Intended for healthcare professionals

Feature Coronavirus

Covid-19 is causing the collapse of Brazil’s national health service

BMJ 2020; 370 doi: (Published 30 July 2020) Cite this as: BMJ 2020;370:m3032

Read our latest coverage of the coronavirus outbreak

  1. Rodrigo de Oliveira Andrade, freelance journalist
  1. São Paulo, Brazil
  1. rodrigo.oliandrade{at}

Brazil is one of the few countries in the Americas that has free universal healthcare. But years of neglect and the pandemic have left the system on the verge of collapse, writes Rodrigo de Oliveira Andrade.

As the number of covid-19 cases in Brazil soars, so do concerns that the country’s celebrated public healthcare system will be overwhelmed after four years of severe budget cuts.

“Covid-19 has reached Brazil at a moment when it is seriously weakened,” Marco Akerman, an epidemiologist at the University of São Paulo, told The BMJ.

Today nearly 160 million people—around 75% of Brazil’s population—depend solely on the Unified Health System (known as SUS) for healthcare. Launched in 1988 as part of a wide-ranging constitutional reform after two decades of military dictatorship, SUS has been cited as an example of a successful healthcare system in Latin America, offering a variety of services free of charge.1

Where previously only workers with formal employment and no debts to social security were entitled to publicly funded medical care, SUS made healthcare a right guaranteed to all Brazilian citizens.

The service also plays an essential role in distributing medicines, which helped Brazil to become one of the first middle income countries to offer free access to HIV/AIDS medication in 1996.2

All that is now under threat. SUS has suffered chronic underfunding since the day it was launched,3 but the situation worsened in 2015 when the public health expenditure per capita started to decline in real terms. As a consequence of worsening political and economic crises, 2.9 million people lost private healthcare plan coverage, while violent deaths and outbreaks of infectious disease increased. This put more pressure on SUS’s capacity to meet the increasing demand for health services.

The lack of resources intensified when, in December …

View Full Text