Strategic Planning: Perpectives and challenges for healthcare governance in the context of Local Health Units in Portugal

The recent creation of Local Health Units (LHUs) in Portugal, organizational entities that integrate different levels of healthcare within the same functional structure, represents a significant step in the ongoing reform of the national health system, in the fulfilment of the objectives of promote more integrated, coordinated, and efficient healthcare delivery.

In this context, strategic planning plays a crucial role, as it enables these new structures to develop a clear and coherent vision for the future, align objectives and priorities, define measures that respond to the needs of the populations they serve, and ensure synergy among the various types of care that compose each LHU.

 

At the same time, strategic planning is essential for addressing future uncertainties and challenges, such as population ageing, epidemiological trends, climate crises, and the impacts of potential conflicts, by systematically analysing both internal and external environments, identifying opportunities and threats, and developing robust action plans to manage them effectively.

 

Given this period of transition and the critical importance of strategic planning, the aim of this study is to analyse and understand the dynamics of strategic planning within LHUs, focusing on the processes of developing and implementing strategic plans. The study explores both the importance of strategic planning and the challenges encountered during its implementation, as well as identifying the key strategic priorities of LHUs in Portugal.

 

This research is based on a qualitative approach, combining two complementary methods of data collection: a survey distributed to the boards of directors LHUs and a series of semi-structured interviews conducted with a sample of board members from these organizations. Both instruments were designed to explore perceptions, experiences, and practices related to strategic planning processes within LHUs.

 

 

The selection of interview participants followed a convenience sampling strategy, ensuring at the same time a broad geographical representation of LHUs across the country. This approach made it possible to capture diverse perspectives reflecting different regional contexts and organizational realities.

The topics explored included:

The process of developing and communicating strategic plans;

The adequacy of resources, partnerships, and mechanisms for continuous evaluation;

Lessons learned: and practical results achieved;

Priority and medium- to long-term actions;

Challenges, threats, and opportunities.

The preliminary data indicate a gap in the standardisation of practices and in incorporating continuous feedback mechanisms into the development and monitoring of strategic plans. Variability across LHUs suggests that while some units have structured approaches to planning and evaluation, others still rely on ad hoc processes and limited coordination between levels of care.

 

The findings highlight the need to develop national framework that promote greater standardisation of strategic planning while maintaining flexibility for local adaptation. They also emphasise the importance of investing in leadership development, data-driven decision-making, and feedback mechanisms to foster a culture of continuous improvement. Strengthening these dimensions will help create more resilient and accountable LHUs capable of responding effectively to the evolving challenges of the Portuguese health system.