30 years of the Brazilian National Health System

Elisete Duarte Laeticia Jensen Eble Leila Posenato Garcia About the authors

Brazil’s Unified Health System (Sistema Único de Saúde - SUS) will be 30 years’ old in 2018. SUS came into being when the 1988 Federal Constitution was enacted, making Brazil the largest country in the world to have a public health system based on the principles of universality, equity and integrality. Despite difficulties it has faced, with every day that has gone by over these three decades SUS has become increasingly indispensable in the lives of Brazilian citizens.

The National Health Survey (2013) shows that the majority of the population (estimated 80%) depends on SUS for healthcare-related actions.11. Macinko J, Harris MJ. Brazil’s family health strategy-delivering community-based primary care in a universal health system. N Engl J Med. 2015 Jun;372(23):2177-81.,22. Stopa SR, Malta DC, Monteiro CN, Szwarcwald CL, Goldbaum M, Cesar CLG. Acesso e uso de serviços de saúde pela população brasileira, Pesquisa Nacional de Saúde 2013. Rev Saúde Pública. 2017;51(Supl 1):3s. In the current context, this situation appears unlikely to change in the short term. In view of the current economic crisis, the prevailing unemployment rate (which has remained in excess of 11% of the economically active population) and the recent behaviour of economic growth, private health services are expected to be unaffordable for the majority of people.33. Doniec K, Dall’Alba R, King L. Austerity threatens universal health coverage in Brazil. Lancet. 2016 Aug;388(10047):867-8. It should be emphasized that SUS is responsible for providing the most vulnerable segments of the population with access to health actions and services, thus working to promote equity.22. Stopa SR, Malta DC, Monteiro CN, Szwarcwald CL, Goldbaum M, Cesar CLG. Acesso e uso de serviços de saúde pela população brasileira, Pesquisa Nacional de Saúde 2013. Rev Saúde Pública. 2017;51(Supl 1):3s.,44. Nunes BP, Flores TR, Garcia LP, Chiavegatto Filho ADP, Thumé E, Facchini LA. Tendência temporal da falta de acesso aos serviços de saúde no Brasil, 1998-2013. Epidemiol Serv Saúde. 2016 out-dez;25(4):777-87. SUS also provides services to patients who have health insurance and use private services when they require high complexity care, such as transplants, haemodialysis and high-cost medication.55. Porto SM, Santos IS, Ugá MAD. A utilização de serviços de saúde por sistema de financiamento. Ciênc Saúde Coletiva. 2006 out-dez;11(4):895-910.,66. Gomes FFC, Cherchiglia ML, Machado CD, Santos VC, Acurcio FA, Andrade EIG. Acesso aos procedimentos de média e alta complexidade no Sistema Único de Saúde: uma questão de judicialização. Cad Saúde Pública. 2014 jan;30(1):31-43.

Notwithstanding, its universal nature is more evident in its health surveillance actions, which extend to the entire Brazilian population. An example of this is the National Immunization Programme, which offers universal access to all immunobiological products recommended by the World Health Organization. The current national immunization schedule provides for 41 immunobiological products. Immunization actions have resulted in general in the successful control of vaccine-preventable diseases.77. Braz RM, Domingues CMAS, Teixeira AMS, Luna EJA. Classificação de risco de transmissão de doenças imunopreveníveis a partir de indicadores de coberturas vacinais nos municípios brasileiros. Epidemiol Serv Saúde. 2016 out-dez;25(4):745-54. Despite the challenges still to be overcome - especially those related to social and regional inequalities -, important progress has been achieved, considering that in the 1980s vaccination coverage for the child immunization schedule was below 50%.88. Domingues CMAS, Teixeira AMS. Coberturas vacinais e doenças imunopreveníveis no Brasil no período 1982-2012: avanços e desafios do Programa Nacional de Imunizações. Epidemiol Serv Saúde. 2013 jan-mar;22(1):9-27.

Another example is found in the combination strategies for controlling the HIV epidemic, whereby Brazil is one of the few countries that makes them available for universal access. Thanks to the excellent results achieved through the universal distribution of antiretroviral drugs, Brazil has been indicated as a model for other middle- and low-income countries,99. Barros SG, Vieira-da-Silva LM. A terapia antirretroviral combinada, a política de controle da Aids e as transformações do Espaço Aids no Brasil dos anos 1990. Saúde Debate. 2017 set; 41(esp 3):114-28. and has even shown better performance than the United States in its response to HIV/AIDS.1010. Gómez EJ. What the United States can learn from Brazil in response to HIV/AIDS: international reputation and strategic centralization in a context of health policy devolution. Health Policy Plan. 2010 Nov;25(6):529-41.

