According to the General Law of Health (Ley General de Sanidad), the National Health System is conceived as the overall health services offered by the Autonomous Communities. Therefore, every Autonomous Community has a Health Service formed by all the centres and services in the Autonomous Community, provincial authorities and municipalities, all under the responsibility of the Autonomous Community. Hence, in Spain Public Health falls under the responsibility of the Autonomous Communities and under the direction and coordination of the State as the definer of common standards.

Central level

State competences[1]

• Responsibility for basic national legislation and general coordination of health, unique funds management;
• External health and international health agreements;
• Legislation about pharmaceutical products;
• Regulation, management and coordination of the National Transplant Organisation (Organización nacional de transplantes);
• Coordination of State and AC measures in case of public health crisis;
• General coordination of the public health system through the sectoral conference on health (Consejo Interterritorial del Sistema Nacional de Salud);
• Management of public health in the AC Ceuta and Melilla (via the National Institute of Public Health management –INGESA-).

In cooperation with AC:

• Public health control of environment and food products, services and products directly linked to human use and consumption;
• Legislation, authorisation and registration of medicine for human and veterinary use, as well as quality control;
• Promotion of rational use of medicine;
• Ruling of technical conditions  and requirements for the approval and standardisation of infrastructure and equipments of public health centres and services;
• Promotion of quality in the National Public Health system (INSALUD);
• Specialised formation in public health centres;
• Establishment of the National Public Health's information system.

Regional level

Regional level authorities are responsible for:

• Development and implementation of national legislation;
• Public health planning;
• Public health assistance;
• Organisation of administrative services;
• Participation in the sectoral conference on health (Consejo Interterritorial del Sistema Nacional de Salud).

Local level

Provincial competences

• Securing coordination and provision of municipal services.
  

Municipal competences[2]

• Cooperation in the management of public basic health services

Responsible ministries/bodies

• Ministry of Health, Consumption and Social Welfare

Sources

Ley 14/1986 de 25 de abril general de sanidad. [Law 14/1986 of 25 April 1986 on Health].

Ley 16/2003 de 28 de mayo de cohesión y calidad del Sistema Nacional de Salud. [Law 16/2003 of 28 May 2003 on the cohesion and quality of the National Health System].

Real Decreto-ley 16/2012 de 20 de abril de medidas urgentes para garantizar la sostenibilidad del Sistema Nacional de Salud y mejorar la calidad y seguridad de sus prestaciones. [Royal Decree-law 16/2012 of 20 April 2012 on urgent measures to guarantee the sustainability of the National Health System and improve the quality and safety of its provisions].   

[1] Art. 149.1.17 Spanish Constitution

[2] These competences shall be exercised in accordance to the conditions defined in the Regional and State laws, therefore there might be slight differences from one Autonomous Community to the other.