Overview of Brazil's Unified Health System (SUS)

Brazil’s Unified Health System
PT: Sistema Único de Saúde (SUS)

History Timeline
&
Public Health System Overview

Prepared by Brazil Pharma News

April 2013

Disclaimer
This presentation was prepared in order to provide the general public a an updated overview on
Brazil’s past and current public health system. The great majority of information contained in this
presentation was originally published by the Brazilian Ministry of Health and UNA‐SUS University
and is of public domain. Therefore, the author of this work does not claim authorship and
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Brazil Pharma News

Federative Republic of Brazil
• Population: 205 million people (July 2012 est.)
• Total land are: 3,287,597 sq. mi.
• GDP: US$ 2.324 trillion (2011)
• GDP Growth: 2.7% (2011)
• One major official language: Portuguese
• Government: Presidential system,
Constitutional republic, Federal republic
• Population concentration in major urban areas:
São Paulo, Rio de Janeiro, Belo Horizonte, Porto
Alegre, Brasilia.
• Urbanization: 40% metropolitan
• Life expectancy at birth : 74.08 yrs (2011 est.)
• Total health expenditures (2006): US$ 87.3
billion
• Health expenditure as % GDP: 9 (2009)

Sources: World Bank , World Fact Book: Central Intelligence
Agency and IBGE (Brazilian Institute of Geography and Statistics)

The Unified Health System
The Brazilian Unified Health System was created by Law N. 8,080 (September
19, 1990) and Law N. 8,142 (December 28, 1990).These laws established that

“Health is a right of every citizen and a duty of the State”

Source: 1988 Constitution of the Federal Republic of Brazil

Evolution of the Constitution and public health law
• Federative Republic of Brazil (1985 to present); 1988 Constitution
1988 • Articles 196‐200: “Health is a right of every citizen, and a duty of the State”, Created  the SUS

• Federative Republic of Brazil (military government : 1964 to 1985); 1967 Constitution
1967 • Article 8 lists the responsibilities of Federal government to establish health and education standards

• Republic of the United States of Brazil (1945 to 1964); Constitution (September 18, 1946)
1946 • Article 5 lists the responsibilities of Federal government to establish fundamental  health standards

• Republic of the United States of Brazil (1889 to 1937); Constitution (November 10, 1937)
1937 • Article 16 lists the responsibilities of Federal government to establish fundamental  health standards

• Republic of the United States of Brazil (1889 to 1937); Constitution (July 16, 1934)
1934 • Article 10 sets forth the obligations of the Union and States in public health assistance

• Republic of the United  States of Brazil (1889 to 1937); Constitution (February 24, 1891)
1891 • Legislation did not include any health provisions

• Empire of Brazil (1822 to 1889); Constitution (March 25, 1824)
1824 • Legislation did not include any health provisions

Source: Brazil Ministry of Health Online Public Health Library (2013)

Timeline: Major Public Health Policies
1990 • Establishement of the Unified Health System (PT: Sistema Único de Saúde)

• Creation of the Unified and Decentralized Health Systems (PT: Sistemas Unificados e
1987 Descentralizados de Saúde (SUDS)

• VII National Health Conference enshrined the principle: “Health is the right of every citizen
1986 and duty of State”

1982 • Integrated Health Actions Program (PT: Programa de Ações Integradas de Saúde (PAIS)

• Creation of the National System of Assistance and Social Security (PT: Sistema Nacional de Assistência e
1977 Previdência Social (SINPAS) and the National Institute of Medical Assistance and Social Security (PT: Instituto
Nacional de Assistência Médica da Previdência Social (INAMPS)

1965 • Creation of the National Social Security Institute (PT: Instituto Nacional de Previdência Social
(INPS)

1932 • Creation of the retirement and pensions institute (PT: Instituto de Aposentadorias e Pensões
(IAPs)

1923 • Creation of the retirement and pensions fund (PT: Caixas de Aposentadorias e Pensões (CAP)

Source: UNA-SUS Políticas Públicas de Saúde: Sistema Único de Saúde (2011)

