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It has been more than 20 years since Brazil's 1988 Constitution formally established the Unified Health System (Sistema Unico de Saude, SUS). Building on reforms that started in the 1980s, the SUS represented a significant break with the past, establishing health care as a fundamental right and duty of the state and initiating a process of fundamentally transforming Brazil's health system to achieve this goal. This report aims to answer two main questions. First is have the SUS reforms transformed the health system as envisaged 20 years ago? Second, have the reforms led to improvements with regard to access to services, financial protection, and health outcomes? In addressing these questions, the report revisits ground covered in previous assessments, but also brings to bear additional or more recent data and places Brazil's health system in an international context. The report shows that the health system reforms can be credited with significant achievements. The report points to some promising directions for health system reforms that will allow Brazil to continue building on the achievements made to date. Although it is possible to reach some broad conclusions, there are many gaps and caveats in the story. A secondary aim of the report is to consider how some of these gaps can be filled through improved monitoring of health system performance and future research. The introduction presents a short review of the history of the SUS, describes the core principles that underpinned the reform, and offers a brief description of the evaluation framework used in the report. Chapter two presents findings on the extent to which the SUS reforms have transformed the health system, focusing on delivery, financing, and governance. Chapter three asks whether the reforms have resulted in improved outcomes with regard to access to services, financial protection, quality, health outcomes, and efficiency. The concluding chapter presents the main findings of the study, discusses some policy directions for addressing the current shortcomings, and identifies areas for further research.

This article addresses recent political, legal and welfare changes to mental health policies in Brazil, demonstrating their effects of Psychiatric Counter-Reform. Based on documentary analysis, we explain the tensions generated by this process, with its repercussions for the complex process of Brazilian Psychiatric Reform, particularly for the Psychosocial Healthcare Network. We discuss the paradoxical case of Counter-Counter-Reform, using the state of Bahia as an example because of its recent proposal to close psychiatric hospitals with the announced aim of deinstitutionalizing people who have been hospitalized, which does not coincide with this moment of change in Brazilian mental health policy. We conclude that the risk of the worsening of the sanitary, social and economic crisis in the country requires increased advocacy and mobilization measures, in order to prevent the loss of social protection mechanisms, which also include mental health. This crisis simultaneously poses a threat to human rights and to the inclusion of people in psychological distress, at the same time as it presents an opportunity to reinvigorate a reform that was at the peak of activity.

Throughout the twentieth century, the profound changes that have taken place in Medicine can only be wholly explained if observed from a historical perspective, for they have always occurred in response to external influences, some scientific and technological, others of a social nature. Modern Family Medicine is one of the many new disciplines that have developed during medical history, and we critically discuss the last 40 years of primary health care in Portugal, which started in 1971, long before the Alma-Ata Declaration (1978). Along the way, in 2005, the Primary Health Care Reform emerges in Portugal, along with the new family health facilities, which until September 2019, attended about 94 % of Portuguese citizens, i.e., 9,5 million people. At the end of this course, in solidarity and voluntarily, this Reform inspired another one in Brazil, in Rio de Janeiro, in 2009. Finally, we present the challenges pointed out in the 2018 Astana Declaration, among them, the issue of the workforce in primary health care as an essential factor for the performance and sustainability of health systems.

Innovative perspectives in the history of science blossomed after the 1962 publication of Thomas Kuhn's classic The Structure of Scientific Revolutions,1 opening the path for approaches that eschew a linear view of scientific and social progress. Elizabeth Fee's invaluable contributions can be framed as part of this drive to renew the construction of scientific knowledge as a reflection and form of interaction with the larger societal context and foster a hopeful vision of its role in the future of health and social policies. By engaging in dialogue with historians and, more important, with broader audiences such as politicians, public health practitioners, and leaders, Fee placed research and the historical imagination at the service of our contemporary fight for the right to health and social justice.

Background The regulation of emergency care has featured prominently in Brazil’s federal health agenda since the 2000s. The aim of this study was to review up to the present day the implementation of the National Emergency Care Policy. Methods The methods employed were documental review, analysis of official data and 11 interviews conducted with federal, state and local managers. The results were analyzed using Giddens’ Structuration Theory, relating the cognitive abilities of the agents to their action strategies, in view of the structural dimensions, rules and resources provided by the federal administration. Results Federal policy for emergency care in Brazil can be divided into three stages: from 1998 to 2003, the initial regulation; from 2004 to 2008, the expansion of the Mobile Emergency Medical Services (SAMU, in Brazil); and from 2009 onwards, the implementation of stationary pre-hospital care facilities, known as Emergency Care Units (UPA). The structuration elements identified for the emergency care policy were the public health system guidelines, legislation, standards and federal financing. Significant restrictions were found such as lack of hospital beds and intensive care treatment, gaps in the information system for producing evidence for management, ineffective Management Committees, as well as a low degree of commitment among physicians to the services. Conclusion Considering the financial constraints imposed on the SUS (Brazilian Unified Health System), emergency care was identified as a political priority with financial support. The individual actions by emergency care workers and governmental agents typified the first period of the policy, structuring the basis and producing changes in the circumstances of action. Federal strategies can be equated to the rules and resources provided to support the implementation process of the policy.

