Federal University of Bahia, Salvador, Bahia, Brazil.
Lancet. 2011 May 21;377(9779):1778-97. doi: 10.1016/S0140-6736(11)60054-8. Epub 2011 May 9.
Brazil is a country of continental dimensions with widespread regional and social inequalities. In this report, we examine the historical development and components of the Brazilian health system, focusing on the reform process during the past 40 years, including the creation of the Unified Health System. A defining characteristic of the contemporary health sector reform in Brazil is that it was driven by civil society rather than by governments, political parties, or international organisations. The advent of the Unified Health System increased access to health care for a substantial proportion of the Brazilian population, at a time when the system was becoming increasingly privatised. Much is still to be done if universal health care is to be achieved. Over the past 20 years, there have been other advances, including investments in human resources, science and technology, and primary care, and a substantial decentralisation process, widespread social participation, and growing public awareness of a right to health care. If the Brazilian health system is to overcome the challenges with which it is presently faced, strengthened political support is needed so that financing can be restructured and the roles of both the public and private sector can be redefined.
巴西是一个幅员辽阔的国家，存在广泛的地区和社会不平等。在本报告中，我们考察了巴西卫生系统的历史发展和构成，重点关注过去 40 年的改革进程，包括创建统一卫生系统。巴西当代卫生部门改革的一个特点是，它是由民间社会推动的，而不是由政府、政党或国际组织推动的。统一卫生系统的出现增加了巴西相当一部分人口获得医疗保健的机会，而此时该系统正日益私有化。要实现全民医疗保健，还有很多工作要做。在过去 20 年中，还取得了其他进展，包括对人力资源、科学技术和初级保健的投资，以及广泛的权力下放进程、广泛的社会参与以及公众对医疗保健权利的认识不断提高。如果巴西卫生系统要克服当前面临的挑战，就需要加强政治支持，以便重新调整融资，并重新定义公共和私营部门的作用。
