63. Advances, challenges, and prospects for the Unified Health System (SUS) resilience

Paschoalotto, M. A. C., Lazzari, E. A., Castro, M. C., Rocha, R., & Massuda, A. (2025). Advances, challenges, and prospects for the Unified Health System (SUS) resilience. Ciência & Saúde Coletiva, 30(6). https://doi.org/10.1590/1413-81232025306.22072024enThis qualitative and exploratory study analyzes the resilience of Brazil’s Unified Health System (SUS), defined as the ability to prepare for, respond to, manage, and learn from shocks, including political, economic, climatic, and public health crises. Based on 30 interviews with academics and practitioners, the study evaluates five key dimensions: governance, financing, resources, service delivery, and context. It identifies 32 advances, 40 challenges, and 32 perspectives. Governance advances include constitutional protection, strong local leadership, and independent regulatory agencies, though instability and weak regulation remain obstacles. Financing is undermined by chronic underfunding and spending freezes, despite some progress through earmarked resources and emergency COVID-19 funds. Resource strengths include workforce expansion, robust infrastructure, and vaccine production capacity, but inequalities and import dependency persist. Service delivery highlights a globally recognized primary care system, though coverage stagnated after 2016. Social determinants worsened after 2015, reversing poverty reduction gains. The study concludes that SUS resilience, while tested, remains vital but requires daily reinforcement through stronger governance, funding, and equity.