INNOVATION DYNAMICS IN PRIMARY HEALTHCARE REFORM: THE INNOVATION-WAVES IN PHC IN PORTUGAL

Introduction and objectives Primary Healthcare (PHC) strengthening can be considered a longer-term strategy to cover population’s health needs, demanding both innovative approaches and a compromise from governments to organize healthcare services responding to these demands. Portuguese PHC is a good example of such an endeavour. Long-time sustainable and innovative strategies are required for effective PHC reform. This will be addressed by an overview of six innovation-waves dynamics since 1962, and by identifying a set of challenges that need to be addressed for sustainable healthcare-reform. Method Kingdon’s three-streams theory of policy development is used to analyze events from 50-years of reform considering the cycles of policy-making and the path of change and innovation. This approach was chosen as a methodology to assess the process of implementing a reform, including the identification of facilitators and obstacles to translate guidance to policy-makers. Results and Conclusions Like other European countries, Portugal has engaged in a reform (as innovation-waves) of its health services aiming at strengthening family-care services to provide universal access services. It was found that innovations have been introduced in five distinct-waves: in the 1960’s, 1970’s, 1980’s, 1990’s, in 2000’s and the last one in the 2010s. The combination of government and other actors enable the creation of “policy-windows” favourable to reform. Sustainable change takes many years and requires all actors in the health-system to act systematically and in coherence. The evolution of the PHC-reform as a set of smaller reforms, or innovation-waves, during 50 years is highlighted.