From January 2020 to May 2023, the world experienced a state of public health emergency due to COVID-19. Faced with the endemic insufficiency of resources, the then Minister of Health recognized, in July 2020, the need to structurally reinforce the extremes of the NHS’s care spectrum: Public Health and Intensive Medicine. More than ensuring a contextual response, it was important to provide the country with a comprehensive capacity to face future (and very likely) global threats.
Until mid-March this year, around 775 million cases of COVID-19 had been cumulatively reported worldwide, of which around 280 million in the WHO European region. The inequity in terms of public health surveillance stands out: despite the territory of WHO Europe comprising just over 11% of the world’s population, the 53 countries that make up it reported around 36% of the accumulated cases…
Like a “robbed house, lock on the door”, the European Health Emergency Preparedness and Response Authority (HERA) was created in September 2021. The creation, in 2004, of the European Center for Disease Prevention and Control (ECDC), had been precipitated by the “bird flu” crisis…
Meanwhile, in our country, the organizational model of local health units (ULS) was imposed, at the beginning of this year, on the entire continental territory – disregarding geodemography and hospital differentiation and, secondarily, individual economic and financial viability.
As for local public health services (public health units in groups of health centers), they were forced to migrate, with the remaining functional units of the primary care network, to that hospital organizational model. They were forced to do so, despite organizing themselves into their own network of services and having population-based objectives and scope of intervention…
It is recognized, however, that the integration of public health units into the ULS could result in gains for those services – and, consequently, for the respective target populations. But, for this to happen, its role must be properly valued, from an organic and functional point of view.
To a General Directorate of Health emptied of the most experienced, it was announced, by a Council of Ministers in its final throes on March 21st, the “coup de grace” of regional health administrations (ARS). In addition to the systemic implications of such a decision, it is important to highlight that the regional level of public health services (public health departments) has the ARS as affiliation bodies.
In summary: in Portugal, not only were there no “locks on the door”, during the COVID-19 pandemic, but the “doors” were thrown wide open, with the disorganization of the network of operational public health services…
Drawing lessons from the COVID-19 pandemic is, from the outset, strengthening the SNS’s first line of defense; This corresponds to operational public health services, antagonistically targeted by political supervision during the current government cycle.
For this to happen, the political decision cannot be guided by ideological prejudice and procedural opacity, nor can it be exempt from scientific evidence. Dialogue must prevail in addressing problems and reasoning in decision-making by the new Government and, specifically, by the appointed Minister of Health.
