Brazil's unified health system: the first 30 years and prospects for the future

In 1988, Brazilian Constitution definedhealth as a universal right and stateresponsibility. Progress towards universal health coverage (UHC) has been achievedthrough a Unified Health System (Sistema Único de Saúde, SUS)which was created in 1990. Withsuccesses and setbacksin the implementation of health programmes and organization of its health system, Brazil has achieved nearly-universal access to health servicesfor her citizens. Thetrajectory of the development and expansion of the SUS offers valuable lessons on how to scale UHC in a health system in a highly-unequal country and relatively low resources. Theanalysis of the 30 years since the inception of SUS shows that innovations in the Brazilian health system extendbeyond the development of new models of care and highlightsthe importance of establishing political, legal, organizational and management-related structures, and the role of the federal and local governmentsin the governance, planning, financing, and provision of health services. Theexpansion of SUS has allowed Brazilto rapidly address the changing health needs, withdramatic scaling up health service coverage in justthree decades. However, despite its successes, analysis of future scenarios suggests the urgent need to address lingering geographic inequalities, insufficient funding, and the suboptimal private-public collaboration. Recent fiscal policies that ushered austerity measures, environmental, educational and health policies of the new administraion introduced in Brazilcould reverse the hard-earned achievements of the SUS and threaten itssustainability and its ability to fulfilits constitutional mandate of providing‘health for all’