The transfer of powers to local authorities – the example of health and the country in patchwork

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.

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