Helenitta Melo da Silva Alves, Juliana Reis de Alcantara, Simonia Mara De Oliveira, Karen de Fátima Figueroa Bohórquez · 8 authors
Brazil's Unified Health System (Sistema Único de Saúde-SUS) represents one of the world's largest publicly funded universal healthcare systems, providing comprehensive healthcare services to more than 200 million citizens. Established through the 1988 Federal Constitution and regulated by subsequent legislation, the SUS is founded on the principles of universality, comprehensiveness, equity, decentralization, regionalization, and social participation. These principles have enabled substantial advances in health indicators, expanded access to essential services, and reduced historical inequalities in healthcare provision. Nevertheless, the system currently faces increasingly complex challenges associated with demographic transitions, epidemiological changes, chronic underfunding, regional disparities, technological innovation, workforce shortages, judicialization of healthcare, and the growing demand for high-cost medical technologies. This academic essay critically examines the constitutional principles underlying the SUS and analyzes the contemporary barriers that threaten the effective realization of universal access to healthcare in Brazil. By integrating theoretical discussions with institutional and policy perspectives, the essay explores how structural, political, economic, managerial, and demographic factors influence the sustainability of universal health coverage. The discussion also reflects upon future strategies capable of strengthening governance, financing, digital transformation, and public management while preserving the constitutional commitment to health as a fundamental social right.
Gislani Mateus Oliveira Aguilar, Luciana Freire de Carvalho, Caio Luiz Pereira Ribeiro, João Roberto Cavalcante · 8 authors
This article describes the trajectory of the city of Rio de Janeiro in facing public health emergencies between 2021 and 2024, based on three axes of action proposed by the World Health Organization (WHO): preparedness, surveillance, and response. Innovation in timely data analysis from non-conventional information sources has enabled an early detection of events, promoting reorientation in health surveillance practices. The construction of a strong institutional identity, as well as the coordination of response actions in Emergency Operations Centers, contributed to the consolidation of a culture of rapid response and networking. The integration of primary health care (PHC) and surveillance networks guaranteed a continuity of care and coordinated risk management, highlighting the importance of a decentralized health system that seeks intersectorality in responding to emergencies. The advances observed in combating the COVID-19 and dengue epidemics during this period in the city were driven by adequate investments in structure and human resources, emphasizing the importance of continuous financing and strategic planning aimed at this model of care.
This article analyzes Brazil's Unified Health System (SUS), established by the 1988 Constitution. The article initially presents the previous trajectory of national health policy and the context of democratization in the 1980s, which favored health reform and created a public, universal, and comprehensive health system. It then explores the advances and contradictions recorded in more than three decades of implementation of the SUS. The main advances observed were the creation of institutional mechanisms compatible with the federative arrangement and social participation, political and administrative decentralization, the national expansion of access to health, changes in the health care model, including strengthening primary care, and improvements in health indicators. On the other hand, the persistence of structural problems and disputes between different health agendas, with differences between governments, led to contradictions in financing and public-private relations in health. Despite the differences between countries, the analysis of the Brazilian case provides lessons on the challenges in building universal health systems in Latin America.
Jorge Lima de Magalhães, Daniela Flores Fernandes, Vítor Coutinho, Filipe Telles · 6 authors
The Brazilian and Portuguese healthcare systems differ in structure, financing and accessibility. They are similar in terms of decentralization of services, coexistence of public and private health providers and universality and comprehensiveness. The Unified Health System is financed by the federal, state, and municipal governments and is free for everyone. Given the territorial size and economic and social inequality in Brazil, the quality of care can vary greatly, with disparities in access to healthcare between its regions. In Portugal, the National Health Service offers universal and largely free tax-funded coverage and provides comprehensive care, but long waiting times can be a problem. Both systems face challenges such as an aging population and budget constraints. This study pointed out that in addition to appropriate financing and the reorganization of models, academic knowledge can assist in improvement actions and public policies.
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This case study aimed to characterize the Specialized Component of Pharmaceutical Services (CEAF) organization in four Brazilian states from diverse regions of the country. Data were collected with representatives of CEAF management from states in different regions, who answered a 21-question questionnaire on scope, organization, financing, hurdles, and facilitators. This information was complemented with data from national health surveys, DataSUS, the applied resources, and socioeconomic indicators. Differences were observed between states on issues such as the proportion of users and the decentralization of services. These characteristics seem to be related to the level of development concerning the socioeconomic indicators used. Advances in access to medicines were highlighted, despite the difficulties complying with the CEAF's objectives, such as insufficient resources, the qualification of human resources, and the provision of necessary visits and exams. The results point to advances, different forms of organization and highlight the need for more in-depth studies on the clinical and economic outcomes achieved as a strategy to outline solutions to achieve the comprehensive and equal care for users.
