In 1988, the Brazilian Constitution defined health as a universal right and a state
responsibility. Progress towards universal health coverage in Brazil has been achieved
through a unified health system (Sistema Único de Saúde [SUS]), created in 1990. With
successes and setbacks in the implementation of health programmes and the organisation
of its health system, Brazil has achieved nearly universal access to health-care services
for the population. The trajectory of the development and expansion of the SUS offers
valuable lessons on how to scale universal health coverage in a highly unequal country
with relatively low resources allocated to health-care services by the government
compared with that in middle-income and high-income countries. Analysis of the past
30 years since the inception of the SUS shows that innovations extend beyond the development
of new models of care and highlights the importance of establishing political, legal,
organisational, and management-related structures, with clearly defined roles for
both the federal and local governments in the governance, planning, financing, and
provision of health-care services. The expansion of the SUS has allowed Brazil to
rapidly address the changing health needs of the population, with dramatic upscaling
of health service coverage in just three decades. However, despite its successes,
analysis of future scenarios suggests the urgent need to address lingering geographical
inequalities, insufficient funding, and suboptimal private sector-public sector collaboration.
Fiscal policies implemented in 2016 ushered in austerity measures that, alongside
the new environmental, educational, and health policies of the Brazilian government,
could reverse the hard-earned achievements of the SUS and threaten its sustainability
and ability to fulfil its constitutional mandate of providing health care for all.