Ciclo de Debates 2026 - Debate 7 - «Liberdade da ação sindical (...)» - Joana Bordalo e Sá

Summary

In this presentation, the president of the Northern Medical Union and vice-president of the National Federation of Doctors discusses the fundamental right to health in Portugal and the critical role of the National Health Service (SNS). He highlights systemic challenges such as chronic underfunding, workforce shortages, regional inequalities, and the risk of privatization. Emphasizing the link between health, education, and social equity, he details the pressures on medical professionals, including long hours, burnout, and low salaries, while advocating for stronger collective bargaining, improved working conditions, and the defense of public health services as essential pillars of democracy and social justice.

Takeaways

• 🩺 The right to health is a fundamental social and constitutional right in Portugal, enshrined in Article 64 of the Constitution, and must be universal, equitable, and largely free.
• 🏥 The National Health Service (SNS) is a key instrument for ensuring citizens' access to healthcare and promoting social solidarity, but it faces chronic underfunding and execution problems.
• 📉 There are severe regional disparities in healthcare access, with Lisbon and the Tagus Valley having over 1.1 million people without a family doctor, creating inequality in healthcare.
• 👩‍⚕️ Half of the 60,000 doctors in Portugal work outside the SNS, highlighting issues in retention, job attractiveness, and working conditions for medical professionals.
• 💸 Portuguese doctors’ salaries, especially for experienced physicians, are lower than the European average, contributing to emigration, internal migration to the private sector, or opting out of specialization.
• ⏳ Doctors face excessive workloads, long hours, and inadequate infrastructure, leading to burnout, particularly among young physicians (25% in burnout, 55% at risk).
• ⚖️ The privatization and public-private partnerships in healthcare threaten SNS’s universality and focus on public welfare, as the private sector prioritizes profitability over comprehensive care.
• 📊 The SNS has improved health outcomes over the years, such as reducing infant mortality and increasing life expectancy, but recent retrogressions like increased ambulance births indicate declining service quality.
• ✊ Unions, including the Federação Nacional dos Médicos, play a critical role in defending workers’ rights, negotiating collective agreements, and safeguarding public health as a constitutional right.
• 📢 Collaboration between health professionals, educators, and society is essential to uphold the social state, ensure access to healthcare, and address systemic challenges like workforce shortages and regional inequalities.
• 🛠️ Proposed solutions include fair compensation, proper staffing, reintegration of medical interns into career tracks, optional exclusive dedication with incentives, and restoration of lost vacation days to improve morale and retention.
• 🚨 Legislative and policy changes, such as labor reform, imposition of hour banks, and attacks on collective bargaining, pose a threat to healthcare workers’ rights and the SNS’s integrity, making civic and professional mobilization crucial.

Q & A

What is the main purpose of the speaker's presentation?

The speaker aims to explain the right to health, the role of unions, the current state and challenges of the Portuguese National Health Service (SNS), and potential solutions to ensure universal and equitable healthcare.

How is the Federação Nacional dos Médicos (FENAM) structured?

FENAM consists of three regional medical unions: North, Center, and South, with a rotating presidency among these regions. The federation coordinates collective actions and represents doctors' interests nationally.

Why is the right to health considered a fundamental constitutional right in Portugal?

Enshrined in Article 64 of the Portuguese Constitution, the right to health is universal, general, and tends to be free, reflecting the social protection and democratic values established after 48 years of dictatorship.

What are some social determinants of health highlighted in the presentation?

Health is influenced not only by medical care but also by education, income, housing, work conditions, environment, and social policies promoting healthy lifestyles.

What achievements has the SNS accomplished since its creation?

The SNS has significantly reduced infant mortality, increased life expectancy by approximately 15 years, and contributed to social equality in healthcare access.

What are the main challenges facing the SNS today?

Challenges include chronic underfunding, staff shortages, poor working conditions, regional inequalities (especially in Lisbon and Vale do Tejo), high workload, infrastructure deficits, and the risk of privatization or public-private partnerships focusing on profitable care.

What are the workforce statistics for doctors in Portugal and the SNS?

Portugal has about 60,000 doctors, with approximately half (30,000) working in the SNS. Of these, 11,000 are junior doctors and 20,000 are specialists. Many trained doctors leave the SNS or migrate abroad due to low pay, excessive workload, and poor conditions.

What are the working condition issues that contribute to burnout among doctors?

Doctors face excessive hours, unpaid overtime, high patient load, poor infrastructure, hierarchical restrictions, and lack of professional autonomy. 25% of young doctors are in burnout, and 55% are at risk.

How does FENAM support doctors and healthcare in Portugal?

FENAM advocates for doctors' rights, negotiates collective agreements, participates actively in workplaces, raises awareness of constitutional rights, opposes privatization, and mobilizes civic actions to defend public healthcare.

What solutions does FENAM propose to improve the SNS?

Proposals include restoring the 35-hour workweek, integrating interns into the medical career, offering optional exclusive dedication with incentives, restoring lost vacation days, improving working conditions, and ensuring equitable allocation of resources.

What role do teachers and education play in public health according to the speaker?

Teachers contribute to health by promoting health literacy, shaping healthy lifestyles, and indirectly influencing social determinants such as income, environment, and well-being, showing the connection between education and health outcomes.

How does the speaker describe the current government’s approach to healthcare and labor rights?

The speaker criticizes the current government for underfunding the SNS, neglecting negotiations with medical unions, threatening labor rights through reforms, and encouraging privatization, which risks undermining universal access to healthcare.