Co-production of health: are communities being heard in local health planning in Portugal?

Abstract

Abstract Background Health planning is an essential tool to address communities' health needs. Although recommended by portuguese national guidelines, Local Health Plans (LHP) lack adequate community participation, which could improve their implementation and contribute to achieve the SDG agenda and universal health coverage. The aim of this study is to assess the degree of community participation in LHP in Portugal. Methods Data was collected from 52 (out of 54) publicly available LHP in April 2021. Each document was reviewed by two independent researchers and analysed considering time frame, participatory approach, stage of the health planning cycle in which the community was involved and methods used to promote community participation. A descriptive analysis was performed. Results Although 52 LHP were available, only 37 were valid for 2020. Although community participation was mentioned in all PLH, most did not include a comprehensive community participation approach (88%). Community representatives were particularly involved in the prioritizing health problems stage of the health planning cycle (81%); no LHP mentioned the involvement of the community in the monitoring and evaluation stage. Methods used to promote community participation were clearly stated in 48% of LHP. Conclusions Community participation is a key strategy for successful implementation of LHP in Portugal. Most LHP show a clear concern to include community representatives when it comes to prioritizing health problems and highlight the importance of co-production of health between health services and the community, but fail to integrate community participation throughout the health planning cycle. Specific community fora could improve community participation and therefore better implementation of LHP. Key messages Most Local Health Plans in Portugal lack a comprehensive community participation approach. A community-centred approach should be prioritized in order to improve LHP implementation.