Em 1971, num processo disruptivo com a cultura dominante, foi iniciada em Portugal a criação de uma rede comunitária de centros de saúde, com cobertura universal do território nacional. Apesar de fases de estagnação e desvios houve uma evolução consistente dos cuidados de saúde primários (CSP), até hoje. Em outubro de 2005, foi impulsionada uma ambiciosa reforma dos CSP. A experiência dessa reforma é agora revisitada, motivando algumas reflexões sobre as lições aprendidas e sobre desafios para o futuro.
Os últimos 20 anos foram divididos em quatro períodos: o de 2005 a 2010, marcado pelo impulso reformista que transformou a organização hierárquica tradicional dos centros de saúde em redes de equipes multiprofissionais de saúde familiar, com autonomia técnica e responsabilização contratualizada; entre 2010 a 2015 decorreu a grave crise financeira que afetou a economia global; de 2015 a 2020, sobressaíram as consequências económicas e sociais e a recuperação pós-crise; finalmente, de 2020 aos dias atuais viveram-se: a pandemia de Covid-19; os efeitos do desgaste pandémico; e, nos últimos dois anos, a generalização da administração conjunta dos cuidados de saúde primários, continuados e hospitalares sob figura jurídica de unidades locais de saúde (ULS). Ponderado todo o percurso, os autores propõem a integração dos aspetos analisados na perspetiva multidimensional do conceito de Saúde Local, destacando várias implicações práticas consequentes.
Palavras-chave:
Centro de Saúde; Reforma dos Cuidados de Saúde Primários; Serviço Nacional de Saúde; Unidades Locais de Saúde, Saúde Local.
Abstract:
In 1971, in a disruptive process with the dominant culture, the creation of a community network of health centers was initiated in Portugal, with universal coverage of the national territory. Despite phases of stagnation and deviation, there has been a consistent evolution of primary health care (PHC) to date. In October 2005, an ambitious PHC reform was launched. The experience of this reform is now revisited, motivating some reflections on the lessons learned and on challenges for the future. The last 20 years have been divided into four periods:2005 to 2010, marked by the reformist impulse that transformed the traditional hierarchical organization of health centers into networks of multi-professional family health teams, with technical autonomy and contractual accountability; between 2010 and 2015 there was the severe financial crisis that affected the global economy;2015 to 2020, the economic and social consequences and the post-crisis recovery stood out; finally, between 2020 and 2025 there were: the Covid-19 pandemic; the effects of pandemic wear; and, in the last two years, the generalization of the joint administration of primary, long-term and hospital care under the legal figure of local health units (ULS). Considering the entire path, the authors propose the integration of the aspects analyzed under the multidimensional perspective of the concept of Local Health, highlighting several consequent practical implications of this approach.
Keywords:
Health Center; Primary Health Care Reform; National Health Service; Local Health Units, Local Health.
In 1971, in a disruptive process with the dominant culture, the creation of a community network of health centers was initiated in Portugal, with universal coverage of the national territory. Despite phases of stagnation and deviation, there has been a consistent evolution of primary health care (PHC) to date. In October 2005, an ambitious PHC reform was launched. The experience of this reform is now revisited, motivating some reflections on the lessons learned and on challenges for the future. The last 20 years have been divided into four periods:2005 to 2010, marked by the reformist impulse that transformed the traditional hierarchical organization of health centers into networks of multi-professional family health teams, with technical autonomy and contractual accountability; between 2010 and 2015 there was the severe financial crisis that affected the global economy;2015 to 2020, the economic and social consequences and the post-crisis recovery stood out; finally, between 2020 and 2025 there were: the Covid-19 pandemic; the effects of pandemic wear; and, in the last two years, the generalization of the joint administration of primary, long-term and hospital care under the legal figure of local health units (ULS). Considering the entire path, the authors propose the integration of the aspects analyzed under the multidimensional perspective of the concept of Local Health, highlighting several consequent practical implications of this approach.
Palavras-chave (keywords):
Health Center; Primary Health Care Reform; National Health Service; Local Health Units, Local Health.
Pisco, LA, Ramos, V.B. “Vinte anos da Reforma dos Cuidados Primários em Portugal: lições aprendidas e novos desafios.”. Cien Saude Colet [periódico na internet] (2025/mar). [Citado em 05/12/2025].
Está disponível em: http://cienciaesaudecoletiva.com.br/artigos/vinte-anos-da-reforma-dos-cuidados-primarios-em-portugal-licoes-aprendidas-e-novos-desafios/19541