Open access
Public Health in Brazil
Health, Nursing, Elderly Care
Health Systems, Economic Evaluations, Quality of Life
The National Health System, being named unique in the Constitution because it refers to a set of elements, such as universalization, equity, integrality, decentralization and popular participation and which is in convergence with the Constitution of 1988 of the Federative Republic of Brazil, which states that health is a right of all and a duty of the State.Thus, with the creation of SUS, the entire Brazilian population now has the right to universal and free health care , financed with resources from the budgets of the Union, the States, the Federal District and the Municipalities, as regulated by article 195 of the Brazilian Constitution. It is noteworthy that SUS is one of the most powerful and important in the world and it serves about 220 million people. It is characterized by a foundation of three pillars: universality, integrality and equity.
Abstract The implementation of a medical course in a city in the Brazilian northeastern region to expand and decentralize medical education as a result of the Project More Doctors for Brazil includes the institutionalization process that takes into consideration cultural and organizational aspects that facilitate or hinder the accomplishment of innovative practices. This study analyzed the implementation process according to key categories: pedagogical project, teaching-service integration, teacher development and infrastructure. The results showed facilitating elements and barriers that depend on the movement among the proposal’s instituted forces, instituting forces and the institutionalization process. A strategy for greater feasibility can be found in autonomous movements triggered by subjects who are committed to the objectives of the involved courses and institutions that work towards making legislations and intentions real.
José Carvalho de Noronha, Gustavo Souto de Noronha, Telma Ruth Pereira, Ana Maria Costa
This article reflects on the future of the Brazilian Unified Health System (SUS, acronym in Portuguese), based on the foresight exercises conducted by the Brasil Saúde Amanhã initiative of the Oswaldo Cruz Foundation. The text briefly reviews some paths followed by the SUS as referred to in the Federal Constitution of 1988. It highlights the movement towards the decentralization of care and the constraint of health financial resources that reduced policies of increasing public expenditures. It examines the public and private arrangements for financing and provision of services that have resulted in sectoral privatization, mainly from economic policies articulated with concession of fiscal benefits. It analyzes the changes in the public sector financing through successive constitutional amendments that resulted in the weakening of established social protection policies, particularly of the health sector. For the future, the text considers population aging and analyzes trends in the epidemiological profile, with consequent changes in the health care paradigm. The article concludes by pointing out the consequences of fiscal strangling in the organization of the healthcare system and the need to reverse legal provisions that hamper the fulfillment of the constitutional mandate for equity and universality.
The research carried out was intended to show the centrality of the financing model as a federative coordination mechanism in the process of institutionalization of the social assistance policy initiated after the implementation of the Unified Social Assistance System in the mid - 2000s. For this, a theoretical revision was made on the relations between federalism, decentralization and social policies, followed by stages of conceptual and documentary analysis about the decentralization process of social assistance policy and the construction of the current financing model; and quantitative and qualitative analysis of data on the institutionalization and operationalization of social assistance financing. In order to operationalize the hypotheses and analytical questions proposed, the research was based on the study of the case of the government of the State of Minas Gerais and municipalities, from 2005 to 2016. The results showed that the processes of institutional transformation of the social assistance policy financing model led to the installation of institutional capacity in the municipalities and the state of Minas Gerais. In the case of municipalities, institutional capacity was followed by the growth of resources in the sector, with gains even in relative importance compared to other public expenditures. In the case of the state government, the results found showed weaknesses in the process of assumption of federal responsibility, evidenced by the non-regularity of expenditures and the transfer of co-financing to municipalities and the low volume of resources executed. As for the model of co-financing, the sharing of resources among the municipalities of Minas Gerais generates an equitable and redistributive distribution, favoring the municipalities that concentrate the largest population in a situation of vulnerability. Thus, it is suggested that the financing model has contributed to the consolidation of the federative accountability process, and, ultimately, to the implementation of the decentralized Brazilian social security.
