Does “local health” make “healthy locals”? Lessons from developing municipal health strategies in Portugal
1
Institute of Environmental Health, Lisbon School of Medicine, Lisbon, Portugal
Popul. Med. 2026;8(Supplement Supplement 1):A3629
ABSTRACT
BACKGROUND:
Decentralization is one of the most significant public sector reforms of the past 50 years. In 1979, the Portuguese National Health Service was designed as a universal and centralized system providing free healthcare. Recently, municipalities have become actively involved in shaping local health policies through the development of health strategies, followed by action plans with defined axes of intervention, priority areas, goals, and indicators. This communication aims to share lessons learned from the development of five local health strategies in Portugal.
METHODS:
The five local health strategies were developed through close collaboration between municipalities and an academic partner. A multisectoral and multiprofessional participatory co-design approach was adopted. The final strategy documents were co-authored by representatives of different local actors with expertise and responsibilities in healthcare and/or health determinants, fostering shared ownership and endorsement for future implementation. Data collection focused on identifying priority intervention areas and included, in each municipality, World Café sessions (involving politicians, local stakeholders, and citizens), focus-groups with citizens, individual interviews with health professionals, and population surveys. These activities informed the definition of mission, vision & values, local resources & barriers, priority areas of intervention, leadership structure, and communication of the strategy.
RESULTS:
Five municipal health strategies were developed and formally approved as local health policy documents, targeting the promotion of health for approximately one million citizens overall. Action plans have been completed in two municipalities. In two cases, the academic partner assumed an ongoing role as a health promotion observatory.
CONCLUSIONS:
Collaboration between academia and local health governance in the development of municipal health strategies represents a promising pathway for systematic monitoring and evaluation of local health promotion initiatives. Healthcare decentralization in Portugal created opportunities to improve population health, wellbeing, and health equity. These findings offer transferable insights for other countries pursuing decentralized health governance models.
Decentralization is one of the most significant public sector reforms of the past 50 years. In 1979, the Portuguese National Health Service was designed as a universal and centralized system providing free healthcare. Recently, municipalities have become actively involved in shaping local health policies through the development of health strategies, followed by action plans with defined axes of intervention, priority areas, goals, and indicators. This communication aims to share lessons learned from the development of five local health strategies in Portugal.
METHODS:
The five local health strategies were developed through close collaboration between municipalities and an academic partner. A multisectoral and multiprofessional participatory co-design approach was adopted. The final strategy documents were co-authored by representatives of different local actors with expertise and responsibilities in healthcare and/or health determinants, fostering shared ownership and endorsement for future implementation. Data collection focused on identifying priority intervention areas and included, in each municipality, World Café sessions (involving politicians, local stakeholders, and citizens), focus-groups with citizens, individual interviews with health professionals, and population surveys. These activities informed the definition of mission, vision & values, local resources & barriers, priority areas of intervention, leadership structure, and communication of the strategy.
RESULTS:
Five municipal health strategies were developed and formally approved as local health policy documents, targeting the promotion of health for approximately one million citizens overall. Action plans have been completed in two municipalities. In two cases, the academic partner assumed an ongoing role as a health promotion observatory.
CONCLUSIONS:
Collaboration between academia and local health governance in the development of municipal health strategies represents a promising pathway for systematic monitoring and evaluation of local health promotion initiatives. Healthcare decentralization in Portugal created opportunities to improve population health, wellbeing, and health equity. These findings offer transferable insights for other countries pursuing decentralized health governance models.
| eISSN: | 2654-1459 |
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