SUS principles: what they are and how they apply

The creation of Brazil’s Unified Health System (SUS) was the result of a broad social, political and public health movement that redefined the role of the State in guaranteeing the right to health in Brazil.

Established by the 1988 Federal Constitution, at a time of redemocratization in the country, SUS was created with the purpose of making access to healthcare universal, reducing historical inequalities and integrating actions that until then had been fragmented and exclusionary. Before that, access to public health services was closely tied to social security contributions.

In this context, the principles of SUS are not just operational rules. They express the logic that has underpinned the system since its origin: health as a right of all and a duty of the State.

What are the principles of SUS?

The principles of the Unified Health System (SUS) are the set of legal, ethical and organizational foundations that guide the design, management and execution of public health policies in Brazil. They are set out in the 1988 Federal Constitution and detailed in Law No. 8,080/1990, the Organic Health Law.

In practice, these principles define:

• how SUS should work;

• who should be served;

• how services are organized;

• which values should guide the system’s decisions.

For teaching purposes, the principles of SUS are organized into two groups: doctrinal principles and organizational principles.

Doctrinal principles of SUS

The doctrinal principles express the core values of SUS and support the conception of health as a social right and a universal public policy.

Universality

Universality guarantees that everyone has the right to access health actions and services, at all levels of care, without any form of discrimination. In SUS, there is no selection by income, employment or prior contribution, which ensures the public and inclusive nature of the system.

Comprehensiveness

Comprehensiveness establishes that healthcare must consider the individual as a whole, not just as the bearer of a disease or an isolated symptom. This principle guides the continuous coordination of health promotion, disease prevention, diagnosis, treatment and rehabilitation, at all levels of complexity.

Equity

Equity is a principle of social justice. It recognizes that people, groups and territories start from different conditions and therefore require different responses from the health system. In practice, it means directing more resources and effort to those who need them most, with the aim of reducing historical, social and regional inequalities.

Organizational principles of SUS

The organizational principles define how the system should be structured and operated so that the doctrinal principles become reality. They guide management, the organization of the service network and the distribution of responsibilities among the levels of government.

Decentralization

Decentralization distributes responsibilities among the federal government, states and municipalities, with an emphasis on the role of municipalities in delivering health actions and services. Each level of government has a single line of command, respecting its legal and administrative competences.

Regionalization

Regionalization organizes health services into health regions, based on epidemiological, geographic and population criteria. This model seeks to ensure orderly and rational access to services, avoiding gaps in care.

Hierarchization

Hierarchization structures the care network into levels of increasing complexity, such as primary, specialized and hospital care. Access should be coordinated, with primary care as the preferred entry point into the system.

Community participation

Social participation ensures that the population takes part in overseeing and shaping health policies, through bodies such as health councils and health conferences. This principle reinforces the democratic and transparent nature of SUS.

Problem-solving capacity

Problem-solving capacity guides health services to offer effective responses to the population’s needs, seeking to solve problems at the most appropriate level of care, with quality and continuity of care.

Integration and rational organization of services

SUS must coordinate health, environmental and basic sanitation actions, recognizing that the determinants of health go beyond medical care. In addition, services must be organized to avoid duplication of means and effort, promoting the efficient use of financial, human and technological resources.

Complementary role of the private sector

The private sector plays a complementary role when SUS contracts private services to meet demand that the public network does not cover, always under state regulation and as a complement, never a substitute.

Which SUS principle aims to guarantee equal access?

The principle that aims to guarantee equal access is equity. It adjusts the supply of services to social, economic and regional inequalities, making access fairer and proportional to the population’s needs.

What is the difference between the principles and the guidelines of SUS?

The principles express the system’s values and foundations. The guidelines, in turn, guide how it operates. They are what translate the principles into concrete models of organization, management and care.

SUS principles and guidelines: a practical summary

• Universality: everyone has the right to health.

• Comprehensiveness: complete, coordinated care.

• Equity: treating unequal situations unequally to promote justice.

• Decentralization: management shared among levels of government.

• Regionalization and hierarchization: organization by territory and complexity.

• Social participation: public oversight of public policies.

How is SUS funded?

The funding of the Unified Health System is structured to sustain a universal public system in a country of continental dimensions. At the federal level, the main instrument of this funding is the National Health Fund (FNS) , responsible for the financial management of the resources allocated to SUS.

Created in 1969, even before the 1988 Constitution, the FNS took on a central role with the institutionalization of SUS, becoming the main operational mechanism for federal public health funding. Through it, the expenditures of the Ministry of Health, its bodies and the direct and indirect administration entities that make up the system are executed.

Beyond budget execution, the National Health Fund acts as an instrument of planning, management and control, allowing the use of public health resources to be tracked on an ongoing basis. This model seeks to ensure transparency, traceability and alignment between funding, public policies and the population’s care needs.