STRATEGIC NOTES Nº4

At a time when the resilience of healthcare systems demands decisions marked by vision, precision and applied intelligence, Portugal still lacks a coherent strategy encompassing domestic manufacturing capacity, hospital procurement and operational sovereignty. This brief explores that paradox in the context of international standards and institutional realities.

Portugal continues to import hospital consumables on a large scale, items that could already be produced domestically, with validated, certified and operationally ready supply chains. Procurement decisions continue to overlook national production capacity, even in critical categories such as sterile devices, laboratory reagents and routinely used consumables.

It is estimated that over 200 industrial companies in Portugal are capable of supplying the National Health Service, yet they lack scale, structured contracts and priority in public procurement (U.S. Department of Commerce, Portugal – Medical Devices, 2024).

APIFARMA, as the representative body for the pharmaceutical industry in Portugal, has consistently emphasised the importance of promoting domestic production, including in areas such as medical devices, reagents and hospital consumables, within public procurement policies. In several institutional interventions, it has warned of the lack of structural incentives to incorporate national products into hospital purchases and the challenges Portuguese companies face in competing on an even playing field in public tenders.

Portugal has installed industrial capacity for the production of hospital consumables — with certified national companies, validated technology, and a consolidated export track record. However, this potential remains underutilised in public procurement, not only due to a lack of scale and integration with the health system, but also due to the absence of structural incentives — such as innovation support, favourable tax regimes, or preferential procurement mechanisms — that could align domestic production with the goals of sovereignty, efficiency, and system resilience.

The European Union’s EU4Health 2021–2027 programme underlines precisely this priority: “Strategic domestic production of essential devices and consumables should be supported by robust public policies, financial incentives, and supranational coordination mechanisms, in order to ensure health security and resilience across Member States.”

The country also hosts international logistics providers, such as DSV and GEODIS, offering GDP/GMP compliant storage, temperature controlled transport and integrated supply-chain management for the healthcare sector. However, the absence of a visionary alignment between domestic production, logistics and hospital procurement undermines operational sovereignty, economic potential and systemic resilience.

In February 2024, the OECD reinforced the warning: “Medical supply chains remain vulnerable. Dependency on imports undermines the resilience of healthcare systems. Countries must diversify sources and strengthen national production and logistics of essential consumables.” (OECD, Securing Medical Supply Chains, 2024).

Following the COVID‑19 pandemic, countries such as Germany, Sweden, South Korea and the United States implemented strategic onshoring programmes and established regulated stockpiles and centralised procurement mechanisms focused on essential items (OECD, 2024).

Even though imports remain necessary in certain segments, they carry well-known constraints: logistical delays, supply instability and critical dependency on external and volatile conditions.

Promoting what we already produce — with quality, rigour and scalable potential — is not merely an economic decision: it’s a strategic choice with systemic impact. It requires, as is well understood, effective coordination with industry, rigorous technical validation, sustained response capacity and, where necessary, operational adjustments to meet system demands.

The return — both economic and institutional — is clear: it reduces external exposure, strengthens service resilience and enhances the value of Portuguese-made goods with legitimacy and ambition.

With international experience across high complexity institutional systems, it is clear to me that this paradox is far from technical: it is structural — and demands applied vision, systemic alignment, and decisions shaped by long-term horizon.