Political Appointments Cloud Portugal's Healthcare Leadership Overhaul

The Portugal Ministry of Health continues to appoint leadership teams for Local Health Units (ULS) using the same procedures as previous governments, despite mounting criticism from medical professionals and unions who argue that political connections are overshadowing competence and clinical experience.

Why This Matters

• Leadership transitions: Multiple ULS administrations have been replaced, with critics arguing that partisan ties influence selection decisions over merit-based criteria.

• Recruitment challenges: Health Minister Ana Paula Martins revealed that "many invitations have been rejected" for ULS board positions, citing low pay and legal risks, including personal fines.

• System overhaul: Portugal's 39 ULS now cover the entire country under a unified management model integrating hospitals and primary care centers—one of the biggest structural reforms in the National Health Service (SNS) since its creation.

The Appointment Controversy

When questioned in Parliament's health committee, Minister Ana Paula Martins insisted that the government "used exactly the same criteria that have always been used" for naming ULS governing boards. She explained that the Executive Directorate of the National Health Service (DE-SNS) continues to recommend candidates to the Cabinet for final approval—a model inherited from prior administrations.

Yet the Portuguese Medical Association (Ordem dos Médicos) has repeatedly challenged this assertion, arguing that selection should prioritize technical competence, field knowledge, and proven management results rather than party affiliation or personal networks. Its president, Carlos Cortes, described partisan appointments as a "pernicious practice" and expressed concern about transitions that lack clear justification or performance-based evaluation.

Why Leadership Roles Go Unfilled

Minister Martins candidly admitted that recruiting qualified candidates for ULS boards has proven difficult. "We have extended many invitations that were declined," she told lawmakers, citing structural disincentives:

• Personal liability: Administrators face fines for operational breaches under existing rules, often without institutional insurance coverage.

• Compensation mismatch: Salaries are "not substantive for the level of responsibility" involved in managing complex health organizations serving hundreds of thousands of residents.

• Reputational risk: Public scrutiny and political pressure make the roles unattractive to many seasoned managers.

Health sector unions have escalated criticism over appointment practices and resource allocation, warning that these challenges threaten service continuity and professional retention.

What This Means for Residents

The 39 ULS now operational across Portugal represent a fundamental shift in how the country organizes public healthcare. By merging primary care centers with hospitals under single executive boards, the model aims to streamline patient pathways, reduce administrative duplication, and strengthen preventive care.

For patients, this integration should mean:

• Faster referrals between primary care and specialist hospital services.

• Coordinated chronic disease management across care settings.

• Reduced bureaucracy when navigating appointments, tests, and follow-ups.

However, leadership transitions and disputes over appointment criteria risk undermining these benefits. Health professionals warn that boards chosen without transparent merit-based evaluation may struggle to implement the complex workflows and coordination the reform requires.

Reform Considerations

Minister Martins indicated that a wider public administration review is underway, which could include changes to how ULS boards are selected. She invited lawmakers and stakeholders to propose alternative criteria if the current system is deemed inadequate.

European models demonstrate alternative approaches where merit-based selection, transparent evaluation, and stakeholder involvement play larger roles in appointing healthcare leadership.

Portugal's centralized, ministerial appointment model stands in contrast to these systems, raising ongoing questions about governance transparency and professional accountability in the healthcare sector.

Looking Ahead

With ULS boards now in place under the new structure, the coming months will test whether the government's approach to appointments can coexist with growing demands for transparency and merit-based governance. Minister Martins acknowledged that the current model leaves "room for improvement" but maintained that no fundamental shift in criteria has occurred between administrations.

For residents, the practical question remains: Will the ULS model deliver faster, more coordinated care, or will appointment disputes and governance concerns distract from operational improvements? The answer will likely emerge in performance data—waiting times, emergency department delays, primary care access, and patient satisfaction scores—which professional associations and lawmakers are certain to scrutinize closely.