Lucília Nunes de Assis, Eliete Albano de Azevedo Guimarães, Juliana Vaz de Melo Mambrini, Filipe Curzio Laguardia · 7 authors
Introduction: The Health Surveillance Strengthening Project implemented in 2012 in Minas Gerais -subsidized by a local diagnosis- aimed at decentralizing Health Surveillance. Objectives: To characterizes the local Health Surveillance services in the state of Minas Gerais in 2014. Method: Descriptive study that analyzed 527 (62%) out of a total of 853 counties. The common variables to the Health Surveillance areas were instruments of management, financing, professional category, qualification and information system. Specific variables to the Health Surveillance areas were characterized infrastructure, reference services and actions. Frequencies, medians, interquartile differences and Spearman’s coefficient (p< 0.05) were analyzed. Results: An association among mana-gement tools, availability of professional categories, information system and population size (p<0.001) was observed. Insufficient infrastructure in the Sanitary and Environmental Surveillance and predominance of programmatic actions against monitoring actions were observed. Conclusions: The challenge of Health Surveillance demands confrontations in the field of management, practices and financing.
Ademar Arthur Chioro dos Reis, Ana Paula Menezes Sóter, Lumena Almeida Castro Furtado, Silvana Souza da Silva Pereira
Decentralization and regionalization are strategic themes for reforms in the health system. This paper analyzes the complex process of health regionalization being developed in Brazil. This paper identifies that the normative framework from the Brazilian National Health System, SUS has made advances with respect to its institutionalization and overcoming the initial centrality involved in municipalization. This has strengthened the development of regionalization and the intergovernmental agreement on health but the evidence points to the need to promote a revision. Based on document analysis, literature review and the views given by the authors involved in management in SUS as well as generating radically different views, the challenges for the construction of a regionalization that is active, is debated. We also discuss: its relations with planning and the dimensioning of service networks, the production of active care networks and shared management spaces, the inter-federative agreements and regional regulations, the capacity to coordinate regional systems and financing and the impact of the political dimension and electoral cycles. Regionalization (and SUS itself) is an open book, therefore ways and possibilities on how to maintain an active form of regionalization can be recommended.
Open access
Health, Nursing, Elderly Care
Interprofessional Education and Collaboration
Health Systems, Economic Evaluations, Quality of Life
This paper considers how financing, institutions, and metropolitan cooperation play into the provision of public services, specifically healthcare and education, in the Metropolitan Region of Campinas (RMC). Given that the municipal level of government is often too small to effectively provide public services, especially in the context of extensive decentralization, I argue that the metropolitan level of aggregation, for reasons including greater economies of scale, more efficient delivery of services and regional equity, constitutes a more relevant unit of service provision. The recent emergence of the Agência Metropolitana de Campinas (Agemcamp) offers the possibility for achieving greater metropolitan cooperation, leading to improved public services in the RMC.
Jovana Gardinali Malagueta, André Luiz Bigal, Érika Valeska Rossetto
Because of the decentralization of the management of public health and the absence of a reform of its financing, the municipalities started to significantly increase the volume of its own funds invested in this area. In this context, this study aimed to analyze the participation of federal entities - Federal, State and Municipalities - the financing of the Unified Health System (SUS) in the municipalities with 50,000 to 100,000 inhabitants, the Metropolitan Health Region of Campinas, from 2012 to 2014. An integrative literature review and survey data were carried out on the municipalities on the Public Budget using the Health System information. Seven articles were selected and analyzed in full. In relation to the data collected, it was found out that municipalities, state and Union fulfilled what determines the Law n° 141/2012; the three federal entities increased health expenses from one year to another; there was an increase of municipal resources at the local health expenditure and a decrease of Union involvement, and the participation of the State wasn’t significant enough. Thus, health financing, by the Union needs to be corrected and should state resources participate in a more significant way, being extremely necessary discussion of new sources of resources to allow more public investment increase in health.
