The author has the intention to propose to the Brazilian health care management and sanitary reform managers an examination and positioning on the course of action in the implementation of SUS (Brazilian National Health System). The findings underscore two non-convergent set of policies that have affected the course of action in the implementation of the SUS in the 1990s: the first and 'main' course of action derives from policies created in 1988 in the so-called Citizen Constitution, of which the SUS is the most important achievement. The second and "additional" course of action derives from the prevailing macro-economic model and its related policies, implemented since the 1990s, besides advocating a social inclusion measure while leaving out all the related improvements of SUS such as Universality, Integrity and Equity. In addition, the second course of action is in opposition to the model based on social protection, besides raising the importance of market-based individualistic values and actions in general, it carries them into the health care system. The author suggests that a clarification on the desirable and on the deviant courses of action of SUS may be a vital contribution to guaranteeing social rights in health care, while preserving its integrity, equity and universal nature.

SUS, política pública de Estado: seu desenvolvimento instituído e instituinte e a busca de saídasThe Brazilian Unified Health System (SUS), State Public Policy: Its institutionalized and future development and the search for solutions

In this text, we refer to the solid and historical civilizational roots of the Brazilian Unified Health System, SUS (Sistema Único de Saúde) that give it a perennial status. Data and analyses are systematized, pointing out, in parallel to the construction of SUS, the construction of another public health policy that has subverted the principles and guidelines of the Federal Constitution of 1988: a real, implicit and hegemonic policy. As for SUS, we identify and reinforce explicit advances and resistances with its principles and guidelines, over this 30 year period, but with invaluable accumulation in management, evaluation, knowledge construction, appropriate technologies, resistance strategies and politicization in defense of the constitutional directives. The knowledge that has been acquired over this time is understood to form part of a drive towards a civilizing pathway that was proposed by the 1988 Constitution. Although SUS is considered to be an unfinished work with deviations, and the need, on one hand, to be consolidated in better achievements, and on the other, to be permanently reinvented in order to accomplish its mission.

Besides recognizing the irreversible advances made in the Brazilian

A necessidade de planejar o número, o perfil e a distribuição da força de trabalho do setor saúde tem sido uma das grandes preocupações dos gestores, trabalhadores e usuários envolvidos na reforma sanitária brasileira, desde a concepção do Sistema Único de Saúde. Este estudo bibliográfico e documental apresenta uma análise da trajetória histórica das políticas de planejamento da força de trabalho em saúde no Brasil, destacando a recrudescência de problemas identificados desde a década de 1970 nessa área, em grande medida, pela manutenção de um modelo assistencial que privilegia os interesses privados em detrimento das necessidades e dos direitos da população.

Objective measures to evaluate quality of life are gaining importance as an adjuvant in assessing therapeutic interventions. The study purpose was to compare quality of life in renal transplant patients with functioning graft and those who restarted dialysis after graft loss. Quality of life was measured using the World Health Organization Quality of Life questionnaire (WHOQOL-Bref). One hundred and thirty two patients were interviewed, and divided into two groups: group I, 100 patients on regular follow-up in outpatient clinics and stable graft functioning; and group II, 32 patients who restarted dialysis after graft loss. The WHOQOL-Bref showed better quality of life in those renal transplant patients with a functioning graft, especially regarding the physical and psychological domains assessed in the general questions. There were no differences between the groups in the social relationship and environmental domains. WHOQOL-Bref is an efficient tool and can be useful for better approaching these patients, not only on a medical basis.

ReSUmo: Destaca-se neste estudo os avanços marcantes na implementação dos princípios e diretrizes constitucionais do SUS, em especial a universalidade e a descentralização que propiciaram a maior inclusão social em sistema público de saúde de que se tem notícia. Destaca-se também os avanços na gestão do sistema público com a criação dos fundos de saúde, dos repasses fundo a fundo das comissões intergestores (tripartite e bipartite), das normas operacionais básicas pactuadas e recentemente, do Pacto pela Vida, em Defesa do SUS e de Gestão, que avança na etapa "pós-NOBs". Identifica-se contudo, limites a esses avanços, dados por obstáculos rígidos ao avanço da gestão/gerência pública e contratada da rede e de cada unidade prestadora de serviços públicos, ainda sob a lógica predominante dos interesses atrelados ao velho modelo de gestão caracterizado por uma conjugação histórica do subfinanciamento público/paralisação da reforma do Estado/promiscuidade da relação público-privado. Tais limites, mais que obstáculos ao prosseguimento dos avanços, vêm escanteando a equidade, a integralidade, a regionalização, a atuação dos conselhos de saúde na formação de estratégias, e balizando a implementação do rumo ao "SUS pobre para os pobres e complementar aos afiliados às empresas dos planos privados". Ao final, são sinalizadas possibilidades potenciais e em embrionamento para uma "virada" de rumo na política pública de saúde, com a retomada dos valores calcados no direito humano à saúde, à consciência social das necessidades de saúde e respectivos direitos, com a adesão efetiva da classe média, dos trabalhadores sindicalizados e dos servidores públicos e com uma relação sociedade-Estado realmente democratizadora.

In the year in which we commemorate the 30th anniversary of the Unified Health System (SUS), Revista Ciência & Saúde Coletiva is proud to present a very wide-ranging selection of texts to our readers. The articles were submitted by more than 100 Brazilian researchers from all regions of the country, which affords us a retrospective overview of the advances, limits and challenges faced over the last three decades. Relevant themes of Public Health are addressed, such as the history of the SUS, health promotion, policies on tobacco control, food and nutrition, primary health care, health surveillance, coping with infectious and parasitic diseases, maternal and child health, health of the elderly, psychiatric reform, supply, access and use of the SUS. Federalism, regionalization and health networks, debate on universal health systems and universal coverage, the economic-industrial complex of health, management of education and work, pharmaceutical assistance, violence in the SUS, national information systems, health communication, environmental health, occupational health, gender and sexual rights are also studied. Financial dominance in health care, public finances and health tax waivers, international health cooperation, stricto sensu post-graduation in Public Health and SUS perspectives are similarly addressed. In this way, a good deal of the analysis and information assembled is revisited and updated 1. The many achievements of the SUS over the past three decades need to be highlighted. The various articles that make up this special issue stress the progress in health, delivery of care, training of professionals and workers, as well as in the production of scientific knowledge, technologies and innovations. At the same time, they record the difficulties, problems, misalignments and setbacks. From this standpoint, the greatest obstacle of the SUS has been under-financing, the greatest threat is the financialization of health and the greatest challenge is the political aspect. We trust that the texts will contribute to the record of the 30-year trajectory of the struggle in the process of construction of the Brazilian health system, serving as material for reflection by society, academia and for the formation of new public health professionals and other health workers in the country.mia and for the formation of new public health physiciansand other health workers in the country.