Law No. 50/2018, of August 16, establishes the framework for the transfer of powers to local authorities and intermunicipal entities. This scheme, which has seen several extensions in its applicability, provides for transfers in particular in the areas of education, social action, health, social protection, culture, heritage, housing, among others.
This system of transfer of powers is part of a political discourse which invites with the unavoidable fight against centralism, but which never affirms, nor defines, where we are going and which drags us with a jargon which includes concepts such as deconcentration, decentralization, transfer of competences and regionalization. By not defining where we are going, we run the risk of deepening the patchwork that our country has become. This can be verified with the example of health in the skills transfer process.
The aforementioned Law No. and the maintenance and management of equipment assigned to primary health care, operational assistants, logistical support services to health centers, as well as participation in public health promotion programs .
The transfer of skills in this area is carried out by decree-law no. workers in the career of operational assistant. A strategic partnership between the municipalities and the SNS is also envisaged regarding disease prevention programmes. It should also be noted that this degree provides for the competences of, in the case of Valongo, the metropolitan area of Oporto, with regard to the participation in the definition of the network of primary health care units and care units intermunicipal scope. .
Thus, the investments related to the new health centers, as well as the management of existing and future equipment, the operational assistants, the logistical support services will be the responsibility of the municipality of Valongo. Pass buildings, operational assistants, non-medical equipment and logistical support to the municipality, this is not the case for certain valences of health centers (or Family Health Units, hereafter USF), particularly in terms of medical human resources. Indeed, this part remains centralized at the Ministry of Health, by virtue of the Groupings of Health Centers (alias ACeS), which, moreover, pursuant to article 6 of this decree-law no., retain their technical autonomy .
The USFs of the municipality of Valongo are part of the ACeS Maia-Valongo which, as its name suggests, brings together the units of two municipalities. This means that in the exercise of the powers transferred in the field of health, the commune of Valongo will have to articulate with an ACeS, which will also have to conform its action with another commune, whose aspirations, goals and strategies may be different – which, given the difference between the two municipalities, is certain to happen. The same thing happens with Feira and Arouca; Oliveira de Azeméis, São João da Madeira and Vale de Cambra; Santo Tirso and Trofa, Póvoa de Varzim and Vila do Conde; Paredes, Penafiel and Castelo de Paiva.
The neighboring municipalities have very different realities, which reinforces the notion of inconsistency conveyed by this regime. There are examples of municipalities that include more than one ACeS, such as Porto. In this case, the same municipality will have to articulate not with one, but with two ACeS. In the case of Vila Nova de Gaia, the municipality not only has to articulate with two ACeS, but one of them is shared with another municipality – Espinho. Matosinhos’ case is also different. Indeed, not being organized in ACeS, but in Local Health Unit, the transfer of skills in the field of health will not materialize to the same extent in Matosinhos, particularly with regard to the built environment.
Next, article 33 of Law no. 50/2018, of August 16, and article 4, no. 2, of Legislative Decree no. on agreements relating to primary health care and continuing care, as well as the appointment of a representative in the management bodies of local health units. Recall that the metropolitan area of Porto includes, in addition to Valongo, Arouca, Espinho, Gondomar, Maia, Matosinhos, Oliveira de Azeméis, Paredes, Porto, Póvoa de Varzim, Santa Maria da Feira, Santo Tirso, São João da Madeira, Trofa, Vale of Cambra, Vila do Conde and Vila Nova de Gaia. In accordance with article 69 of law n° 75/2013 of September 12, the metropolitan council is composed of the presidents of the municipal councils of the municipalities that make up the metropolitan area.
This means, neither more nor less, that the mayor of Vale de Cambra will have a say on the long-term care agreements linked to Ermesindeas the The mayor of Arouca will have his say in the appointment of a member to the board of directors of the ULS of Matosinhos.
The last note of reflection that I want to leave concerns regionalization. If, with the context presented to us, the country is already a patchwork, How will all these inconsistencies fit into another level of administrative power created by regionalization?
Partner and head of the economic unit of health, pharmaceuticals and biotechnology at PRA