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Revista Panamericana de Salud Pública

On-line version ISSN 1680-5348Print version ISSN 1020-4989


GUIMARAES, Luisa  and  GIOVANELLA, Lígia. From cooperation to competition: different roads to health sector decentralization in Brazil. Rev Panam Salud Publica [online]. 2004, vol.16, n.4, pp.283-288. ISSN 1680-5348.

Decentralization was one of several global phenomena that were experienced by societies and governments during the 1980s and 1990s. In Brazil, the creation of a Unified Health System (UHS) was part of such decentralization initiatives. However, implementing the UHS proved difficult because Brazil's central authorities encourage competition, rather than cooperation, between different levels of government. There were other challenges as well: the vastness of the country, the asymmetric distribution of human and financial resources, the uneven concentration of health services, and the fact that Brazilian municipalities vary greatly in size. However, several important things have already been accomplished as a result of decentralization. Basic health coverage has increased, as witnessed by the fact that during the 1990s there was an impressive rise in the number of municipalities with health clinics, in the availability of primary health care services per capita, and in the number of public hospitals. Still, several tasks lie ahead, and one of the most important is organizing and integrating regional networks to ensure universal, efficient, and cost-effective health care at all levels of health services provision in all Brazilian municipalities.

Keywords : Sistema Único de Saúde.

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