Maria Helena Machado, Mônica Wermelinger, Monica Vieira, Eliane De Oliveira · 11 authors
O artigo tem como objetivo analisar os aspectos gerais da formação profissional dos trabalhadores da equipe de enfermagem. É um estudo transversal cuja população alvo é constituída por todos os enfermeiros, técnicos e auxiliares de enfermagem do Brasil, que possuem registro ativo no Conselho Federal de Enfermagem (COFEN). Os resultados enfatizam que a formação é realizada principalmente no setor privado e no Sudeste. Mostram ainda, que a maioria concluiu a graduação há menos de 10 anos e em horário parcial. Constata que 1/3 fez o curso de técnico e/ou auxiliar em enfermagem e em sua maioria exerceu a função. Já a formação dos técnicos e auxiliares é realizada pela iniciativa privada e em cursos noturnos, mais de 1/3 tem ou está realizando graduação e, desses 11,5% já concluíram e a maior parte demonstra interesse em continuar os estudos na própria área. As políticas públicas existentes não têm sido efetivas no sentido de desconcentrar o aparelho formador e o financiamento, bem como reverter o quadro de desequilíbrio entre oferta e demanda de profissionais. Os dados da pesquisa permitem subsidiar a construção de políticas públicas adequadas com a realidade desse imenso contingente de trabalhadores, fundamentais para o Sistema Único de Saúde.Descritores: Perfil da enfermagem, formação profissional, equipe de enfermagem.The article aims to analyze the general aspects of their training. It is a cross-sectional study whose target population consists of all nurses, technicians and nursing assistants from Brazil, which have active registration with the Federal Nursing Council (COFEN).The results emphasize that the training is carried out mainly in the private sector and in the Southeast. Still show that the majority concluded graduation less than 10 years and part-time. It notes further that 1/3 made the technical course and / or auxiliary nursing and mostly served the function. Already the training of technicians and assistants are held by the private sector and evening courses. Realize the data that more than one third have or are conducting graduate and, of these 11.5% have completed and most shows interest in continuing their studies in their own area. Still show the existing public policies have not been effective in order to decentralize the trainer device and financing, as well as reverse the imbalance between supply and demand picture professionals. The survey data may subsidize the construction of public policies adequate to the reality of the huge number of workers, fundamental for the National Health Sistem.Descriptors: Profile of nursing, vocational training, the nursing staff.El artículo tiene como objetivo analizar los aspectos generales de su formación. Se trata de un estudio transversal cuya población objetivo consta de todas las enfermeras, técnicos y auxiliares de enfermería de Brasil, que tienen el registro activo con el Consejo Federal de Enfermería (COFEN).Los resultados ponen de manifiesto que la formación se lleva a cabo principalmente en el sector privado y en el sureste. Aún muestran que la mayoría llegó a la conclusión de graduación inferior a 10 años y de tiempo parcial. Señala además que 1/3 hicieron el curso técnico y / o auxiliar de enfermería y en su mayoría se sirve la función.Ya la formación de los técnicos y auxiliares están en manos de los cursos del sector privado y de la tarde. Darse cuenta de los datos que más de un tercio han o están llevando a cabo de posgrado y, de éstos el 11,5% ha completado y la mayoría de los espectáculos de interés en continuar sus estudios en su propia área. Aún muestran las políticas públicas actuales no han sido eficaces, a fin de descentralizar el dispositivo de entrenador y la financiación, así como revertir el desequilibrio entre los profesionales de la oferta y la demanda de imagen. Los datos de la encuesta pueden subsidiar la construcción de políticas públicas adecuadas a la realidad de la gran cantidad de trabajadores, fundamental para el Sistema Único de Salud...Descriptores: El perfil de la enfermería, la formación profesional, el personal de enfermería.
Cristianne Maria Famer Rocha, Silvia Helena De Bortoli Cassiani
In recent decades, health care networks in diff erent parts of the world have incorporated new forms of social organization that involve extensive use of technology to produce and disseminate information and are based on the autonomous, non-hierarchical and decentralized cooperation and collaboration of those within these networks. In Latin American countries, Nursing Networks were created in the 2000s on the initiative of professionals seeking to exchange knowledge and experiences. Over time this initiative gained ground with the support and leadership of the Regional Council for Nursing and Health Technicians of the Pan American Health Organization (PAHO) and, in 2007 and, in 2007, the 1 st International Nursing Network Conference was held in Toledo (Spain), during the 9 th Ibero-American Conference of the Latin American Association of Nursing Schools (ALADEFE). These networks operate as a communication strategy, stimulating cohesion and cooperation between nurses interested in developing nursing care, management, research, information and education with a view to supporting the advancement of the profession and help countries achieve universal health care coverage and access to health services. There are currently around 25 International Nursing Networks in the Americas, which together form Rede EnfAmericas and consist of more than 3000 nurses in Latin America. Information on each of these networks is available at: http://www.
