Health care in big cities: challenges to the consolidation of SUS

Abstract

The implementation of SUS in Brazil has represented an important inflection in the pattern of State intervention in health, by instituting the notion that health is a right of all people and a duty of the State. Since the establishment of the constitutional guarantee, health services have considerably expanded, especially at the primary care level under municipal management. However, access to the other levels remains a challenge. This goes sharply against the notion of the right to healthcare and the principles of equity and integrality. This paper examines the constraints to integrality in healtcare, drawing on the experiences of Rio de Janeiro’s metropolitan region II.