The ''Sistema Único de Saúde'' (, ''Unified Health System''), better known by the acronym SUS, is
Brazil
Brazil ( pt, Brasil; ), officially the Federative Republic of Brazil (Portuguese: ), is the largest country in both South America and Latin America. At and with over 217 million people, Brazil is the world's fifth-largest country by area ...
's
publicly funded health care
Publicly funded healthcare is a form of health care financing designed to meet the cost of all or most healthcare needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are se ...
system. Created in 1989, the SUS is the largest government-run public health care system in the world, by number of beneficiaries/users (virtually 100% of the Brazilian population; 220 million people), land area coverage (3.3 million square miles), and affiliated network/number of treatment centers (over 50,000 clinics). The system is entirely free of any cost at the point of service for any person, including foreigners.
Creation
After the end of
the military dictatorship that had ruled the country for 20 years from the 1960s to the 1980s, the 1988
Constitution of Brazil
The Constitution of the Federative Republic of Brazil ( pt, Constituição da República Federativa do Brasil) is the supreme law of Brazil. It is the foundation and source of the legal authority underlying the existence of Brazil and the feder ...
sought to guarantee more rights and freedoms to the population, and set many objectives of social development. Among those, improving health care was set as a priority:
Two years later on Wednesday, 19 September 1990, the objectives set in the constitution were consolidated in the letter of the law by the Federal Law Number 8.080, whose articles created the SUS and defined its actuation.
Prior to that, only people who contributed with the
social security
Welfare, or commonly social welfare, is a type of government support intended to ensure that members of a society can meet basic human needs such as food and shelter. Social security may either be synonymous with welfare, or refer specificall ...
were able to receive health care. The creation of the SUS was important in that more than 80% of the Brazilian population depend on it to receive medical treatment. Brazil provides
two-tier health care
Two-tier healthcare is a situation in which a basic government-provided healthcare system provides basic care, and a secondary tier of care exists for those who can pay for additional, better quality or faster access.
Most countries have both pu ...
, and almost 25% of the population pay for private insurance.
Objectives
![Manguinhos_fiocruz1](https://upload.wikimedia.org/wikipedia/commons/2/25/Manguinhos_fiocruz1.jpg)
The SUS's objectives are, by the law of its creation, defined as:
* The identification and publication of determinant and conditioning factors for human health;
* The formulation of the health policy;
* Assistance to the people through actions of promotion, protection and recuperation of health, with the integrated realization of assistance actions and preventive activities;
*
Sanitation
Sanitation refers to public health conditions related to clean drinking water and treatment and disposal of human excreta and sewage. Preventing human contact with feces is part of sanitation, as is hand washing with soap. Sanitation systems ...
and
health surveillance Health surveillance may refer to:
* Public health surveillance
* Workplace health surveillance
Workplace health surveillance or occupational health surveillance (U.S.) is the ongoing systematic collection, analysis, and dissemination of exposure ...
;
*
Epidemiological
Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population.
It is a cornerstone of public health, and shapes policy decisions and evidenc ...
vigilance;
*
Occupational safety
Occupational safety and health (OSH), also commonly referred to as occupational health and safety (OHS), occupational health, or occupational safety, is a multidisciplinary field concerned with the safety, health, and welfare of people at wor ...
and health;
* Integral therapeutic assistance, including pharmaceutic;
* Organization of the formation of
health human resources
Health human resources (HHR) – also known as human resources for health (HRH) or health workforce – is defined as "all people engaged in actions whose primary intent is to enhance positive health outcomes", according to World Health Organizati ...
;
* Nutritional vigilance and orientation;
* Collaboration with the protection of environment, including work environment;
* Formulation of policies regarding
drugs
A drug is any chemical substance that causes a change in an organism's physiology or psychology when consumed. Drugs are typically distinguished from food and substances that provide nutritional support. Consumption of drugs can be via inhalat ...
,
equipment
Equipment most commonly refers to a set of tools or other objects commonly used to achieve a particular objective. Different job
Work or labor (or labour in British English) is intentional activity people perform to support the needs and ...
, immunobiologicals and other resources of interest for human health, and participation in its production;
* The control and fiscalization of services, products e substances of interest for human health;
* The fiscalization and inspection of food, water and beverages for human consumption;
* The participation in the control and fiscalization of the production, transportation, safety and utilization of
radioactive
Radioactive decay (also known as nuclear decay, radioactivity, radioactive disintegration, or nuclear disintegration) is the process by which an unstable atomic nucleus loses energy by radiation. A material containing unstable nuclei is consid ...
