FEMP-Health Agreement 2026: what municipalities can do now

Key data

Municipalities and provincial councils integrated in the Spanish Network of Healthy Cities have had, since April 14, 2026, a formal legal instrument that supports their public health actions. The State Secretariat for Health and the Spanish Federation of Municipalities and Provinces (FEMP) have signed an agreement—published by Resolution of April 7, 2026—that establishes local entities as recognized actors within state health policy.

The agreement is not a statement of intent: it establishes a formal collaboration framework that allows municipalities and provincial councils to access institutional support and possibly financial backing from the State to locally implement the Health Promotion and Prevention Strategy. For local public managers, this has direct implications for budget planning, resource capture and health program design.

What does this regulation establish?

The agreement articulates the relationship between the central administration and local entities in preventive health matters. Its main elements are:

• Strengthening of the Spanish Network of Healthy Cities: the network grouping municipalities and provinces committed to local public health policies is institutionally reinforced.
• Local implementation of the Health Promotion and Prevention Strategy: adhering local entities will be able to develop programs aligned with this national strategy, with the support of the State Secretariat for Health.
• Formal collaboration framework: the agreement formalizes coordination between central administration and local entities, facilitating resource capture and alignment of actions.
• Possible financing: the agreement contemplates that adhering municipalities and provincial councils may access state financial resources, although specific amounts are not specified in the published resolution.

The resolution was signed on April 7, 2026 and published in the BOE on April 14, 2026.

Economic and operational impact

For local entities, the impact of this agreement occurs on two levels:

Opportunity for resource capture: the formal framework established facilitates municipalities and provincial councils accessing state financing for preventive health programs. Without this agreement, many local public health actions lacked a clear institutional channel to obtain economic support from the State.

Reduction of coordination costs: with a formal agreement between FEMP and the State Secretariat for Health in place, local entities can align their programs with the national strategy without needing to negotiate individually with the central administration. This reduces administrative burden and improves efficiency in local health policy design.

Budget planning: local public managers who are already in the network—or who are considering joining—should include this agreement in their planning for 2026 and subsequent years, especially in budget items allocated to public health and health promotion.

Specific financing amounts are not specified in the published resolution. Available information indicates that there is the possibility of access to state financial resources, but conditions and amounts will need to be specified in the agreement's development.

Who does it affect?

• Municipalities integrated in the Spanish Network of Healthy Cities
• Provincial councils adhering to the network
• Other local entities that are part of the Spanish Network of Healthy Cities
• Municipal public health managers and health technicians in local entities
• Managers and directors of local administrations who plan preventive health programs
• Non-adhering local entities that are evaluating joining the network, given that the agreement strengthens incentives to do so

Practical example

A medium-sized municipality integrated in the Spanish Network of Healthy Cities wants to launch a municipal cardiovascular disease prevention program aimed at people over 60 years old. Until now, this type of initiative depended exclusively on the municipal budget or occasional subsidy calls.

With the agreement in force, that same municipality can frame its program within the Health Promotion and Prevention Strategy, which allows it to:

• Access institutional support from the State Secretariat for Health to legitimize and strengthen the program.
• Explore state financing channels linked to the agreement, reducing dependence on the municipal budget.
• Coordinate program design with the criteria and methodologies of the national strategy, improving its technical quality.

Without membership in the network and without this agreement, that municipality would not have access to this collaboration and financing channel with the central administration.

What should local entities do now?

1. Verify if your entity is adhering to the Spanish Network of Healthy Cities. Only entities integrated in the network can directly benefit from the agreement. If you are not, evaluate the membership process.
2. Review municipal public health programs currently underway. Identify which ones can be framed within the Health Promotion and Prevention Strategy to take advantage of the new collaboration framework.
3. Contact FEMP to learn about the specific mechanisms for accessing resources. The agreement contemplates the possibility of state financing, but conditions and amounts need to be specified. FEMP is the natural interlocutor for local entities.
4. Incorporate this agreement into 2026-2027 budget planning. If there is a possibility of capturing external resources for preventive health, it should be reflected in the financial planning of the corresponding area.
5. Designate an internal person responsible for monitoring. The agreement's development will generate instructions, calls and additional requirements. It is necessary to have identified the person or area that will do the monitoring.