<strong>Background</strong> Regional-based Integrated Healthcare Networks (IHNs) have been promoted in Brazil to overcome the fragmentation due to the health system decentralization to the municipal level; however, evaluations are scarce. The aim of this article is to analyse the content of IHN policies in force in Brazil, and the factors that influence policy implementation from the policymakers’ perspective. <strong>Methods</strong> A two-fold, exploratory and descriptive qualitative study was carried out based on (1) content analysis of policy documents selected to meet the following criteria: legislative documents dealing with regional-based IHNs; enacted by federal government; and in force, (2) semi-structured individual interviews were conducted to a theoretical sample of policymakers at federal (eight), state (five) and municipal levels (four). Final sample size was reached by saturation of information. An inductive thematic analysis was conducted. <strong>Results</strong> The results show difficulties in the implementation of IHN policies due to weaknesses that arise from the policy design and the performance of the three levels of government. There is a lack of specificity as to the criteria and tools for configuring and financing IHNs that need to be agreed upon between involved governments. For their part, policymakers emphasize the difficulty of establishing agreements in a health system with disincentives for collaboration between municipalities. The allocation of responsibilities that are too complex for the capacity and size of the municipalities, the abandonment of essential functions such as network planning by states and the strategic role by the Ministry, the ‘invasion’ of competences among levels of government and high political turnover are also highlighted. <strong>Conclusions</strong> The implementation of regional-based IHN policy in Brazil is hampered by the decentralized organization of the health system to the municipal level, suggesting the need to centralize certain functions to regional structures or states and to define better the role of the government levels involved.
This study characterizes as an exploratory qualitative case study, with the aim of analyzing the foundations of federal and state funding in Primary Healthcare of the municipalities of the state of Bahia, bringing light upon current conflicts after the deployment of the Pact for Health as well as the uncertainties that surrounded its funding. Data were collected in two stages, the first semi-structured interviews were conducted with closed and open questions, applied to current managers of the State Council of Municipal Health Secretaries of the State of Bahia (BA-COSEMS/ Conselho Estadual dos Secretrios de Sade-BA), in the second stage, it was developed a document review, through reading and analysis of ordinances, resolutions, state and federal, as well as minutes of meetings of the Managers Bipartite Commission (Comisso Intergestores Bipartite-CIB), which dealt with the theme Politics and funding of primary healthcare. It was observed that the issues, in relation to health financing, particularly Primary Healthcare, persist even after the institution of the Pact for Health. Therefore, it was concluded that decentralization will succeed when the amount of financial resources needed to meet commitments assumed to serve the population is adequate, and also when there is regular funding, increased resources for health by the three spheres of government. It is estimated to be necessary to discuss the
This dissertation is a study on the organization form of the Brazilian Unified Health System -Sistema nico de Sade (SUS) that, according to article 198 of the Brazilian Federal Constitution, is a system of federative interdependence managed by autonomous entities, as set forth under article 18 of such Constitution. It adopts an interdisciplinary approach, with emphasis in the legal standpoint and interpretation of the major guidelines of the Principles embedded in the Constitution and the protection of the Basic Human right to Health. There is an initial focus on the conceptual framework of Federalism and the traditions where the Brazilian Model got its background. The Brazilian State and its organization form and structure for the Health are scrutinized: the role of the Federal State, its centralistic imposition and influence on SUS' management. The study analyses how the characteristics of federative interdependence and mutual relationship, are harmed by the strong presence of central authority, the Federal Government, through the Brazilian Health Ministry. Concerning the SUS, the federal centralism is materialized through the form of its financing, since a large amount of resources that supports it is assigned by the federal Government to programs and projects determined by federal scope, prevailing over a federal or decentralized system. That situation has a strong impact on SUS' organization, defining its priorities rather by the sources of its financing than by global health planning, that should have as its foundation the peoples need for health. The interdependence and autonomy require solutions that reaches a compromise between these contradictions, assuring to SUS a legal and administrative structure that allow overcoming its contradictions, in order to bring together an efficient system. To achieve this purpose, some ideas are presented, ideas that attempt to reconcile all required elements to a management that guarantees to citizens the right to health.
The article aimed to analyze the impacts of earmarking revenues and conditional transfers on the supply of health financing in Brazil. After analyzing the role of these Federal regulation mechanisms on decentralized healthcare administration, the article verified the effects on total expenditure in health and disaggregated by level of government, evaluated whether transfers by the Unified National Health System (SUS) were consistent with the evolution in the decentralized supply, and measured the inequalities in per capital health spending by municipalities. The conclusions showed the complementary relationship between earmarking revenues and conditional transfers according to supply, which: (1) increased the share of State and Municipal governments in health financing; (2) provided incentives for the decentralization of primary care according to Federal guidelines; and (3) reduced the inequalities between municipalities in per capita health expenditures.