Current Law: Constitution and amendments
Brazil: 1988 Federal Constitution (Articles 196-200)
Constitution Amendment No. 29 (September 13, 2000): Modifies articles: 34, 35, 156, 160,
167 and 198 of the Federal Constitution and adds an article to the Temporary Constitutional
Provisions Act, to ensure the minimum resources to finance actions and public health
services.
Law No. 8.080 (September 19, 1990): Provides for the protection, promotion of health, the
organization and operation of health services, and other provisions.
Law No. 9.836 (September 23, 1999): Adds provisions to Law No. 8.080
Law No. 11.108 (April 7, 2005): Modifies Law No.8.080
Law No 10. 424 (April 15, 2002) : Adds chapter and article to Law No. 8.080
Law No. 8.142 (December 28, 1990): Provides for the community participation in the
management of the Unified Health System (SUS), and intergovernmental transfers of financial
resources to health services, and other provisions.
Ordinance N. 2,048 (September 3, 2009): Approves the Unified Health System (SUS)
regulation, and other provisions.
Ordinance N. 2,230 (September 23, 2009): Implementation of Ordinance N. 2,048/GM from
September 3, 2009, and other provisions

Source: Brazilian Ministry of Health Online Public Health Library (March 2013)

Public Health Management

Health Minister (Dr. Alexandre Padilha)

Related entities:
Collegiate Bodies: ANVISA, ANS, FUNASA,
FIOCRUZ, HEMOBRAS.
National Health Council (CNS) and Hospitals: Our Lady of
Supplemental Health Council (ANS) Conceição, Fêminaa and
Health Minister Executive Secretariat Christ Redeemer

Office of Office of
Office of Office of
Office of Science, Office of
Labor and Strategic and Native
Health Technology and Health
Health Participative Indians
Services Strategic Surveillance
Education Management Health
Supplies

Source: Brazil Ministry of Health Organizational Structure per Decree N. 7,336 (October 19, 2010)

Unified Health System Users Letter of Rights
The “Letter of the Rights for the Unified Health System Users" provides information
for the citizens to know their rights when it comes to seeking health care services. It
brings together the six basic principles of citizenship which ensure every Brazilian
the right of health, whether public or private. The Letter is an important tool for
citizens to know their rights and thus help Brazil have an even more effective health
system.

The principles of the Letter of Rights are:

1st. Every citizen has the right to access an orderly and organized health systems
2nd. Every citizen has the right to an appropriate and effective health treatment
3rd. Every citizen has the right to humane, free from any discrimination treatment
4th. Every ci zen has the right to care that respects their person, their values nd their rights

a
5th. Every citizen also has responsibilities to assure their treatment is managed properly
6th. Every citizen is entitled to health authorities' commitment to the principles above are met

“Letter of the Rights for Users of the Unified Health System" (Click here for the 2011 version)
Source: Brazil’s Ministry of Health website (March 2013)

The SUS since 1988
The Brazilian Unified Health System has greatly evolved since 1988. “The
Unified Health System is a unique social project whose principles of
universality, comprehensiveness and fairness are established in the
Constitution of 1988. Based on this perspective, in order to understand the
actions promoting, and preventing health care, the Brazilian Ministry of Health
organizes and develops plans and policies that meet the constitutional
requirements.”

Several new major health policies and programs have been put in place in the
areas of:

- Pharmaceutical assistance
- Health assistance
- Science and Technology
- Health education
- SUS work management
- SUS participatory management
- Health surveillance Source: Brazil’s Ministry of Health Online Public Health Library (2013)

Guiding Principles of SUS
• Universal acess to health services at all levels of health assistance.
• Completeness of health assistance through either individual or collective
actions and services set to prevent and cure, required in each case at all
levels of the health sytem.
• Preservation of the autonomy in defense of physical and moral integrity.
• Equal rights to healthcare without prejudice of any privileges.
• The right of health information to disabled people.
• Disclosure of to health services information.
• Use of epidemiology data to establish priorities, resources allocation and
programmatic guidances.
• Community participation.
• Political and administrative decentralization.
• Resolution capability for services in all levels of health assistance.
• Organization of public health services in order to avoid duplication of work.
Source: www.unasus.unifiesp.com.br

The Brazilian Health System

Public Health Care:
free, universal access

Private Health Care: Supplemental Health
access by direct Care: private access to
payment of services to beneficiaries of
the health care provider supplemental health
plans

Source: Brazil’s Ministry of Health: Desafios do SUS e Propostas de Superação (2008)

SUS: Financial Resources

The Unified Health System (SUS) is funded by the three levels of
government: federal, state and municipal, as determined by the
1988 Federal Constitution, which establishes the minimum tax
revenues resources to cover the costs associated with public health
services.

