Unified Health System (SUS):

structure, principles and how it

works
What is the Unified Health System (SUS)?
The Unified Health System (SUS) is one of the largest and most complex public health systems in
the world, ranging from simple care for blood pressure assessment, through Primary Care, to
organ transplantation, ensuring comprehensive, universal access and free for the entire population
of the country. With its creation, the SUS provided universal access to the public health system,
without discrimination. Comprehensive health care, and not just assistance care, became a right of
all Brazilians, from pregnancy and throughout life, with a focus on health with quality of life, aiming
at prevention and health promotion.
The management of health actions and services must be solidary and participatory between the
three entities of the Federation: the Union, the States and the municipalities. The network that
makes up the SUS is extensive and covers both actions and health services. It encompasses
primary care, medium and high complexities, urgent and emergency services, hospital care,
actions and services of epidemiological, sanitary and environmental surveillance and
pharmaceutical assistance.
ADVANCEMENT: According to the Federal Constitution of 1988 (CF-88), “Health is a right for all
and a duty of the State”. In the period prior to CF-88, the public health system provided assistance
only to workers linked to Social Security, approximately 30 million people with access to hospital
services, while other citizens were responsible for philanthropic entities.

Structure of the Unified Health System (SUS)

The Unified Health System (SUS) is composed of the Ministry of Health, States and Municipalities,
as determined by the Federal Constitution. Each entity has its co-responsibilities.

Ministry of Health
National SUS manager, formulates, regulates, inspects, monitors and evaluates policies and
actions, in conjunction with the National Health Council. He works within the scope of the Tripartite
Inter-manager Commission (CIT) to agree on the National Health Plan. , Funasa, Anvisa, ANS,
Hemobrás, Inca, Into and eight federal hospitals.

State Department of Health (SES)

It participates in the formulation of health policies and actions, provides support to municipalities in
conjunction with the state council, and participates in the Bipartite Inter-Management Commission
(CIB) to approve and implement the state health plan.

Municipal Health Department (SMS)

It plans, organizes, controls, evaluates and executes health actions and services in conjunction
with the municipal council and the state level to approve and implement the municipal health plan.

Health Advice
The Health Council, within its scope of action (National, State or Municipal), on a permanent and
deliberative basis, a collegiate body composed of government representatives, service providers,
health professionals and users, works to formulate strategies and control the execution of health
policy in the corresponding instance, including economic and financial aspects, whose decisions
will be ratified by the head of the legally constituted power in each sphere of government.
It is up to each Health Council to define the number of members, which will obey the following
composition: 50% of entities and movements representing users; 25% of entities representing
health workers and 25% representing government and private service providers with agreements,
or non-profits.

Tripartite Interagency Committee (CIT)

Forum for negotiation and agreement between federal, state and municipal managers regarding
the operational aspects of the SUS

Bipartite Intermanagers Committee (CIB)

Forum for negotiation and agreement between state and municipal managers regarding the
operational aspects of the SUS

National Council of Health Secretary (Conass)

Representative entity of state and Federal District entities at CIT to deal with matters related to
health

National Council of Municipal Health Secretariats

(Conasems)
Representative entity of municipal entities in the CIT to deal with matters related to health

Councils of Municipal Health Secretariats (Cosems)

They are recognized as entities that represent municipal entities, at the state level, to deal with
matters related to health, as long as they are institutionally linked to Conasems, as provided for in
their statutes.