Moreover, the role of SUS must be highlighted for its health surveillance actions in response to events with the potential to produce Public Health emergencies. The most striking example was the response to the Zika virus emergency in Brazil and to the congenital syndrome epidemic related to Zika infection. Despite the lack of knowledge regarding the aetiology of congenital Zika syndrome at the beginning of the epidemic, SUS coordinated a series of health surveillance, control and care actions which demanded intense political and institutional mobilization and achieved internationally recognized results.1111. Ministério da Saúde (BR), Secretaria de Vigilância em Saúde. Vírus Zika no Brasil: a resposta do SUS [Internet]. Brasília: Ministério da Saúde; 2017 [citado 2018 jan 25]. 136 p. Disponível em: Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/virus_zika_brasil_resposta_sus.pdf
http://bvsms.saude.gov.br/bvs/publicacoe...

Owing to its scope, universal nature and results achieved, SUS has drawn the attention of international experts,22. Stopa SR, Malta DC, Monteiro CN, Szwarcwald CL, Goldbaum M, Cesar CLG. Acesso e uso de serviços de saúde pela população brasileira, Pesquisa Nacional de Saúde 2013. Rev Saúde Pública. 2017;51(Supl 1):3s. who highlight that the combination of restrictive contexts and austerity policies to curb public expenditure, including expenditure on health, may put at risk the progress achieved and the right to health of the majority of the Brazilian population. SUS is a national heritage, a State policy that guarantees the entire population’s access to health actions and services.

By disseminating epidemiological knowledge produced by Brazilian and foreign researchers and health service workers, publishing quality articles offering analyses, evaluations, criticisms and contributions to the enhancement of the services offered by SUS, the Epidemiology and Health Services journal (Epidemiologia e Serviços de Saúde - RESS) takes on an important role in promoting the strengthening of the Brazilian health system. Defending SUS is the duty of all governments, health service managers, civil society organizations, the scientific community and health professionals. Long live SUS!

References

  • 1
    Macinko J, Harris MJ. Brazil’s family health strategy-delivering community-based primary care in a universal health system. N Engl J Med. 2015 Jun;372(23):2177-81.
  • 2
    Stopa SR, Malta DC, Monteiro CN, Szwarcwald CL, Goldbaum M, Cesar CLG. Acesso e uso de serviços de saúde pela população brasileira, Pesquisa Nacional de Saúde 2013. Rev Saúde Pública. 2017;51(Supl 1):3s.
  • 3
    Doniec K, Dall’Alba R, King L. Austerity threatens universal health coverage in Brazil. Lancet. 2016 Aug;388(10047):867-8.
  • 4
    Nunes BP, Flores TR, Garcia LP, Chiavegatto Filho ADP, Thumé E, Facchini LA. Tendência temporal da falta de acesso aos serviços de saúde no Brasil, 1998-2013. Epidemiol Serv Saúde. 2016 out-dez;25(4):777-87.
  • 5
    Porto SM, Santos IS, Ugá MAD. A utilização de serviços de saúde por sistema de financiamento. Ciênc Saúde Coletiva. 2006 out-dez;11(4):895-910.
  • 6
    Gomes FFC, Cherchiglia ML, Machado CD, Santos VC, Acurcio FA, Andrade EIG. Acesso aos procedimentos de média e alta complexidade no Sistema Único de Saúde: uma questão de judicialização. Cad Saúde Pública. 2014 jan;30(1):31-43.
  • 7
    Braz RM, Domingues CMAS, Teixeira AMS, Luna EJA. Classificação de risco de transmissão de doenças imunopreveníveis a partir de indicadores de coberturas vacinais nos municípios brasileiros. Epidemiol Serv Saúde. 2016 out-dez;25(4):745-54.
  • 8
    Domingues CMAS, Teixeira AMS. Coberturas vacinais e doenças imunopreveníveis no Brasil no período 1982-2012: avanços e desafios do Programa Nacional de Imunizações. Epidemiol Serv Saúde. 2013 jan-mar;22(1):9-27.
  • 9
    Barros SG, Vieira-da-Silva LM. A terapia antirretroviral combinada, a política de controle da Aids e as transformações do Espaço Aids no Brasil dos anos 1990. Saúde Debate. 2017 set; 41(esp 3):114-28.
  • 10
    Gómez EJ. What the United States can learn from Brazil in response to HIV/AIDS: international reputation and strategic centralization in a context of health policy devolution. Health Policy Plan. 2010 Nov;25(6):529-41.
  • 11
    Ministério da Saúde (BR), Secretaria de Vigilância em Saúde. Vírus Zika no Brasil: a resposta do SUS [Internet]. Brasília: Ministério da Saúde; 2017 [citado 2018 jan 25]. 136 p. Disponível em: Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/virus_zika_brasil_resposta_sus.pdf
    » http://bvsms.saude.gov.br/bvs/publicacoes/virus_zika_brasil_resposta_sus.pdf

Publication Dates

  • Publication in this collection
    26 Mar 2018
Secretaria de Vigilância em Saúde - Ministério da Saúde do Brasil Brasília - Distrito Federal - Brazil
E-mail: leilapgarcia@gmail.com