SIOPS: Information system which collects, retrieves, process,
stores, organizes data and information regarding total revenues
and public health services expenses in order to monitor the
utilization of resources by health authorities.

Source: Brazil Ministry of Health website (March 2013)

SUS: Financial Resources, cont’d
Federal
States
District

Federal
Municipalities
Government

Social SUS Other
Security Financing

Source: Prof. Romulo Passos study guide (2013)

SUS: Financial Resources, cont’d
Minimum Financial Resources in Health (Constitution Amendment N. 29/2000)

Federal • Value utilized in the previous year, at minimum,
Government plus nominal GDP variation

States • 12% of tax revenues from each state jurisdiction

• 15% of tax revenues from each municipality
Municipalities jurisdiction

• 12% and 15% of tax revenues from the state and
Federal District municipality jurisdiction

Source: Prof. Romulo Passos study guide (2013)

Federal Health Budget (BRL)

Sources: Brazil’s MoH #susmaisforte presentation. Dr Padilha (Sep 2011)

SUS systems and applications
• SIA: Outpatient Information System / Credit report to health
providers.
• SIGTAP: Unified Health System List of Procedures,
Pharmaceutical drugs, Orthotics, Prosthetics and Special SUS
Materials.
• SIPAR: Integrated Protocol System and the Ministry of Health
File.
• SIS‐Fronteira: Borders Health.
• SOMASUS: Development Support System for Investment
Projects in Health
• TABNET: Ministry of Health Tabulation Program.

Political Science: Participation and Management in SUS
Unified Health System (SUS) - Set of health actions and services rendered by federal public, state and
municipal agencies and institutions and by the private sector and non-governmental organizations through
contracts and health plans. It is organized in regionalized and under a hierarchy of networks with single
management in each governmental area.

Ministry of Health (MS) - National management of SUS, formulates, standardizes, inspects, monitors and
assess policies and actions, in combination with CNS. Acts in the scope of CIT to make an agreement with
the National Health Plan. The following make up its structure: Fiocruz, Funasa, Anvisa, ANS, Hemobras,
Inca, Into and eight federal hospitals.

State Health Offices (SES) - Participates in the formulation of health policies and actions, render support to
the municipalities in conjunction with the state council and participates in CIB to approve and implement the
state health plan.

Municipal Health Offices (SMS) - Plans, organizes, controls, alleviates and executes the health actions
and services in conjunction with the municipal council and the state area to approve and implement the
municipal health council.

Health Councils (municipal and state) - There are 26 state councils, one in the Federal District and 5,562
municipal councils that operate as court of social participation and health policy and plan control. National
Health Council (CNS) - CNS proposes, deliberates, monitors and assesses the health policies and plans
adopted in the three government areas. It is made up of 48 institutions, half representing entities
of users and social movements.
Source: 20 years of SUS (Brazilian Ministry of Health website)

Participation and Management in SUS, cont’d
National Council of Health Secretaries (Conass) - Representing entity of state and Federal District
health secretaries, part of CIT and operates in health actions and services.

Municipal Council of Health Secretaries (Conasems) - Representing entity of municipal health offices,
part of CIT and operates in health actions and services.

Council of Municipal Health Secretaries (Cosems) - State representation of Conasems, part of CIB,
articulates and mobilizes the municipal secretaries to exchange experiences and consolidate the health
policies.

Tripartite Intermanagers Commission (CIT) - Deliberative court that comprises municipal, state and
federal managers to plan, implement and assess the health policies and plans.

Bipartite Intermanagers Commission (CIB) - Deliberative court that comprises state and municipal
managers to plan, implement and assess the health policies and plans

National Table of Permanent Negotiation of SUS (MNNP-SUS) - Created in 2003, MNNP-SUS unites
mangers and workers to negotiate and improve the work relationships in the Health Sector

Source: 20 years of SUS (Brazilian Ministry of Health website)

