Eng
One of the public policies that brings Brazilians the most pride turns 35 today: the SUS. The Unified Health System (SUS) is one of the largest and most complex public health systems in the world, and through it, people living in Brazil have access to comprehensive healthcare, from pregnancy and throughout their entire lives.
Before SUS, health was not yet treated as a right for all, and the Brazilian healthcare system did not reach the entire population, excluding a significant portion of it. Access was mainly limited to people employed with a formal work contract, through the National Institute of Medical Assistance of Social Security (INAMPS). Those who did not contribute to social security had very restricted access to healthcare, usually through philanthropic organizations.
It was only with the beginning of Brazil’s redemocratization process and the 1988 Constitution that health began to be viewed with the importance it deserved. Article 196 of the Constitution states that “Health is the right of all and the duty of the State,” marking an important milestone that, shortly afterwards, led to the creation of a public and free healthcare system for the entire population.
Principles and functioning of SUS
SUS was officially created in 1990 through Laws No. 8.080 and 8.142, known as the Organic Health Laws, which established the system’s guidelines and structure. Currently, the system operates through three main bodies that ensure its functioning for the population.
The Ministry of Health serves as the national manager, formulating, regulating, monitoring, and evaluating policies and actions in coordination with the National Health Council. The State Health Secretariat helps develop health policies and actions, supporting municipalities in coordination with the state council, while the Municipal Health Secretariat works with the municipal council and the state level to approve and implement the municipal health plan.
Additionally, three principles form the foundation of SUS:
Universality: Health as a citizenship right for all, with the State responsible for ensuring this right. Access to services must be guaranteed to everyone, regardless of gender, race, or other personal or social characteristics.
Equity: Even though access to healthcare is guaranteed to all, people are not the same and therefore require different types of care according to their individual needs. This principle aims to reduce inequalities by properly treating people who need special care.
Comprehensiveness: The integration of actions such as health promotion, disease prevention, treatment, and rehabilitation helps the population lead healthier lives. This principle refers to the articulation of the healthcare network with other public policies across different areas to improve individuals’ quality of life.
Achievements of SUS over the years
Considered one of the best and most comprehensive health systems in the world, SUS stands out in several areas that make Brazil a reference. One example is the National Immunization Program (PNI), which offers free and large-scale vaccinations to eliminate or control diseases such as polio, measles, diphtheria, and tetanus, among many others that were once major public health concerns in the country.
Other highlights include the free distribution of several medications, including high-cost ones. Treatment for HIV/AIDS and chronic illnesses such as diabetes and hypertension is also provided to the population.
A great example of prevention and continuous care that yields results is the Family Health Strategy (ESF), which operates under the primary care model. This is also recognized by professionals who serve people using these services, such as Giovana Santos, a social worker at Instituto C, who considers the ESF a benchmark program.
“The Family Health Strategy has several functions, such as providing comprehensive and personalized care. It looks after the population’s health considering social, physical, and emotional aspects, not just the illness itself. Through health promotion and disease prevention, the Family Health Strategy aims to carry out pedagogical actions within communities,” Giovana highlights.
Beatriz Martins, a nutritionist at the Institute, also emphasizes the teamwork involved in this approach: “The teams work in an integrated way, which promotes broader access and strengthens the connection between families and health units. It is a highly successful policy.”
Little-known SUS services
Beyond the widely known services such as primary care at UBS units or urgent care at UPAs, SUS is also present in areas that are part of Brazilians’ daily lives. One of these is sanitary surveillance, carried out by the National Sanitary Surveillance System (SNVS), which inspects products, services, and environments to prevent health risks.
For those who cannot travel to a health facility, SUS offers the “Better at Home” program, which sends a team to patients’ homes. To access it, the patient must be referred by another team within the Healthcare Network (RAS), whether from a hospital, Primary Healthcare (APS), or emergency care.
Rehabilitation is also part of SUS, which provides prostheses, wheelchairs, and other resources for people with disabilities. Additionally, it maintains Specialized Rehabilitation Centers (CER), which offer multidisciplinary follow-up. To access these services, patients must seek a UBS.
Challenges of the system
Despite its well-deserved recognition, SUS still faces many challenges, mainly related to public management and the misadministration of health resources. This directly affects everyone who needs its services, who often face long waiting times or barriers to access.
For Giovana, focusing on preventive care is more effective within the public system: “If the public resources allocated to SUS focused on care, prevention, and health promotion, fewer people would become ill, require hospitalization, or need expensive exams and medications,” she reflects.
Geographic location also remains a barrier preventing people from receiving certain types of care, as many hospitals and more complex treatments are located in large cities. “Some populations living in remote or distant regions have difficulty accessing these services. And richer capitals have faster and broader access,” explains Beatriz.
In this context of limited access, social organizations are strong allies in connecting people to health services that are their right.
Social organizations as allies of SUS and the population
Instituto C and many other organizations act as tools that connect people to services. Our technical team provides support to numerous families with children receiving treatment through SUS, working to make the process more accessible through clear information.
“At the Institute, for example, we reinforce the political role of the families we serve. Considering the Institute and other NGOs I know, I believe they are all very aligned with the idea of social rights,” Giovana emphasizes. In addition to organizations working with families outside healthcare facilities, community organizing within local territories is also essential to ensure the system’s principles continue to be upheld.
One of these organizations’ key roles is working in territories that lack more active services, as Beatriz points out: “They play a very important role in expanding access, especially in regions where the Unified Health System cannot reach.”
The work we do at Instituto C—alongside many other dedicated organizations—is also a way of strengthening SUS and ensuring people can exercise their health rights.
Now, we want to take this care and this bridge between families and health services even further, and we will do so by expanding our work to a new municipality. With a contribution starting at 10 reais, you can take part in this transformation and help us reach new families. Click the image and join us in taking this next step!
