This paper explores the implementation of social prescribing in Guimarães, Portugal to enhance social health through community integration. Recognizing the integral role of social health, defined by the World Health Organization as a key component of overall well-being, the paper identifies gaps in the current social support infrastructure and offers recommendations for improvement. Guimarães, with its unique demographics and comprehensive public health services, provides a robust social support network through various programs including Local Social Development Offices (Gabinetes Locais de Desenvolvimento Social), Social Network (Rede Social), Guimarães 65+, Guimarães Welcomes (Guimarães Acolhe), Local Volunteer Bank (Banco Local de Voluntariado), Commission for the Protection of Children and Youth (Comissão de Proteção de Crianças e Jovens), Municipal Equality Space (Espaço Municipal para a Igualdade), and Inclusion Desk (Balcão da Inclusão). These programs address diverse community needs but face challenges such as resource limitations, service disparities, and coordination difficulties.

Key recommendations for implementing social prescribing include developing a formalized framework, enhancing awareness and training for healthcare providers, detailed mapping of social resources, improving inter-agency communication, and establishing robust evaluation mechanisms. By addressing these areas, Guimarães can improve social health outcomes and provide a model for other cities in Portugal.

• Health Equity

• Social Prescribing

• Family Medicine

• Primary Care

• Social Health IMRAD

• Systematic Review

• Research

Teixeira M, Ribeiro S, Teixeira S, Nunes T (2024) Enhancing Social Health through Community Integration: Overview of Social Services and a Framework for Social Prescribing in Guimarães, Portugal. J Family Med Community Health 11(1): 1202.

WHO: World Health Organization; SNS: Serviço Nacional de Saúde; CPCJ: Comissão de Proteção de Crianças e Jovens; EMI: Espaço Municipal para a Igualdade

The World Health Organization (WHO) defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” [1]. While physical and mental health have received significant attention, the crucial aspect of social health often remains overlooked. Social health, characterized by our relationships and interactions within our community, is integral to our overall well-being. It has a profound impact on our mental resilience and physical health, with poor social health potentially leading to increased stress, depression, and even physical ailments, while strong social connections can enhance mental resilience and physical health. In today’s world, especially in the wake of the COVID-19 pandemic, social health issues like isolation are on the rise, thus highlighting the importance of ‘social prescribing’.

This concept, also known as community referral, emphasizes a holistic healthcare approach by connecting individuals with social, emotional, or practical needs to community resources, thereby enhancing their social well-being. This article delves into the current social support infrastructure in Guimarães, Portugal, identifying areas that require additional resources and exploring effective ways to implement social prescribing in the city.

Current Landscape and Recommendations

Portugal’s healthcare system, managed by the Serviço Nacional de Saúde (SNS), is known for its comprehensive public health services. The SNS offers universal coverage to all residents, ensuring access to a wide range of healthcare services including primary care, specialist care, hospital care, and long-term care. However, while coverage is universal, access can vary based on geographic location and individual circumstances. Most residents see their primary care provider at least once a year, but accessing specialist services or urgent care can be more challenging due to waiting times and regional disparities.

Guimarães, often acclaimed as the ‘birthplace of Portugal,’ is a charming mid-sized city nestled in the north of Portugal. With a population of around 160,000, this historic city boasts an abundance of architectural wonders and cultural richness. The city’s unique demographics, characterized by a significant ageing population and a growing migrant community, shape its social health needs. The economy of Guimarães is a mixture of traditional industries and modern enterprises, influencing the kinds of social support its residents require. Recognizing these unique traits is critical when designing effective social prescription programs [2].

Guimarães has developed a comprehensive social support network, as outlined in the Plano de Desenvolvimento Social 2022-2026 [2]. This plan details various programs aimed at addressing the social needs of the community, each with its strengths, limitations, and areas needing improvement (Table 1).

Table 1: Social Prescription Programs in Guimarães, Portugal.

Local Social Development Offices (Gabinetes Locais de Desenvolvimento Social): These local offices, government- funded and operated, are integral in providing personalized support tailored to the unique needs of different communities within Guimarães. They offer services such as job training programs, social and psychological support, and community development initiatives. Residents typically learn about these services through local outreach programs, community events, and referrals from social workers. All services are free to residents.

