Institutional configuration and administration of Brazil’s National Health System (SUS): problems and challenges

This paper analyzes the ‘institutionality’ of Brazil’s National Health System, stressing crucial aspects to be dealt with, due to a return to the Public Health Reform Project. The reflection focus on the System ́s institutional configuration, covering issues related to the process for its political and management conduct, rooted in the authoritarian/patrimonialistic organizational culture of the Brazilian State, entangled in red tape and colonized by private interests. It describes matters such as strategic resources/services management, hobbled by legal constraints imposed through economic policies, e.g. the Fiscal Liability Act; the inadequacy of subsidiary ‘alternatives’ suggested by managerialistic reforms cutting the System management processes; and the markedly amateur approach to administration due to the shortage of trained professionals and the ongoing clout of the old-boy network and pork-barrel politics when appointing civil servants to all level management positions. It presents arguments urging the introduction and consolidation of institutional innovations, similar to State Foundations created under private law, and discusses strategies to strengthen the governing capacities of the System ́s managing institutions, mainly the introduction of professional management with specific training and qualifications.