Major Public Health Policies
• National Policy for Pharmaceutical Assistance
• National Policy for Medicinal Plants and Herbal Medicines
• National Policy for Pharmaceutical Drugs
• National Policy for Mental Health of Children and Teenagers
• National Policy for Integral Attention to Users of Drugs and Alcohol
• National Cancer Policy
• National Policy for Comprehensive Health Care for Women
• National Policy for Assisted Human Reproduction Comprehensive Care
• National Policy for Kidney Disease Patients
• National Policy for Hearing Health Care
• National Policy for Trauma and High Complexity Orthopedics
• National Policy for Health Emergencies


Major Public Health Policies cont’d
• National Policy for Small Hospitals
• National Humanization Policy: HumanizaSUS
• National Policy for Natural Medicine and Complementary Practices
• National Policy on Integrative and Complementary Practices (PNPIC) SUS
• National Policy for Elective Surgical Procedures
• National Policy for Elective Average Complexity Surgical Procedures for
Outpatients and Inpatients
• National Policy on Health Promotion
• National Health Policy for the Afro-Brazilian Population
• Monitoring System Incentive Policy in the Framework of the National STD
and AIDS
• National Policy for Health Information Systems
• National Policy on Science, Technology and Innovation in Health


Major Public Health Policies cont’d
• Nation Policy on Education SUS Development
• National Policy on Permanent Education for the Ministry of Health Workers
• SUS Training and Development Policies
• National Policy for Strategic and Participative Management in the SUS:
ParticipaSUS
• National Policy for the Health of Indigenous People
• National Policy for Reduction of Morbidity and Mortality from Accidents and
Violence


Major Public Health Programs
• Better at home: People in need of motor rehabilitation, elderly, chronically
ill or post-surgical patients, for example, will have multidisciplinary health
care provided in their own homes free of charge with comfort of being closer
to family.
• S.O.S Emergency: Gradual and strategic action to qualify SUS emergency
services. The initiative shall include 40 largest Brazilian emergency rooms,
covering all 26 states and the Federal District by 2014.
• Health academy: Encourages the creation of public spaces suitable for
physical activities and recreation with the goal to help promote population
health.
• Family health: Seeks to maintain health and prevent diseases, thereby
altering the health model centered hospitals.
• Dengue disease control: MoH actions to control the disease

Source: Brazil Ministry of Health Web Portal (2013)

Major Public Health Programs cont’d
• Farmácia Popular (People’s Pharmacy): program created by the MoH to
increase the population's access to essential medicines, sold at prices lower
than those prevailing in the market.
• PNAN: The National Food and Nutrition Policy seeks to ensure the quality
of food available for consumption in the country, as well as promoting
healthy eating habits and prevent and control nutritional disorders.
• UPA24h: The UPAs are 24 structures of intermediate health complexity
services.
• Organ donation: Campaign seeking to raise awareness about the
importance of organs donation.
• SAMU 192: Mobile Emergency Service. In case of emergency call # 192.
• Olhar Brasil project: The goal of this program is to identify vision problems
in students enrolled in public elementary schools and in people over the age
of 60.


• Humaniza SUS: National Policy with strategies built by managers, workers
and users of SUS who qualify the public health management.
• Customized drug package: Medicinal drugs are manufactured in special
sizes packaging and sold in the exact amounts recommended by the
medical doctor.
• Mortality rate reduction: The Pact for the Reduction of Child Mortality in
the Northeast-Amazon region is part of a commitment to accelerate the
reduction of regional inequalities.
• Human Milk Bank Network: Seeks to promote a quantitative and
qualitative expansion of human milk banks in Brazil, through integration and
partnerships between federal agencies, private sector and society.
• National Cancer Control Program: Provides subsidies to help advance
cancer diseases control plans.
• Back home: proposes the social reintegration of people affected by mental
disorders and discharged from long hospitalizations.


• Project ‘Expansion’: Launched in 2001 by the National Cancer Institute
(Inca) and the Ministry of Health, this project has the main objective of
structuring the integration of cancer care in Brazil in order to obtain a high
quality standard in population health care coverage.
• Tobacco Control: The National Cancer Institute (INCA) is the agency of the
Ministry of Health responsible for coordinating and implementing the
Tobacco Control Program in Brazil. The goal is to prevent disease and
reduce the incidence of cancer and other smoking-related diseases, through
actions that encourage the adoption of healthier behaviors and lifestyles.
• QualiSUS-Network: Established as a strategy to support the organization
of health care management and technologic development networks within
SUS.
• National Health Card: Tool that enables the linking procedures
implemented under SUS to the user, the professional who performed them,
and also to the health facility where health services were provided.