In 2023, over 500 individuals found employment via targeted training programs facilitated by these offices. Additionally, these offices provided social support services to over 1,200 residents, including psychological counselling and community development programs.

However, these offices do face some limitations. They can only serve specific areas, leading to disparities in service provision across different regions. Furthermore, they often operate with limited resources, which can impact their overall effectiveness. Addressing these issues is crucial. By extending their reach across the municipality and increasing their funding and resources, these offices could offer more comprehensive support programs. This would tackle a broader spectrum of social issues, reduce disparities in service provision, and ensure that all communities within Guimarães have access to essential support services [3].

Other services in Guimarães that offer similar assistance include the Local Volunteer Bank (Banco Local de Voluntariado), which mobilises volunteers for various community needs, and the Municipal Equality Space (Espaço Municipal para a Igualdade), which provides support and advocacy for gender equality and inclusivity. These organizations, alongside the Local Social Development Offices, play a vital role in supporting the social health of the community but also face challenges related to resource constraints and demand exceeding supply.

Social Network (Rede Social): The Rede Social initiative fosters collaboration among various social entities, enhancing resource sharing and coordination. This network approach addresses complex social issues by harnessing the strengths and capabilities of different organizations. It brings together local NGOs, government bodies, and private entities to tackle social issues like homelessness and poverty. In the past year, it coordinated efforts to provide housing for 200 homeless individuals and reduce food insecurity for 1,000 families [4].

However, coordinating effectively among diverse entities can be challenging. The Rede Social’s success relies heavily on active participation and cooperation from all partners, which can sometimes be inconsistent [4]. Strengthening communication mechanisms within the network could significantly benefit the Rede Social initiative. Moreover, offering incentives for active participation and ensuring all partners are adequately resourced can enhance this collaborative approach’s effectiveness. These measures would improve coordination and ensure consistent active engagement from all involved partners [4].

Guimarães 65+: Guimarães 65+ is specifically designed for senior citizens, providing tailored programs that cater to their unique needs, promoting their health, well-being, and social inclusion. This focus on seniors is an intentional feature of the program design. Services such as daily health check-ups, social clubs, and fitness classes are offered. A recent survey revealed that 85% of participants experienced an improved quality of life and reduced feelings of loneliness [5]. While effective for seniors, this program is resource-intensive, potentially limiting the scope of services provided. It is essential to expand the range of services to include more comprehensive healthcare and recreational activities for seniors. Additionally, enhancing support for caregivers, who play a crucial role in the well-being of the elderly, would be beneficial. This approach would cater to the specific needs of the senior population and enhance their overall health and social inclusion [5].

Guimarães Welcomes (Guimarães Acolhe): Guimarães Acolhe, an independent community program funded through a combination of government grants and private donations, offers critical support services to migrants and refugees facilitating their integration into the community. Services include housing assistance, educational support, and employment services. Language barriers are addressed through translators who speak languages such as Arabic, Ukrainian, and Mandarin.

However, challenges remain due to the diversity of languages spoken by the migrant population. In 2023, Guimarães Acolhe received over 1,000 requests for assistance, indicating a high demand for its services. Despite its success in helping 300 individuals secure employment last year, there are still many immigrants who do not have access to appropriate translators for their native languages, leading to significant challenges in effective communication and service delivery. Moreover, limited resources can constrain the scope of support, making it challenging to address all integration aspects [6].

To improve, Guimarães Acolhe should implement more extensive language and cultural orientation programs. Providing extra-legal and employment assistance can also greatly increase the chances of successful integration. These enhancements would tackle the cultural and language barriers currently affecting the program’s effectiveness [6].

Local Volunteer Bank (Banco Local de Voluntariado): The Local Volunteer Bank, a community-based program funded by municipal funds and private donations, emphasizes community involvement and volunteerism which are essential for many social initiatives’ success. It organises various volunteer activities, including tutoring, elderly care, and environmental conservation. Typical volunteers include students, retirees, and working professionals. Last year, it mobilized 1,200 volunteers, but the need for services still exceeds the volunteer supply. According to the 2023 Annual Volunteering Report by the Banco Local de Voluntariado, the program received over 2,500 requests for volunteer assistance, indicating that less than half of the demand could be met with the current volunteer resources [7]. This disparity highlights the ongoing challenge of meeting community needs despite significant volunteer mobilization efforts.

