The Hospital Referral Network (RRH) for the area of Pediatrics and Neonatology is done and was published this Monday, 16th, on the website of the Executive Board of the Unified Health System (DE-SUS) for public discussion for 14 days. The objective of this network is to “classify all hospitals according to their characteristics and differentiation so that there is better coordination between units and better care provided to the population”, argues the pediatrician and coordinator of the working group that prepared this proposal, Alberto Caldas Afonso, who included eight more specialists in the pediatric areas.
For the doctor, the definition of this network “guarantees the connection of each hospital to all the others. From here, hospitals know what they have to treat and where they should refer the most complex cases. In other words, we can say that this network is a way of organizing services, in this case Pediatrics and Neonatology throughout the country, in order to increase accessibility to care, providing a safe response to children and newborns, according to the specificity of each situation”, underlining: “It is a model of health organization that all developed countries have”.
The pediatrician also highlights that “this model should be adopted in many areas of Medicine, precisely because hospitals have different missions, not everyone can have the same care. The mission of a pediatric service in Bragança cannot be the same as the mission of a pediatric service in Porto or Lisbon”. However, he highlights, “in the case of Pediatrics and Neonatology we can say that 85% of the units will respond to the overwhelming majority of cases”.
According to the document now published, this RRH integrates services from 41 hospitals from the north to the south of the country, but only six are level III and are located in central and university hospitals in Porto, Coimbra and Lisbon. Namely: São João, Santo António, Universitário de Coimbra, Santa Maria and D. Estefânia, in addition to the Alfredo da Costa Maternity Hospital. In other words, this is where all the most complex cases – such as rare diseases, for example – should be sent to be treated.
According to what is described about this network for the area of Pediatrics, of the 41 hospitals it is part of, 27 are level II a) and b), with the capacity to respond to “the overwhelming majority of needs of the population in their areas of influence. Only in situations of extreme differentiation will they have to report to level III hospitals, which are central hospitals”, reinforces the working group coordinator. The remaining eight Level I services will provide basic care in this area. However, Caldas Afonso does not fail to emphasize that in the area of pediatrics “the country is asymmetrical, but it has very good care, even in hospitals with basic care”.
The coordinator of the working group, who is also coordinator of the National Commission for Women’s, Children’s and Adolescents’ Health, explains to DN that the creation of this network, as well as the Hospital Referral Network for the area of Gynecology-Obstetrics, published last week on the DE-SNS website, appears precisely to resolve the asymmetries that exist in terms of care provision in the country. “Now there is an interconnection that is perfectly established, allowing teams to know where they should refer their cases and who they will discuss them with clinically.” On the other hand, “it is a way of optimizing existing resources according to the complexity of the situation”.
However, as is the case in other areas, in pediatrics there is also a shortage of professionals, and this is the problem that has led to the closure of some emergency services in some regions of the country, especially during the summer, such as in Lisbon and the Tagus Valley. A problem for which RRH already has “some solutions, a path, so that there are always services working and it is known where users should be sent”.
It is worth remembering that this reference network arises within the scope of the work that has been carried out by the National Commission for Women’s, Children’s and Adolescents’ Health (CNSMCA) since it was appointed in 2024, which has aimed to “strengthen the strategic coordination and articulation of maternal, child and adolescent health policies, constituting a relevant milestone for the adequacy of care responses to the needs of the population in the maternal and child area”, the published document states. But not only. It is mentioned that this RRH “results from more than four decades of structural reforms and integrated policies, which have consolidated Portugal as an international reference in the area of child health”.
The document will be under public discussion for the next 14 days, to receive contributions from civil society, and may still register changes.
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