National Health Card
“The National Health Card meets a historical demand of
public health in Brazil. The goal is to identify each SUS
key user and monitor the health care provided by the
health system, wherever they occur, through the access
of the national citizen's health database.”

“It is a modern information system instrument needed for the organization of the
network of health care and SUS management.”

Ordinance MS / GM # 940 of April 28, 2011 Regulates the National Health Card System

Source: Cartão Nacional de Saúde – Normas e Procedimentos de Uso (2011)

People’s Pharmacies program
The Federal government People’s Pharmacies program
"Farmácia Popular do Brasil“ was established by the Decree N.
5.090, dated May 20, 2004.

Ordinance N. 971 (May 15, 2012) updated the People's Pharmacies
regulation including the updated description of definitions, operation norms and
criteria for the registration of pharmacies and drugstores in the program which is
comprised of a network of public and private pharmacies/drugstores accredited
by the Ministry of Health.

The large number of accredited pharmacies and drugstores in this program have
greatly improved the access to medications for common diseases. Some
medications are distributed “free of charge” while others are offered with a
discount of up to 90%
Official list of medicines available through the People’s Pharmacies program
Ministério da Saúde e Municipios. 2ed. (2013)

SUS in numbers: capacity
 39,526 basic health units**
 8,502 public hospitals
 17,000+ emergency facilities
 17,202 intensive care facilities:
10,986 adult; 2,217 pediatric; and 3,999 neonatal
 1,287 intensive care care units beds
 504,270 hospital beds
 63,000 outpatient units
 26,000 family health teams
 215,000 community health agents
 13,000 dental health teams
 Health assistance in 5,000+ Brazilian municipalities
Source: Relatório de Gestão – Secretaria de Atenção à Saúde. (2011)
**Ministério da Saúde e Municipios. 2ed. (2013)

CNES: National Register of Health Centers
STATE Total %
ACRE (AC) 695 0,27%
ALAGOAS (AL) 2715 1,04%
AMAPA (AP) 452 0,17%
AMAZONAS (AM) 1901 0,73%
BAHIA (BA) 14028 5,35%
CEARA (CE) 9025 3,44%
DISTRITO FEDERAL (DF) 5504 2,1%
ESPIRITO SANTO (ES) 5425 2,07%
GOIAS (GO) 7592 2,9%
MARANHAO (MA) 4337 1,65%
MATO GROSSO (MT) 4486 1,71%
MATO GROSSO DO SUL (MS) 3763 1,44%
MINAS GERAIS (MG) 32227 12,3%
PARA (PA) 5262 2,01%
PARAIBA (PB) 4830 1,84%
PARANA (PR) 20070 7,66%
PERNAMBUC O (PE) 7407 2,83%
PIAUI (PI) 3026 1,15%
RIO DE JANEIRO (RJ) 16094 6,14%
RIO GRANDE DO NORTE (RN) 3613 1,38%
RIO GRANDE DO SUL (RS) 20001 7,63%
RONDONIA (RO) 1828 0,7%
RORAIMA (RR) 476 0,18%
SANTA CATARINA (SC) 12887 4,92%
SAO PAULO (SP) 60595 23,12
Total in Brazil: 252,620 SERGIPE (SE) 3047 1,16%
TOCANTINS (TO) 1334 0,51%

Source: CNES (National Register of Health Establishments) April 2013

SUS in numbers: assistance
 11,117.634 hospitalizations, 2011 annual cost of BRL 11,1 billion:
 52.76% supplemental health assistance
 47.23% public health assistance
 3,523,910.480 procedures, 2011 annual cost of BRL 15,1 billion:
 1,682,010.649 basic outpatient procedures
 1,841,899.831 specialized procedures in the areas of clinical pathology, radiology, ultrasound,
CT scans, hemodialysis, cytopathology, cataract surgery and oncology
 150 million medical visits**
 2 million child births**
 300 million laboratory tests**
 1 million CT scans**
 10.5 million oncology treatment*
 282 heart surgeries *
 98,000 oncology surgeries *
 9 million ultra-sound scans**
 140 million immunization doses**
 21,000 human organ transplants *

