The GOVERNANCE of the health system with regard to COVID-19 relates to pandemic response plans and the steering of the health system to ensure its continued functioning. It includes emergency response mechanisms, as well as how information is being communicated, and the regulation of health service provision to patients affected by the virus.
On 30 April, the government announced publicly the calendar and the conditions for lifting some containment measures (https://www.portugal.gov.pt/pt/gc22/comunicacao/documento?i=plano-de-desconfinamento). The calendar includes a number of measures in several sectors to be revised every two weeks. All sectors must adopt the necessary measures to ensure physical distancing by reducing their maximum capacity, and adequate cleaning, hygiene and ventilation (see Section 1.2).
Since 2016, the Centre for Public Health Emergencies, created within the Directorate-General of Health, is mandated to design the national response to public health emergencies (https://dre.pt/application/conteudo/75319456). There are two seasonal response plans for health-related issues: Winter and Summer. In the first, contingency responses to respiratory infections are addressed, while the latter includes responses to high temperatures and heat. The Winter module covers several issues including prevention of infection (respiratory etiquette), coordination of public health and hospital services, surveillance, and flu vaccination, among others (https://www.dgs.pt/documentos-e-publicacoes/plano-de-contingencia-saude-sazonal-modulo-inverno-2019-referenciais-pdf.aspx). The plan is usually in place between 1 October and 30 April, so when the COVID-19 outbreak started in Portugal, the Winter contingency plan was in place.
Following the activation of a COVID-19 Task-Force within the Directorate-General of Health, a specific contingency plan to face the COVID-19 epidemic was produced (https://covid19.min-saude.pt/wp-content/uploads/2020/03/Plano-de-Conting%C3%AAncia-Novo-Coronavirus_Covid-19.pdf). The National Preparedness and Response Plan to the Novel Coronavirus Disease (COVID-19) outlines the main measures to be implemented in each stage of the national epidemics, defines the national, regional and local leadership and establishes the coordination among the different stakeholders (https://covid19.min-saude.pt/wp-content/uploads/2020/03/Plano-de-Conting%C3%AAncia-Novo-Coronavirus_Covid-19.pdf).
From the health system perspective, the Ministry of Health is responsible for leading the national response, although the Autonomous Regions have specific coordinating bodies. Regional Health Administrations coordinate the response at the regional level, communicating with hospitals and primary health care. From the public health perspective, the Director-General of Health, as National Health Authority, leads the national response, while Regional and Local Health Authorities coordinate the response at the regional and local levels, respectively.
Legislation regulating the State of Emergency (both the first declaration on 18 March and the reviews on 2 and 17 April) established compulsory confinement at home or health institution to all confirmed COVID-19 cases and all those isolated by determination of public health authorities, the possibility of temporary requisition of health care units by public authorities, and the possibility of temporary civil requisition of workers from both the public and private health care sectors (https://dre.pt/application/conteudo/130473161; https://dre.pt/application/conteudo/131068124).
Epidemiological surveillance, contact tracing and public health measures are coordinated by the Directorate-General of Health, while the National Institute of Health Dr Ricardo Jorge, as the National Reference Laboratory, coordinates laboratory activity. The Directorate-General of Health issues a daily report on the country’s epidemiological situation (https://covid19.min-saude.pt/relatorio-de-situacao/) and reports data to international institutions such as ECDC and WHO.