Before SUS, access to public healthcare in Brazil was not a universal right. The public system was largely linked to Social Security and primarily served workers who were formally enrolled in it. Those outside the system often depended on private services or philanthropic institutions.
The Creation of SUS (Unified Health System)
The creation of the Unified Health System, SUS, was the result of a broader movement through the health reform that gained strength during the 1970s and 1980s. The movement advocated for a different way of understanding health: not only as the treatment of diseases, but as a social right connected to the living conditions of the population.
The 8th National Health Conference, held in 1986, was an important milestone in this process. Its proposals helped shape the health provisions of the 1988 Brazilian Constitution, which established healthcare as a right for all and laid the foundation for SUS.
Article 196 of the Constitution establishes that “health is a right for all and a duty of the State”. Based on this principle, a system was built around universal access and community participation. SUS was regulated in 1990 by Law No. 8,080, which established its organization and operation, and by Law No. 8,142, also enacted in 1990, which defined social participation through health councils and conferences.
What does having a universal healthcare system mean in practice?
For Brazilians, SUS can mean the local primary healthcare clinic where they get vaccinated, the emergency room they go to after an accident, medication provided free of charge, or a hospital where they undergo complex treatment.
The healthcare network ranges from primary care and disease prevention to specialized services, emergency care, hospital treatments, organ transplants, and home-based care.
The system is also much larger than it may seem. Its operation involves federal, state, and municipal governments, healthcare professionals, laboratories, hospitals, pharmacies, and different levels of care. Primary care, especially through services such as Basic Health Units (UBSs), plays an important role in prevention and patient follow-up before their conditions require more extensive treatment.
For the professionals who work within this structure, however, SUS is not just a set of policies, hospitals, and numbers. It is a system experienced through individual stories.
For Ingrid Silva, a general practitioner who works in São Paulo’s public healthcare network, the story of a patient named Lavine illustrates this difference.
“Lavine’s story shows that she is not a number; she is a person. She lived in the pediatric ICU for a year and a half because she had nowhere else to go. It became her home, and she was welcomed by the entire healthcare system that worked there.”
Lavine’s story also highlights one of SUS’s principles: comprehensive care, which means addressing patients’ different healthcare needs rather than focusing only on a specific disease.
Challenges Faced by SUS
Although many people benefit from treatments through SUS every day, this does not mean that the system operates without difficulties. A universal network serving a country of continental dimensions with more than 210 million people must coordinate different levels of government, regions with limited resources, and an enormous variety of demands.
Healthcare professionals working within SUS face these challenges in their daily routines: dealing with a large number of patients, facing infrastructure limitations, a lack of adequate resources, and trying to provide appropriate care within the available conditions.
“In my experience, a doctor can see around 70 to 80 patients during a 12-hour shift within SUS. Many people are accessing one system, and you only truly understand the scale of it by experiencing the daily routine”, says Ingrid.
At the same time, the existence of a universal system means that access to healthcare does not depend exclusively on a person’s ability to pay. This difference is especially important in a country marked by significant social and economic inequalities.
SUS also reaches people who may not even realize that they have already benefited from it. Vaccination campaigns, epidemiological surveillance, health inspections, emergency services, and organ transplants are among the activities that are part of the public healthcare network.
More than three decades after its constitutional creation, SUS therefore exists in two dimensions at the same time. On one hand, there is an enormous structure: laws, hospitals, healthcare facilities, professionals, governments, funding, and millions of patients. On the other, there are stories like Lavine’s: that structure becomes something much more intimate, a place where a person was cared for when she had nowhere else to go.
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The article above was edited by Isabella Simões.
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