A total of 145 million Brazilian citizens rely exclusively on the SUS
Sources: *Relatório de Gestão – Secretaria de Atenção à Saúde. (2011)
**SUS, conquistas e desafios by Luiz Odorico Monteiro de Andrade (Nov. 2012)

SUS Public Health Access Index

Source: Índice de desempenho do sistema único de saúde IDSUS (April 2013)

SUS Performance Index


SUS Medium and High Complexity
Performance Index


SUS: Total Number of Outpatient Procedures of Medium
Complexity per region (2008‐2011)
Data analysis: Brazil Pharma News (March 2013)

North
3,523,910,480
3,363,761,138 Northeast
3,246,439,600
Midwest
2,914,162,162
Southeast

1,652,671,478
South

1,573,297,609
1,524,714,510
1,389,157,195

Total

852,589,286
834,415,967
804,108,538
730,220,151

508,963,125
465,360,273
434,228,857
384,863,345

263,536,586

262,668,090
252,288,362

247,018,501
231,099,333

226,958,202
210,381,308

199,520,716

Quantity Quantity Quantity Quantity
2008 2009 2010 2011

Data source: Relatório de Gestão 2011 – Secretaria de Atenção à Saúde

SUS: Total Number of hospital admissions by region (2008‐2011)

Data analysis: Brazil Pharma News (March 2013)

North
Northeast
11,128,809 11,357,965 11,117,634 Midwest
10,743,603
Southeast
South
Total

4,358,294
4,342,659
4,226,450
4,094,612

3,211,310
3,134,816

3,078,840
3,016,562

1,891,360
1,887,681

1,850,041
1,812,052

1,011,174
992,653

969,039
945,632

901,462
887,209
874,745

861,420
2008 2009 2010 2011

Data source: Relatório de Gestão 2011 – Secretaria de Atenção à Saúde

Department of Science, Technology
and Strategic Supplies (SCTIE)
It is responsible for implementing the policies of pharmaceutical evaluation and
incorporation of technologies in health, and to encourage the development of
the industrial and scientific sectors.

In the context of science and technology, the Secretariat is responsible
for encouraging the development of health research in the country, so as to
direct the investments made by the Federal Government to the needs of public
health.

The SCTIE directs the industrial health complex policy for the public sector in
joint action with other ministries and state agencies, encouraging the
development of pharmaceuticals, medical equipment and health technologies.

The goal of the Federal Government is, thus, to make Brazil independent from
the external market.
Source: Ministry of Health (SCTIE) website (April 2013)

SCTIE Management
SCTIE
(Mr. Carlos Augusto Grabois Gadelha

Chief of staff Budget and
Planning Office

Office of
Office of
Management
Office of Office of Industrial
and
Pharmaceutical Science and Complex and
Incorporation of
Assistance Technology Innovation in
Health
Health
Technology

Source: Ministry of Health (SCTIE) website (April 2013)

Essential Medicines
RENAME 2012
The Ministry of Health issued the Ordinance MS / GM No. 533 of 28 March 2012
with the list of medications and health supplies from the National List of Essential
Medicines ‐ RENAME.
The RENAME/2012 was compiled from the definitions of Decree No. 7508 of 28
June 2008 and structured in accordance with Resolution No. 1/CIT of January 17,
2012.
The RENAME/2012 includes medicines and supplies available through SUS in the
Basic Component of Pharmaceutical Care, Strategic Components of the
Pharmaceutical Assistance, Specialized Components for Pharmaceutical Services,
and certain medicines for hospital use.

RENAME 2012

Actions and Health Services
RENASES 2012
The Ministry of Health issued the Ordinance MS / GM No. 841, of May 2, 2012,
establishing the National List of Actions and Health Services (RENASES) in the SUS.
The actions and services described in RENASES include, in aggregate, the entire
Table of Procedures, Orthotics, Prosthetics and Drug Administration in SUS. The
RENASES 2012 was compiled from the definitions of Decree No. 7508 of 28 June
2008 and structured in accordance with Resolution No. 2/CIT of January 17, 2012.

The additions, deletions and changes IN RENASES actions and services will be
conducted by the National Incorporation of Technologies in SUS (CONITEC). States
and Municipalities must submit requests for amendment and incorporation of
health technologies to CONITEC , in order to complement RENASES for the state or
municipalities.

