The clinics are part of the Projeto +Saúde, involving the Social Services of Lisbon City Council and the municipal company Gebalis, an initiative addressing gaps in access to the National Health Service (SNS).
In total, the two proximity clinics, which opened in March (Bairro do Armador) and May (Alta de Lisboa) last year, conducted 2,296 general practice consultations, over 470 nutrition consultations, and more than 3,000 nursing consultations.
At the Bairro do Armador Primary Health Care Unit (UCSP), more than 22,000 people are registered, with over half (13,173) lacking a family doctor. In Alta de Lisboa, the situation is more complex, with less than 30% of the 37,560 registered at the UCSP Santa Clara and Lumiar having an assigned family doctor.
These clinics offer the population, relocated from various degraded neighborhoods, general practice, nursing, and nutrition consultations.
“People face two types of disadvantages: economic-financial and a lack of knowledge,” particularly about nutrition, explained Rui Julião, clinical director of the Lisbon City Council Social Services. He highlighted the correlation between poverty and higher disease burden.
Though initially hesitant about nutrition consultations, residents embraced them, with a current attendance rate exceeding 80%.
The director also emphasized the “success in the nursing area,” where users can measure blood pressure, glucose, or dress wounds or surgical sites free of charge.
The Bairro do Armador clinic offers a general practitioner three days a week, a nurse three times a week, and a nutritionist one day a week. The Alta de Lisboa clinic has a general practitioner two days a week, a nurse twice a week, and a nutritionist one day a week.
The initial installation investment (equipment, desks, chairs, and supplies) at Armador was 21,000 euros, with an annual operating cost of 78,000 euros. In Alta de Lisboa, the initial investment was 35,000 euros, with first-year operating expenses for the municipality totaling 60,000 euros.
With general practice consultation attendance rates exceeding 90%, Rui Julião asserts that the clinics could serve more users across all areas. He envisions a “qualitative evolution,” potentially extending nutrition education to schools and maternal and child health.
“Fundamentally, it’s about educating for healthy habits,” he stated.
An advocate for public health service, Rui Julião argues for advancing towards “true health municipalization” as the only way to improve population access to healthcare: “Access is where everything is determined; it dictates the present and the future.”
“In Alta de Lisboa, we had a health center just meters away with no doctors. People were eventually referred to the municipal clinic, as it became known, and we ended up receiving individuals from areas not covered by the clinic,” which aims to provide basic health services to the most disadvantaged.
He highlights the overwhelming numbers of residents without family doctors in the two neighborhoods, pointing out that even those with family doctors often lacked access: “Here, besides physicians and nursing, they have SNS medical prescriptions available and the possibility of SNS exam prescriptions.”
João Carmona, who leads general practice consultations at Bairro do Armador in Marvila, underscores the difficulty this population faces in accessing healthcare: “It’s an impoverished, aging population urgently needing both health center and family health unit services, which lack available doctors. The few who are available are overwhelmed.”
The physician, with over four decades of experience in the area, notes the neighborhood’s continuous growth and the population’s characteristics, which heighten the urgency for nearby health solutions.
“People don’t have appointments because they’re hard to book, (…) and these units have somewhat filled that access gap, even if just for medication,” he stated. He also emphasized the gap left by former permanent service arrangements, forcing many to seek hospital emergency responses.
