Twenty years of the Primary Care Reform in Portugal: lessons learned and new challenges.

In 1971, in a disruptive process with the dominant culture, the creation of a community network of health centers was begun in Portugal, with universal coverage of the national territory. In October 2005, an ambitious PHC reform was launched. The experience of this reform is now being revisited, motivating some reflections on the lessons learned and on challenges for the future. The last 20 years have been divided into four periods: from 2005 to 2010, marked by the reformist impulse that transformed the traditional hierarchical organization of health centers into networks of multidisciplinary family health service (FHS) teams; between 2010 and 2015, focusing on the severe financial crisis that affected the global economy; from 2015 to 2020, marked by economic and social consequences and the post-crisis recovery; and between 2020 and 2025, tainted by the COVID-19 pandemic, the lasting impacts of the pandemic, and, in the past two years, the generalization of the joint administration of primary, long-term, and hospital care under the legal figure of local health units (LHUs). Considering the full spectrum, the authors propose the integration of the aspects analyzed under the multidimensional perspective of the concept of Local Health.