The program’s effectiveness largely depends on the availability and dedication of volunteers. However, managing and coordinating numerous volunteers can be resource-demanding [7]. The Local Volunteer Bank could benefit from comprehensive volunteer training and development programs. Additionally, implementing improved systems for aligning volunteers with community needs would amplify their contributions’ impact. These actions would enhance the volunteers’ skills and effectiveness and ensure their efforts meet community needs [7].

Commission for the Protection of Children and Youth (Comissão de Proteção de Crianças e Jovens (CPCJ)): CPCJ, a government program funded by national and local government budgets, is dedicated to protecting vulnerable children and youth in Guimarães, providing specialized support to those at risk. Services include legal representation, psychological counselling, and emergency shelter. Last year, the commission provided interventions and support for 400 children in need.

However, legal and bureaucratic processes often limit its efficiency, potentially delaying the delivery of support. Additionally, the high demand for services can strain resources, affecting the quality and availability of aid [8]. To address these challenges, it would be beneficial to increase the number of professionals within the commission. Expanding preventive and educational programs could also help reduce the prevalence of issues that require intervention. These improvements would guarantee that vulnerable children and youth receive prompt and effective support [8].

Municipal Equality Space (Espaço Municipal Para a Igualdade (EMI)): EMI is committed to promoting gender equality and inclusivity. It serves as a platform to confront discrimination issues and supports initiatives aimed at fostering a more equitable society. Last year, EMI hosted 20 workshops and campaigns on these topics, reaching over 2,000 participants [9]. However, efforts to advocate for gender equality and inclusivity often encounter opposition from conservative groups. Sustained advocacy and awareness initiatives are crucial to maintaining progress [9].

To enhance its social impact, EMI should consider expanding public awareness campaigns to shift societal attitudes towards inclusivity. Increasing support services for discrimination victims could also amplify the effectiveness of the program. These strategies can help overcome opposition from conservative groups and uphold ongoing advocacy for gender equality and inclusivity [9].

Inclusion Desk (Balcão da Inclusão): The Balcão da Inclusão, funded by the national government and local municipality, is an essential support system for individuals with disabilities, providing centralized access to a variety of resources. It offers services such as disability assessments, assistive technology provision, and employment support. The service desk assisted 500 individuals last year but often faces overwhelming demand due to resource constraints. According to the 2023 Annual Report by Balcão da Inclusão, the program received over 1,200 requests for assistance, indicating that more than half of the demand could not be met with the current resources. Its resources include a limited number of specialized staff and funding for assistive technologies, which are insufficient to address the needs of all individuals requiring support [10]. This highlights the critical need for increased funding and resources to meet the growing demand effectively.

Despite its importance, the Balcão da Inclusão often faces overwhelming demand and, due to limited resources, it may not meet all the specific needs of those it serves [10]. The Balcão da Inclusão must broaden the accessibility and availability of its services. The introduction of more specialized support programs and the provision of assistive technologies would greatly improve the quality of support for individuals with disabilities. These enhancements would help manage the high demand for services and ensure that the unique needs of individuals with disabilities are effectively met [10].

Considering the crucial need for equitable social support, the immediate priorities should be expanding the Gabinetes Locais de Desenvolvimento Social and the Balcão da Inclusão. These expansions would promptly address the disparities in service provision and enhance support for individuals with disabilities. Concurrently, improving communication within the Rede Social initiative and enhancing the Guimarães 65+ program should be prioritized to promote better collaboration and enhance senior care.

Additional Recommendations for Implementing an Effective Social Prescription Program

To establish a robust social prescription program in Guimarães, several key areas need further development. The recommendations below aim to create a structured and effective approach to incorporating social prescription into healthcare and social support systems.

Formalized Social Prescription Framework: A formalised social prescription framework is vital. As such a program is not explicitly mentioned within the existing infrastructure, a structured framework is necessary. This will clearly define roles, responsibilities, and processes involved in social prescription, ensuring consistent implementation across various sectors. It will also provide clear guidelines for healthcare providers, social workers, and community organizations, leading to a more unified approach to addressing social determinants of health. For instance, the social prescription program in Rotherham, UK, has shown significant benefits such as reducing hospital admissions and improving patient well-being through community referrals [11]. This model can be adapted to Guimarães, utilizing existing community resources to address social determinants of health.