Célia Regina Pierantoni, Ana Cláudia Pinheiro Garcia
BACKGROUND: The Brazilian health reform process, following the establishment of the Unified Health System (SUS), has had a strong emphasis on decentralization, with a special focus on financing, management and inter-managerial agreements. Brazil is a federal country and the Ministry of Health (MoH), through the Secretary of Labour Management and Health Education, is responsible for establishing national policy guidelines for health labour management, and also for implementing strategies for the decentralization of management of labour and education in the federal states. This paper assesses whether the process of decentralizing human resources for health (HRH) management and organization to the level of the state and municipal health departments has involved investments in technical, political and financial resources at the national level. METHODS: The research methods used comprise a survey of HRH managers of states and major municipalities (including capitals) and focus groups with these HRH managers - all by geographic region. The results were obtained by combining survey and focus group data, and also through triangulation with the results of previous research. RESULTS: The results of this evaluation showed the evolution policy, previously restricted to the field of 'personnel administration', now expanded to a conceptual model for health labour management and education-- identifying progress, setbacks, critical issues and challenges for the consolidation of the decentralized model for HRH management. The results showed that 76.3% of the health departments have an HRH unit. It was observed that 63.2% have an HRH information system. However, in most health departments, the HRH unit uses only the payroll and administrative records as data sources. Concerning education in health, 67.6% of the HRH managers mentioned existing cooperation with educational and teaching institutions for training and/or specialization of health workers. Among them, specialization courses account for 61.4% and short courses for 56.1%. CONCLUSIONS: Due to decentralization, the HRH area has been restructured and policies beyond traditional administrative activities have been developed. However, twenty years on from the establishment of the SUS, there remains a low level of institutionalization in the HRH area, despite recent efforts of the MoH.
This paper describes the Brazilian health system, which includes a public sector covering almost 75% of the population and an expanding private sector offering health services to the rest of the population. The public sector is organized around the Sistema Unico de Saude (SUS) and it is financed with general taxes and social contributions collected by the three levels of government (federal, state and municipal). SUS provides health care through a decentralized network of clinics, hospitals and other establishments, as well as through contracts with private providers. SUS is also responsible for the coordination of the public sector. The private sector includes a system of insurance schemes known as Supplementary Health which is financed by employers and/or households: group medicine (companies and households), medical cooperatives, the so called Self-Administered Plans (companies) and individual insurance plans. The private sector also includes clinics, hospitals and laboratories offering services on out-of-pocket basis mostly used by the high-income population. This paper also describes the resources of the system, the stewardship activities developed by the Ministry of Health and other actors, and the most recent policy innovations implemented in Brazil, including the programs saude da Familia and Mais Saude.
Luciane Cristina Feltrin de Oliveira, Marluce Maria Araújo Assis, André Renê Barboni
This study of theoretical revision discuss the Pharmaceutical Assistance in the Basic Units of Health, rescuing briefly the history of the National Drug Policy, the mechanisms of financing in the process of health decentralization and Pharmaceutical Assistance on the Basic Attention to Health. The expansion of the population access to the health system has demanded changes on drug distribution in order to increase the coverage and at the same time to reduce costs. It was identified advances in legal and institutional structures: the management decentralization of actions on pharmaceutical assistance; the expansion of the population access to essential medicines; and the establishment of the pharmaceutical assistance in some cities. However, it still persists priority actions in relation to the financing and population coverage, in detriment of quality processes. The conclusion is that, many Brazilian cities has low availability and discontinuity of essential medicine offer; dispensation by workers without qualification; inadequate conditions of storage that compromise the quality of medicines; medicine prescription that does not belong to the National Reference of Essential Medicines; and problems related to the access of users to the pharmacotherapy.
This article discusses the model of oral health care implemented in the Unified Health System of Brazil in the last decade. This model was conceived as a sub-sector policy that, over the years, has sought to improve the quality of life of the Brazilian population. Through a chronological line, the study presents the National Policy on Oral Health as a counter-hegemonic patient care model for the dentistry practices existing in the country before this policy was implemented. The reorganization of the levels of oral health care, the creation of reference facilities for secondary and tertiary care, through Centers of Dental Specialties and Regional Dental Prosthesis Laboratories, and the differential funding and decentralized management of financial resources were able to expand the actions of oral health for more than 90 million inhabitants. The evolution shown after the deployment of the National Oral Health Policy, as of 2004, demonstrates the greater integration of oral health care under the Unified Health System and provides feedback information to help this policy to continue to be prioritized by the Federal Government and receive more support from the state and local levels in the coming years.