Contratualização na atenção primária à saúde: a experiência de Portugal e Brasil

Translated title of the contribution: Contractual arrangements in primary health care: the experience of Portugal and Brazil

Vanessa Costa e Silva, Ana Escoval, Virginia Alonso Hortale

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)
9 Downloads (Pure)


The contractual arrangements adopted in the Family Health Strategy are a topic as yet scantly addressed in studies. It is introduced in Brazil in different models in accordance with the contracting entity and the legal status of the contracted service provider; and in Portugal, it is based on a model of inter-governmental contractual arrangements with the Family Health Units. In this paper, the current status of contractual arrangements in both countries is presented and their attributes of joint planning, accountability with autonomy and performance-based incentive programs are discussed. The main contributions are: better coordination of the health organizations; substitution of the hierarchical command-control logic with greater participation; and accountability of professionals with enhanced performance of their activities. The conclusion reached is that one of the facilitating elements is gradual construction, in an environment of ongoing learning, with health professionals playing the leading role. However, the major challenges include transparency in the implementation of processes, the enforcement of sound auditing mechanisms and information systems, as well as the continuous review of indicators and their suitability for the health needs of the population.

Translated title of the contributionContractual arrangements in primary health care: the experience of Portugal and Brazil
Original languageUnknown
Pages (from-to)3593-3604
Number of pages12
JournalCiência & Saúde Coletiva
Issue number8
Publication statusPublished - Aug 2014


  • Primary health care
  • Family health
  • Health management
  • Contractual arrangements
  • Contracts


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