Brazil's unified health system: the first 30 years and prospects for the future

Abstract

In 1988, Brazilian Constitution definedhealth as a universal right and state responsibility. Progress towards universal health coverage (UHC) has been achieved through a Unified Health System (Sistema Único de Saúde, SUS) which was created in 1990. With successes and setbacks in the implementation of health programmes and organization of its health system, Brazil has achieved nearly-universal access to health services for her citizens. The trajectory of the development and expansion of the SUS offers valuable lessons on how to scale UHC in a health system in a highly-unequal country and relatively low resources. The analysis of the 30 years since the inception of SUS shows that innovations in the Brazilian health system extend beyond the development of new models of care and highlights the importance of establishing political, legal, organizational and management-related structures, and the role of the federal and local governments in the governance, planning, financing, and provision of health services. The expansion of SUS has allowed Brazil to rapidly address the changing health needs, with dramatic scaling up health service coverage in just three decades. However, despite its successes, analysis of future scenarios suggests the urgent need to address lingering geographic inequalities, insufficient funding, and the suboptimal private-public collaboration. Recent fiscal policies that ushered austerity measures, environmental, educational and health policies of the new administraion introduced in Brazil could reverse the hard-earned achievements of the SUS and threaten its sustainability and its ability to fulfil its constitutional mandate of providing 'health for all'. 2000 2010 2015 Births attended by skilled health staff (% of total) 87•6 98•6 98•9 99•1 Immunization, BCG (% of one-year-old children) 79 99 99 99 Immunization, measles (% of children ages 12-23 months) 78 99 99 96 Immunization, DPT (% of children ages 12-23 months) 66 98 99 96 Immunization, Hib3 (% of children ages 12-23 months) 90 99 96 Immunization, Pol3 (% of one-year-old children) 58 99 99 98 Immunization, HepB3 (% of one-year-old children) 94 96 96 Antiretroviral therapy coverage (% people living with HIV) 27 38 57

Predisposing, enabling, and need characteristics of dental services utilization among socially deprived schoolchildren

“…The expansion of the Brazilian health care system over the last recent decades has increased the access to healthcare services and positively impacted on the reduction of health inequalities in the country. However, recent fiscal austerity and policies measures could possibly result in insufficient funding in the public health sector . This is particularly relevant for utilization of dental services since Brazilian individuals with private health plan tend to use more dental services than those without a private health plan .…”

Esp teaching in contemporary medical education in Brazil

“…This study has proved the impact of such regulations over medical education and services, evidenced by the expansion of Medical schools and the consequent broad coverage of doctors in marginal regions, for instance. A recent article published on the Lancet (Castro et al, 2019) restates the importance of establishing and maintaining the quality provision of healthcare services rapidly achieved (just three decades) in Brazil, without threatening its sustainability and "ability to fulfil its constitutional mandate of providing healthcare for all" (p. 345). Regarding ESP teaching, even though data, as we interpret it, have shown that there is still a generalized lack of concern with the teaching of English in Medicine undergraduate courses (only 35.7% of the institutions cover it), we have offered a representative case of implementation that works out effectively (a sequential program rather than one or two isolated English language disciplines) with the national healthcare and medical education regulations as well as updated pedagogical principles of ESP teaching and international foreign language guidelines.…”

Enhancing citizenship through nursing care in Brazil: Patients' struggle against austerity policies

“…The best available evidence shows that income inequality, in turn, is associated with lower self‐rated health (McCartney et al, ). Austerity measures implemented by the most recent Brazilian governments has been threatening the hard‐earned achievements of the SUS in its pursuit to provide universal health care (Castro et al, ; Massuda et al, ; Souza et al, ). Similar detrimental effects of austerity measures in health care have been shown in other countries such as Cyprus (Petrou, ), Finland (Saltman & Teperi, ), Portugal (Morais Nunes, Cunha Ferreira, & Campos Fernandes, ), and in many other countries (Horridge et al, ; Ruckert & Labonté, ), even as evidence shows that local and national public health interventions are highly cost‐saving (Masters, Anwar, Collins, Cookson, & Capewell, ).…”