Brazil’s powers collaborate on public health policy
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Brazil’s Federal Constitution assigns specific roles to the Executive, Legislative, and Judicial branches in delivering healthcare to citizens.
The country’s Unified Health System (SUS), established in the 1990s, aims to provide universal access to health services and improve life expectancy, becoming a model for social inclusion in healthcare. The Constitution divides responsibilities for the SUS among these three branches of government and the federal, state, and municipal levels, emphasizing cooperation between them.
The Executive Branch implements health policies, managing services and resources across all levels of government. The Union formulates, coordinates, regulates, and evaluates national health policies, while states act as a link between the Union and municipalities, supporting medium and high-complexity care. Municipalities deliver the majority of services directly to the population. In 2023, the Union accounted for 40% of health funding at 179.8 billion reais, while states and municipalities contributed 27% and 34% respectively.
The Legislative Branch approves the financial viability of public health policies by analyzing the Multi-Year Plan, Budget Guidelines Law, and Annual Budget Law. Lawmakers can also propose new health policies, with the caveat that laws concerning administrative organization and resource allocation fall under the exclusive authority of the Executive Branch. The Judiciary generally intervenes when health rights are violated, often through lawsuits seeking access to treatments, and played a key role in establishing free HIV medication during the AIDS epidemic.
In 2025, 168,000 of the 368,000 cases in the justice system involved requests for medication.
