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Health decentralisation in Portugal

2026-12Artigo científico Acesso aberto
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dc.contributor.authorOliveira, Rafaela
dc.contributor.authorMarques, Teresa Sá
dc.contributor.authorPerelman, Julian
dc.contributor.authorSantinha, Gonçalo
dc.contributor.institutionEscola Nacional de Saúde Pública (ENSP)
dc.contributor.institutionComprehensive Health Research Centre (CHRC) - Pólo ENSP
dc.contributor.institutionCentro de Investigação em Saúde Pública (CISP/PHRC)
dc.contributor.pblBioMed Central (BMC)
dc.date.accessioned2026-05-20T11:17:01Z
dc.date.available2026-05-20T11:17:01Z
dc.date.issued2026-12
dc.descriptionPublisher Copyright: © The Author(s) 2026.
dc.description.abstractHealth decentralisation has been promoted worldwide as a means of improving responsiveness, efficiency, and citizen participation in health governance. In Portugal, this reform represents a major shift in local policy responsibilities, particularly in health promotion, disease prevention, and well-being, following the transfer of competences established by Decree-Law No. 23/2019. Despite its relevance, empirical evidence on how local governments perceive and approach this process remains limited. This study addresses this gap by examining municipal perspectives on health decentralisation in mainland Portugal. A questionnaire survey was administered to all 278 mainland Portuguese municipalities formally involved in the decentralisation process, yielding valid responses from 163 municipalities (approximately 60% of the total). Data were analysed using Multiple Correspondence Analysis combined with cluster analysis. Five distinct municipal profiles were identified, ranging from proactive and consensual engagement to constrained acceptance or resistance shaped by financial, operational, and political factors. The results indicate that institutional capacity, transparency of financing mechanisms, and the quality of intergovernmental coordination are closely associated with how municipalities interpret and implement decentralised health responsibilities. Municipalities with stronger technical and organisational capacity and more collaborative governance arrangements tend to view decentralisation as an opportunity to enhance proximity, efficiency, and responsiveness in health service delivery, whereas limited capacity, financial uncertainty, and weak coordination are associated with more hesitant or resistant positions. This study contributes empirical evidence to international debates on decentralised health governance and offers policy-relevant insights for strengthening collaborative arrangements and maximising the public health benefits of decentralisation.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent1481163
dc.identifier.doi10.1186/s12982-026-01830-4
dc.identifier.issn3005-0774
dc.identifier.otherPURE: 163199999
dc.identifier.otherPURE UUID: 497dd931-20b7-4545-9fa4-c68285c1edf5
dc.identifier.otherScopus: 105035458152
dc.identifier.otherWOS: 001732097000005
dc.identifier.urihttp://hdl.handle.net/10362/203239
dc.identifier.urlhttps://www.scopus.com/pages/publications/105035458152
dc.language.isoeng
dc.peerreviewedyes
dc.subjectCluster analysis
dc.subjectHealth decentralisation
dc.subjectHealth governance
dc.subjectMunicipalities
dc.subjectPortugal
dc.subjectTerritorial profiles
dc.subjectEpidemiology
dc.subjectPublic Health, Environmental and Occupational Health
dc.subjectSDG 3 - Good Health and Well-being
dc.subjectSDG 11 - Sustainable Cities and Communities
dc.titleHealth decentralisation in Portugalen
dc.title.subtitlelocal government profiles, territorial dynamics and policy implicationsen
dc.typejournal article
degois.publication.issue1
degois.publication.titleDiscover public health
degois.publication.volume23
dspace.entity.typePublication
rcaap.rightsopenAccess

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