Workers needed: a needed assessment of the workforce in local public health services in Portugal

BACKGROUND: Portugal is planning to reform its public health services, which have been struggling with a shortage of professionals, even after hiring more staff during the COVID-19 pandemic. Meanwhile, in 2023, new local health units will be created to reorganize the local public health services (LPHS). Therefore, it is essential to examine and discuss how many and where the professionals in LPHS are in Portugal. METHODS: A cross-sectional descriptive analysis was conducted using hiring data, in the second trimester of 2023. The number of professionals in LPHS in mainland Portugal was described and compared between the 55 LPHS and the 5 health regions. They were classified into categories, with a special attention given to medical specialists, nurses, and environmental health technicians, who have specific regulations. RESULTS: More than 20 different professions can be found in the different LPHS. The total number of professionals in public health services in mainland Portugal was 1720, of which 380 (22.1%) were medical specialists, 304 (17.7%) were nurses, 443 (25.8%) were environmental health technicians. The highest number of professionals was found in ACES Baixo Vouga with 70. The health region with the highest number of professionals was ARS Norte with 635. When considering full-time equivalents, only 18 (32,7%) LPHS have the legally recommended ratio of one medical specialist per 25 000 inhabitants, the ratio of one nurse per 30 000 inhabitants is attained in 18 (32,7%) LPHS, and only 12 (21,8%) have the indicated one environmental health technician per 15 000 inhabitants. CONCLUSIONS: This study provides a comprehensive overview of the number and distribution of professionals in LPHS in mainland Portugal, at a time of change, with concerning results. These can be useful to plan and evaluate policies and interventions regarding public health personnel recruitment and organization, considering impending the reforms. KEY MESSAGES: • There is a lack of professionals in local public health services in Portugal, with few meeting the legally recommended ratios of medical specialists, nurses, and environmental health technicians. • The incoming changes in public health services organizations are a good opportunity to reorganize and invest in their workforce, which is essential to improve public health in Portugal.