Mapping health-related responses for people experiencing homelessness in Lisboa, Portugal

Background

People experiencing homelessness (PEH) rely on a range of residential, social and health services. This study mapped the existing responses which provide any type of healthcare service supporting PEH in the Lisbon area, examining how service models may affect access and continuity of care.

Methods

We conducted a cross-sectional mapping study based on guided visits to public and third-sector services between June 2025 and January 2026. Data were collected through structured field notes during non-participant observation visits and validated for accuracy by staff. Analysis consisted of a structured descriptive synthesis of the information collected across care pathway dimensions, from reachability to follow-up.

Results

Twelve visits were conducted. These include residential (5), outpatient and low threshold (4), and outreach models (3). Services were delivered by public and third-sector organisations. Residential settings combine accommodation and basic support with structured health services. Outpatient and low-threshold services and outreach teams both delivered harm-reduction activities, while outpatient services also focused on mental healthcare and outreach teams provided basic clinical support, mediation, service navigation, and medication supply. Documentation requirements, legal status, electronic prescriptions, lack of phone access, and digital procedures limited access to care and medicines. Follow-up was the most fragile step, mainly due to informal cross-sectoral coordination and difficulty recontacting users.

Conclusions

Health responses for PEH in Lisbon area are delivered through a heterogenous network of actors. Access and continuity of care remain shaped by administrative barriers and challenging continuum of care across sectors. Public health action should prioritize simplified access procedures when standard requirements are not suitable. Ultimately, improving cross-sector data sharing could enhance access and continuum of care.

Key messages

• Health responses for people experiencing homelessness in Lisbon are delivered through diverse service models, but continuity of care remains fragile across the different settings.

• Simplifying administrative procedures and strengthening cross-sectoral coordination may improve access and follow-up for people experiencing homelessness.