World health report

Primary Health Care in Action

Country examples


Portugal in numbers1

  • Life expectancy (both sexes, 2006): 79 years
  • Gross National Product per capita (PPP in international $, 2006): 19 960
  • Per capita total expenditure on health (PPP in international $, 2005): 2034
  • Number of physicians (per 10 000 population, 2005): 34


  • Portugal has cut infant mortality by over 90% in past 30 years
  • Life expectancy has grown by over nine years since 1978 to 79 years
  • Health care is universal, comprehensive and free of charge
  • Health centres staffed by family physicians and nurses cover entire country

Life expectancy at birth is now 9.2 years more than it was 30 years ago, thanks to one of the world’s most consistently successful performances in reducing mortality.

Since the mid-1970s, infant mortality rates have halved every eight years to reach three per 1000 in 2006, on a par with levels in the rest of western Europe, and down from over 40 in 1975.

Portugal’s success is the result of the development of a nationwide primary health care system, rooted in the principles of the Declaration of Alma-Ata in 1978 when World Health Organization Member States pledged to provide health for all based on primary health care.


Portugal recognized the right to health in its 1976 constitution, approved two years after a democratic revolution ended over 40 years of authoritarian rule.

Political pressure to reduce the large health disparities led to the creation of a national health system, funded by taxation and complemented by public and private insurance schemes and out-of-pocket payments

The constitution describes the system as universal (for everyone), comprehensive (full-range of services) and free of charge.

A network of health centres staffed by family physicians and nurses progressively covered the entire country. Portugal considers this network to be its greatest success in terms of improved access to care and health gains.


Nevertheless, some imbalances have emerged over the years, between hospital and primary care, for example, and between the numbers of nurses and physicians3.

As patients are still making intensive use of hospital emergency departments4, the 2004-2010 National Health Plan aims to further decentralize primary care facilities. In this way, primary care – the first point of contact with the country’s health services – will be brought closer to the people through smaller scale family health units.

Portugal’s primary health care successes are featured in the World Health Report 2008: Primary Health Care - Now more than ever.

1World Health Statistics 2008, Online version: (accessed on 26/09/2008)

2World Health Organization, World Health Report 2008: Primary health Care: Now More than Ever, WHO, Geneva, October 2008.

3Health Systems in Transition, Vol. 9 No. 5 2007. Portugal - Health system review. Conclusions on p. 127–129.

4Health Systems in Transition, Vol. 9 No. 5 2007. Portugal - Health system review. Conclusions on p. 127–129.

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