Portugal's rapid progress through primary health care

Abstract

It really is a great time for a family doctor to be working in Portugal, says Dr Andre Biscaia. Speaking from the Cascais Health Centre where he works at Sao Joao de Estoril, some 15 kilometres north along the coast from Lisbon, Biscaia says that reforms initiated by the Portuguese government are transforming the way family practitioners work and the way they relate to their patients. Launched in 2005, these changes have improved job satisfaction among family doctors and are beginning to reverse a worrying decline in their numbers, while at the same time winning strong levels of approval from patients attending the country's health clinics. At the heart of the changes are the new Family Health Units, Unidades de Saude Familiares (USF), groups of family doctors, nurses and administrative staff who work together as a single team to bring a more personal and flexible approach to the care of patients. key thing about the USFs is that they really encourage team work, says Biscaia. function in an autonomous way. The big decisions within the team are taken democratically, by vote--one health professional, either doctor, nurse or administrative staff, one vote, he adds. Patients benefit because important decisions on health issues and on treatment are brought closer to the communities in which they will be applied. [ILLUSTRATION OMITTED] USF teams know their communities very well and can organize resources to meet community needs. We can adjust our schedules very quickly, in accordance with what is needed and wanted at any particular time, he says. In the year of the 30th anniversary of the World Health Organization's (WHO) Declaration of Alma-Ata on health for all, the Portuguese reform embodies the spirit of that landmark agreement. At a conference in Alma-Ata, the then capital of the former Soviet Socialist Republic of Kazakhstan, now called Almaty, countries pledged to combat health inequities both within and between countries. They agreed that a primary health care approach would be the key strategy for achieving what they called 'health for all', in other words, equal access to a comprehensive range of health services for everyone, regardless of ability to pay. Portugal is one of the countries that has been determined to put those primary health care principles into practice over the past three decades. And the results are plain to see. Since the 1970s, infant mortality rates have halved every eight years to reach three per 1000 in 2006, on a par with levels in the rest of western Europe, and down from more than 40 per 1000 in 1975. Life expectancy among the country's 10.6 million people has increased 9.2 years in a generation. Portugal first recognized the right to health in its 1976 Constitution, approved two years after a democratic, army-led revolution ended more than 40 years of authoritarian rule. Under political pressure to reduce large health disparities, the democratic government created a national health system (NHS), which the constitution describes as universal (for everyone), comprehensive (full-range of services) and approximately free of charge. Primary health care in Portugal is one of the pillars on which the public health system rests, says Anabela Coelho Candeias, head of the integrated disease management division at the General-Directorate of Health in Lisbon. But it would be wrong to say that health reform in Portugal began with democracy. Even before the so-called Carnation Revolution of 1974, the previous authoritarian rulers had already sought to address the country's appallingly high levels of infant and maternal mortality. A lot of studies were done in the 1960s that showed that in Portugal the health situation was catastrophic. …