Awareness and Training: Enhancing the training of healthcare providers and community workers on the benefits and implementation of social prescription is crucial. This training should cover social prescribing principles, the types of non- medical interventions available, and the process for referring patients to community resources. By equipping healthcare professionals with the necessary knowledge and skills, the program’s reach and impact can be significantly expanded. Practical methods include conducting workshops and online training modules for healthcare providers. These sessions would cover the principles of social prescribing, the types of non-medical interventions available, and the referral process. Collaborating with local medical schools and professional organizations for continued medical education credits can incentivize participation. A central agency, such as the local health authority, could oversee and coordinate these training efforts.

Resource Mapping and Accessibility: In order to support an effective social prescription program, it is important to create a detailed map of all available social resources. This should be easily accessible to both healthcare providers and the public to simplify the referral process and ensure that individuals get the support they need. An up-to-date and comprehensive directory of community resources, including the services provided by non-profit organizations, local government programs, and volunteer groups, will help improve the coordination and use of these resources. The local government, in collaboration with community organizations, would be responsible for this “Resource Mapping.”

Collaboration and Communication: Enhanced communication channels between social and healthcare services are crucial for seamless referrals and ongoing support for individuals. Robust communication mechanisms, such as regular inter-agency meetings, shared electronic health records, and integrated case management systems, will improve collaboration and coordination among service providers. This will lead to more effective and efficient service delivery, ultimately improving patient outcomes. The “Collaboration and Communication” efforts will be overseen by an inter-agency committee comprising representatives from health services, social services, and community organizations.

Evaluation and Feedback Mechanisms: It is essential to establish strong methods for assessing the effectiveness of social prescriptions and collecting feedback to enable continuous improvement. Consistent monitoring and evaluation will help to identify successful areas as well as areas that need improvement. Regular meetings with stakeholders and feedback loops can ensure that the program meets the community’s needs and can adjust to changing circumstances. Defining clear success metrics and using data-driven approaches to refine the program will enhance its overall impact. A dedicated team within the local health authority would manage ‘Evaluation and Feedback’, utilizing data from service providers and feedback from community members.

Family doctors in Guimarães play a pivotal role in implementing social prescribing. They often serve as the first point of contact for patients in the healthcare system, allowing them to identify medical, social, and emotional needs. However, barriers such as lack of knowledge, infrastructure, and resources have hindered their engagement in social prescribing. Overcoming these barriers through focused training, enhanced infrastructure, and sufficient resources can improve their engagement and effectiveness.

This integrated approach not only improves individual health but also eases the pressure on healthcare services, promoting a healthier and more unified community. By collaborating with various social entities and using a patient-centred care model, family doctors in Guimarães are crucial to the success and effectiveness of social prescribing.

In conclusion, although Guimarães possesses a strong social support infrastructure, certain areas require additional resources and improvements to enhance program effectiveness. Implementing social prescription in Guimarães presents a promising opportunity to boost community health and well- being. For successful social prescription implementation, it’s important to address identified gaps in the social support infrastructure. By addressing these gaps and prioritizing key development areas, Guimarães can establish a meaningful model for other cities in Portugal, promoting health equity and overall community well-being.

The authors would like to extend their gratitude to all the individuals and organizations who contributed to this research. Special thanks to the Serviço Nacional de Saúde (SNS) for providing invaluable data and insights into the healthcare system in Portugal. The authors would also wish to acknowledge the support and cooperation of the local social service agencies in Guimarães, including Gabinetes Locais de Desenvolvimento Social, Rede Social, Guimarães 65+, Guimarães Acolhe, Banco Local de Voluntariado, Comissão de Proteção de Crianças e Jovens, Espaço Municipal para a Igualdade, and Balcão da Inclusão.

This research was supported by the Portuguese Foundation for Science and Technology (FCT), within the Project Scope: UIDB/00319/2020 (ALGORITMI). The authors also acknowledge their colleagues at USF Vimaranes, ULS Alto Ave, for their valuable feedback and encouragement.

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