ABSTRACT Objective: to describe the nursing care performed by the nursing team to the person with mental disorder submitted to ECT and to analyze the implications of the Psychiatric Reform in this care. Method: socio-historical study, which uses the Thematic Oral History method. Results: the nursing team is present in a continuous way in the monitoring of people submitted to ECT, performing care before, during and after the same, as well as visualizing the evolution of the technique and also of nursing care itself, however, does not recognize the Psychiatric Reform as agent for this change. Final considerations: the Brazilian Psychiatric Reform triggered a process of humanization of nursing knowledge, influencing the care of the person with mental disorder submitted to ECT, with this, care practices also changed, a law was approved, regulating its practice, and its application was decreasing. RESUMEN Objetivo: describir el cuidado de Enfermería realizado por el equipo de Enfermería a la persona con trastorno mental sometido a la TEC y analizar las implicaciones de la Reforma Psiquiátrica en ese cuidado. Método: estudio socio-histórico, que utiliza el método de la Historia Oral Temática. Resultados: el equipo de Enfermería se hace presente de forma continua en el acompañamiento de las personas sometidas a la TEC, realizando cuidados antes, durante y después de la realización de la misma, así como visualiza la evolución de la técnica y también del cuidado de Enfermería en sí, sin embargo, no reconoce la Reforma Psiquiátrica como agente formador de este cambio. Consideraciones finales: la Reforma Psiquiátrica brasileña desencadenó un proceso de humanización del saber de Enfermería, influenciando en el cuidado a la persona con trastorno mental sometido a la TEC, con eso, las prácticas asistenciales también sufrieron alteración, una ley fue aprobada, regulando su práctica, y su aplicación fue decreciente. RESUMO Objetivo: descrever o cuidado de Enfermagem realizado pela equipe de Enfermagem à pessoa com transtorno mental submetida à ECT e analisar as implicações da Reforma Psiquiátrica nesse cuidado. Método: estudo sócio-histórico, que utiliza o método da História Oral Temática. Resultados: a equipe de Enfermagem se faz presente de forma contínua no acompanhamento das pessoas submetidas à ECT, realizando cuidados antes, durante e após a realização da mesma, bem como visualiza a evolução da técnica e também do cuidado de Enfermagem em si, contudo, não reconhece a Reforma Psiquiátrica como agente formador desta mudança. Considerações finais: a Reforma Psiquiátrica brasileira desencadeou um processo de humanização do saber de Enfermagem, influenciando no cuidado à pessoa com transtorno mental submetida à ECT, com isso, as práticas assistenciais também sofreram alteração, uma lei foi aprovada, regulamentando a sua prática, e sua aplicação foi diminuindo.

A brief review of the career of the public health physician Walter Sidney Pereira Leser, who died in 2004 aged 94. Self-taught, from his 1933 doctoral thesis he became a country reference in the field of statistics and epidemiology, with dozens of studies and supervisions. In the clinical field he is one of the founders of Fleury Laboratory, and participates in the creation of CREMESP. As an academic, Leser was a professor at the Escola de Sociologia e Política de São Paulo, Escola Paulista de Medicina e Faculdade de Farmácia e Odontologia da USP. Also, Leser introduced objective tests in the college entrance examination, and led the creation of CESCEM and Carlos Chagas Foundation. In the Escola Paulista de Medicina he created the first Preventive Medicine Department of the country. As a public official, he was secretary of the State Department of Health of São Paulo between 1967 and 1971 and between 1975 and 1979, responsible for extensive reforms and innovations. Among the most remembered, the creation of sanitary medical career. Throughout this legacy, he lent his name to the \"Medal of Honor and Merit Public Health Management\" of the State of São Paulo.

This article traces significant moments in the history of the magazine Saúde em Debate - sourcing references and information from documents, historical studies, editions of the magazine, academic work and interviews with physicians and writers who contributed to its creation. In its 39 years of existence, although there may have been variations in the magazine's editorial policy, its role as a means for exchange of ideas and debate on critical health thinking, and making a contribution by in some way intervening in the Brazilian political process, has not changed. The magazine established itself with a firm reputation as a vehicle of scientific communication especially in the areas of health policy and management, expanding the scope of subjects over time. Among the challenges it has faced, as well as that of financial sustenance, has been its role as an instrument for dissemination of Latin American thinking in the field of health.