RENASES 2012

Current challenges in SUS
• Underfinanced system: Brazil invests 3,67% of the GDP in health (2010), or only half of what
is recommended by the WHO.
• Universal health care priorities: Great part of SUS resources is destined to 1/3 of the
population who utilize supplemental health systems services.
• Fragmented national networks for health assistance and surveillance.
• Lack of sufficient human resources: Insufficient number of health care professionals in public
health systems, and their poor distribution and availability across the country. 1.8 medical
doctors per 10,000 inhabitants
• Lack of active social participation: Brazilian citizens need to be more engaged in the political
aspects of SUS and not leave it as a government only priority.
• Unequal health care between population groups and regions: fragmentation of care and
empty territories in both cities (eg slums) as in less developed regions across the country.
• Inefficiency: hospital and clinics patient lines, low remuneration of medical procedures.
• Overload of urgent and emergency care requests
• Low production capacity in the country of essential medical products such as pharmaceutical
drugs, vaccines and medical devices.
Sources:
Desafitos do SUS e propostas de Superação – Secretaria de Gestão Estratégica e Participativa – MS (2008)
SUS, conquistas e desafios by Luiz Odorico Monteiro de Andrade (Nov. 2012)
Revista Princípios aborda os desafios do SUS. Fenafar (Feb. 2013)

SUS Dimensions
• Largest network of human milk bank in the world
• Largest number of human organ transplants in the world
• 90% of vaccines are funded and offered by SUS
• 50% of medical equipment market is managed by SUS
• 80% investments in oncology treatments in Brazil
• More than 90% of the total hemodialysis

Sources: Brazil’s MoH #susmaisforte presentation. Dr Padilha (Sep 2011)

Major Ongoing Efforts
• 2,834 emergency response units
+ 54% over 2010, covering 127,8 million people
• 267 emergency care units working 24h/7 (UPA 24h)
– Seek to reduce the amt. of patients in urgency and high complexity care units
• + 86 % invested in medium complexity surgeries over 2011
• + 90 dental offices opened between 2011‐2012
– For a total of 942 centers benefiting 94.5 million people in the country
• + 121% invested in oncology care in 2013 compared to2011
• Investment in new technologies
– 26 new medical products included in SUS

Data source: Ministério da Saúde e Municipios. 2ed. (2013)

Achievements in Public Health
• Reduction in maternal mortality rate (50%), child mortality rate (70%)*
• 70% Reduction in cardiovascular diseases*
• 86% Reduction in deaths caused by influenza (2011)
• Current policies increased number of medical procedures and medical
products offered
• Strategic interministerial initiatives which foster collaboration, research
and education
• The MoH strives to meet the World Health Organization Millennium
development goals pertaining to health and improve public health
services
Ministry of Health extended BRL 7 Billion in financing to Healthcare Sector
(Foxbusiness.com April 2013)

Sources: * Brazil’s MoH International Convention “Cuba Health 2012”
Minissry of Health web portal (March 2013)

Recent Advancements in SUS
• Partnerships for Productive Development (PDPs): comprise of several
agreements between the private sector and goverment for the technology
transfer of pharmaceutical produts for domestic production.
– 55 PDPs as of November 2012!
• PROVAB: Primary Health Care Professional Enhancement Program seeks
to expand public health assistance in Brazil by allocating 4,392 primary
health care doctors to several regions of the country, benefiting 1,047
municipalities in need of health services.
• Plans to hire foreign health care professionals: The Federal government is
working on a new program which will offer work permits to foreign
medical doctors interested in working in the country.

“Despite several limitations, the SUS has managed to
vastly improve access to primary and emergency care,
reach universal coverage of vaccination and prenatal
care, and invest heavily in the expansion of human
resources and technology, including major efforts to
produce the country’s most essential pharmaceutical
needs”.
Paim et al. The Brazilian health system: history, advances, and challenges.
The Lancet, Health in Brazil . May 2011

Images source: Ministério da Saúde e Municipios. 2ed. (2013)

25 years of SUS
1988‐2013

Note: All images were extracted from the Brazilian Ministry of Health website (March 2013)

Resources

Brazilian Ministry of Health website

Resources

Federal Republic of Brazil 1988 Constitution

Resources

Current health legislation database

Resources

Brazil’s Public Health Online Library

Resources

National Health Fund

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Overview of Brazil's Unified Health System (SUS)

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