to combat unemployment through the implementation of active employment policies, including vocational training 0.
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:
− 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;
− Clarifying and consolidating common understandings that facilitate the integration of efforts and of the agents in the achievement of gains and value in health;
− Framing and articulating the various levels of strategic and operational decision-making around the objectives of the Health System;
− Creating and sustaining an expectation of the development of the Health System through guidelines and proposals for action;
− 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.
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 Saúde, 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.
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:
− Implementation of local health units (since 1999);
− Development of information systems (mainly since 2007);
− Implementation of the Family Health Units (2007);
− Reconfiguration and autonomy of primary care centres, by creating the ACES (Decree-Law No. 28/2008, of 22 February 2008);
− 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:
− Family Health Units (Unidade de Saúde Familiar, USF)
− Personalised Health Care Units (Unidade de Cuidados de Saúde Personalizados, USCP);
− Community Care Units (Unidade de Cuidados na Comunidade, UCC);
− Public Health Units (Unidade de Saúde Pública, USP);
− 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 Saúde 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 Saúde 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 Saúde Pública, 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
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
Integrated Long-term Care
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.
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