Origins of successful health sector reform: Public health professionals and institutional opportunities in Brazil

During the 1990s Brazil saw the creation of a Unified Health System (SUS), based on the principals of universal and free access, fully integrated care, and decentralisation and participation, The reforms leading to SUS run counter to the international macroeconomic prescription of the time, which emphasised a reduction of the state's role in social policy, but are seen by many experts in the field as a reform success story. What are the origins of this reform? This article argues that the financial crises of the social security and the interaction between the sector's principal actors (military regime, techno-bureaucracy, private sector and Sanitarista movement made up of highly trained public sector health professionals) produced policies capable of introducing important changes of a reformist nature in the early 1980s. This interpretation contrasts to the most recurrent one in the national literature on the Brazilian health sector, which points to the 1988 Constitution as a sectoral turning point.