Abstract
The 2005 Portuguese primary health care (CSP) reform was one of the most successful reforms of the country's public services. The most relevant event was the establishment of Family Health Units (USF): voluntary and self-organized multidisciplinary teams that provide customized medical and nursing care to a group of people. Then, the remaining realms of CSP were reorganized with the establishment of Health Center Clusters (ACeS). Clinical governance was implemented aiming at achieving health gains by improving quality and participation and accountability of all. This paper aims to characterize the 2005 reform of Portuguese CSP with an analysis of its systemic and local realms. This is a case study of a CSP reform of a health system with documentary analysis and description of one of its facilities. This reform was Portuguese, modern and innovative. Portuguese by not breaking completely with the past, modern because it has adhered to technology and networking, and innovative because it broke with the traditional hierarchized model. It fulfilled the goal of a reform: it achieved improvements with greater satisfaction of all and health gains.
Highlights
IntroductionThe last Portuguese reform of primary health care (CSP – “Cuidados de Saúde Primários”) (equivalent to the Brazilian “Atenção Primária à Saúde”) formally began in 2005 and is one of the most successful reforms of public services in the last decades in Portugal
The last Portuguese reform of primary health care (CSP – “Cuidados de Saúde Primários”) formally began in 2005 and is one of the most successful reforms of public services in the last decades in Portugal
The most relevant event and the first field change was the establishment of Family Health Units (USF – “Unidades de Saúde Familiar”): voluntary and self-organized multidisciplinary teams that operate in health centers run by the State and that respond with autonomy and flexibility to the health needs of a group of people, with a focus on customized medical and nursing care
Summary
The last Portuguese reform of primary health care (CSP – “Cuidados de Saúde Primários”) (equivalent to the Brazilian “Atenção Primária à Saúde”) formally began in 2005 and is one of the most successful reforms of public services in the last decades in Portugal. The most relevant event and the first field change was the establishment of Family Health Units (USF – “Unidades de Saúde Familiar”): voluntary and self-organized multidisciplinary teams that operate in health centers run by the State and that respond with autonomy and flexibility to the health needs of a group of people, with a focus on customized medical and nursing care This first change broke with the very hierarchical organizational structure of public services; the remaining realms of CSP were reorganized with the establishment of Health Center Clusters (ACeS – “Agrupamentos de Centros de Saúde”). In order to give consistency and sustainability to changes, actions focused on clinical governance, seeking to achieve health gains by improving quality and participation and accountability of all This reform did not emerge from a situation of chaos, very bad results, great inefficiencies or great dissatisfaction. What was done is what has happened during the various Portuguese CSP reforms: health systems of other countries were studied, namely those that have historically served as reference for Portugal, as well as scientific literature, and a Portuguese solution was constructed
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