, toxic, and psychoactive substances and products;
* Scientific and technological developments in its area of actuation;
* The formulation and execution of the national policy for blood and its derivatives.
Constitutional principles
A closer look at the Health section, (of the Article 196 to the Article 198) of the Constitution, shows that five basic principles have been established that guide the legal system in relation to SUS. They are: universality (Article 196), integrality (Article 198-II), equity (Article 196 - "universal and equal access"), decentralization (Article 198-I) and social participation (Article 198-III).
Universality
This principle can be obtained from the definition of the Article 196, which considered health as a "right of all and duty of the State". Thus, the
right to health
The right to health is the economic, social, and cultural right to a universal minimum standard of health to which all individuals are entitled. The concept of a right to health has been enumerated in international agreements which include the U ...
is a fundamental right of any and all citizens, even being considered a clause set in stone, that is, it cannot be removed from the Constitution under any circumstances, as it constitutes an individual right and guarantee, according to the Section of the Legislative Process, the Article 60, the Paragraph 4, the Item IV.
Comprehensiveness
Completeness, according to the Article 198, in the Item II, confers on the State the duty of “comprehensive care, with priority for preventive activities, without prejudice to assistance services” in relation to the access that any and every citizen is entitled to. For this reason, the State must establish a set of actions that range from prevention to curative assistance, at the most diverse levels of complexity, as a way of implementing and guaranteeing the postulate of health.
“Man is an integral, biopsychosocial being, and he must be served with this integral vision by a health system that is also integral, aimed at promoting, protecting and restoring his health.”
Equity
The principle of equity is related to the constitutional mandate that “health is the right of all”, provided for in the aforementioned Article 196 of the Constitution. The aim here is to preserve the postulate of isonomy, since the Constitution itself, in Individual and Collective Rights and Duties, the Article 5, establishes that “all are equal before the law, without distinction of any kind”. Therefore, all citizens, equally, must have their health rights guaranteed by the State. However, regional and social inequalities can lead to the innocence of this isonomy, after all, a more needy area may demand more spending compared to others. For this reason, the State must treat "unequal unequals", concentrating its efforts and investments in territorial areas with the worst rates and deficits in the provision of public services.
Equal access (equity principle) does not mean that the SUS should treat everyone equally, but rather respect the rights of everyone, according to their differences, based more on the intimate conviction of natural justice than on the letter of the law.
Decentralization
It is established in Da Saúde, the Article 198, that “public health actions and services are part of a regionalized and hierarchical network and constitute a single system, organized according to the following guidelines: I - decentralization, with a single direction in each sphere of government
..”. For this reason, the Unified Health System is present at all federal levels — Union, States, Federal District and Municipalities — so that what falls within the scope of national coverage will be the responsibility of the Federal Government, which is related to the competence of a State must be under the responsibility of the State Government, and the same definition occurs with a Municipality. In this way, a greater dialogue is sought with the local civil society, which is closer to the manager, to ask him about the appropriate public policies.
Throughout the years, the Brazilian Unified Health System (SUS) has undergone a significant decentralization process. This process has allowed greater participation in health care decision-making among the state, federal and municipal levels of government. Likewise, this has encouraged social participation in health policy legislation and increased accountability for providing health care services.
Social participation
It is also foreseen in the same Article 198, the Item III, the “participation of the community” in the actions and public health services, acting in the formulation and in the control of their execution. Social control, as this principle is also called, was better regulated by the aforementioned Federal Law Number 8,142 of 1990. Users participate in the management of the SUS through the Health Conferences, which take place every four years at all federal levels - Union, States, Federal District and Municipalities. In Health Councils, there is a so-called parity: while users have half of the vacancies, the government has one room and workers another. Therefore, it seeks to encourage popular participation in the discussion of public health policies, giving greater legitimacy to the system and the actions implemented.
Nevertheless, it is observed that the Original Constituent of 1988 did not seek only to implement the public system of universal and free health in the country, in contrast to what existed in the military period, which favored only workers with a formal contract. It went further and also established principles that would guide the interpretation that the legal world and the spheres of government would make about the aforementioned system. And from the reading of these principles, the Constituent concern to reinforce the defense of the citizen before the State is noticed, guaranteeing means not only for the existence of the system, but also for the individual to have a voice to fight for its improvement and greater effectiveness.
References
External links
Health National Website (in english)DataSUS official websiteby Lenaura Lobato
{{DEFAULTSORT:Sistema Unico de Saude
Government agencies of Brazil
Medical and health organisations based in Brazil
Publicly funded health care