Health systems in Brazil and regionalization policies

By Maria Cecília de Souza Minayo, Editor-in-chief and Luiza Gualhano, Communication Assistant, Rio de Janeiro, RJ, Brazil

Ciência & Saúde Coletiva, in its issue number 4, presents articles that result from analyzes carried out in cooperation environments between national and international researchers, their institutions and governmental bodies on the theme of SUS regionalization. Social inequalities and local and regional asymmetries are treated as a background or direct objective of most studies that address mainly: gaps in the federative system; governance mechanisms, social participation and governance; sector financing and social inequalities; regional asymmetries in access to networks, services and medicines; and different dynamics and perceptions of political actors.

The edition brings together an immense wealth of knowledge about the implementation of the SUS – a system in permanent process of criticism and changes that needs improvement. It would be very difficult to show here the conclusions about its federalization, because there are many thinkers and their research and analysis perspectives. But without any doubt, it is possible to say with Ribeiro, et al. (2017, p.1041) that “although there are many successful examples, the dynamics between cooperation and competition within the system is one of the main failures of SUS. Cooperative federalism is a contradictory and pre-defined process. And there is no evidence that cooperation has become a dominant pattern in Brazil. […] [Thus], successful experiences of consortia, health districts and regional colleges say more about the model’s potentials than about a sustained and widespread pattern”.

Given the size of the country, the differences and inequalities between and within states and municipalities, one of the most crucial points for the Unified Health System (SUS) is the process of regionalization that hypothetically would bring the proximity of management and provision of services to individuals and their needs. However, for the success of this task, today it would require a new political fervor such as the one experienced in the initial times of the so-called Brazilian Health Reform, so that the performance of the SUS builders was supported by a serious and responsible financial provision (REIS, et al., 2017). It is well known to all scholars that if there are management problems – the eternal excuse for disinvestment in the SUS – there is no doubt that the financial resources allocated are few and insufficient. To get an idea of ​​this state of affairs, comparing the average expenditure with the percentage of GDP among the countries that integrate the WHO that is of 5.5%, the one of Brazil is only to 3.7%. It is also below what is destined in Uruguay, Argentina, Chile and Costa Rica and is about 15 times smaller than that of Canada, European countries and Australia. For Brazil to be equated to countries with universal systems, public health spending should rise to 8.3% of the GDP, according to the WHO (CARVALHO, 2013).

At this moment, in the middle of the whole Brazilian crisis that reaches all the public policies, a new and powerful obstacle has appeared. For the first time, it can be observed that the political-partisan system and the State Executive Power are the major absentees in the coalitions in support of the regionalization policies. This is a new fact because, since its inception, SUS has always been of extreme interest to political coalitions, receiving supra-party support and social leadership, often manifesting itself in the pressure for occupation of municipal and state executive positions that guaranteed support in critical moments. This is shown by the article by Moreira, Ribeiro and Ouverney (2017).

In summary, this edition constitutes a criticism within the SUS about how its capillarization is being done through the country. This critique is from people who seek to know the problems to point directions and solutions. They are unanimous in valuing the system that serves the majority of Brazilians. For, they consider it a good of society, which cannot be scrapped and despised, but rather be treated as an effective tool for building social and health equity.


CARVALHO, G. A saúde pública no Brasil. Estud. Av. [online]. 2013, vol. 27, no. 78, pp. 7-26, ISSN 0103-4014 [viewed 24 April 2017]. DOI: 10.1590/S0103-40142013000200002. Available from:

MOREIRA, M. R., RIBEIRO, J. M. and OUVERNEY, A. M. Obstáculos políticos à regionalização do SUS: percepções dos secretários municipais de Saúde com assento nas Comissões Intergestores Bipartites. Cienc. Saude Colet. [online]. 2017, vol. 22, no. 4, p. 1097-1108, ISSN 1413-8123 [viewed 24 April 2017]. DOI: 10.1590/1413-81232017224.03742017. Available from:

REIS, A. A. C., et al. Reflexões para a construção de uma regionalização viva. Ciênc. saúde coletiva [online]. 2017, vol. 22, no. 4, pp. 1045-1054, ISSN 1413-8123 [viewed 24 April 2017]. DOI: 10.1590/1413-81232017224.26552016. Available from:

RIBEIRO, J. M., et al. Políticas de saúde e lacunas federativas no Brasil: uma análise da capacidade regional de provisão de serviços. Ciênc. saúde coletiva [online]. 2017, vol. 22, no. 4, pp. 1031-1044, ISSN 1413-8123 [viewed 24 April 2017]. DOI: 10.1590/1413-81232017224.03732017. Available from:

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Ciência & Saúde Coletiva: <>


Translated from the original in Portuguese by Lilian Nassi-Calò.


Como citar este post [ISO 690/2010]:

MINAYO, M.C.S. and GUALHANO, L. Health systems in Brazil and regionalization policies [online]. SciELO in Perspective | Press Releases, 2017 [viewed ]. Available from:


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