Analysis of the new specialized care policy: A change in the federative role of the Ministry of Health?

Abstract

This article analyzes the Ministry of Health’s recent policy on specialized care in the Unified Health System (SUS), highlighting its impact on Brazil’s federative pact. The discussion begins with the international and national trajectory of health reforms, emphasizing the need for integration, coordination, and strengthening of federal governance. In the Brazilian case, following a period of weakening federal institutional capacity, the Ministry of Health has regained its leading role with the creation of the National Specialized Care Policy, the More Access to Specialists Program, and later the Now There Are Specialists Program. These initiatives introduce innovations in financing arrangements, regulation instruments, professional training, the use of digital technologies, the organization of care networks, and the expansion of service provision, including new prerogatives for direct federal action. The analysis concludes that these strategies represent a gradual effort to restore the Ministry of Health’s capacity for federative coordination, which had been eroded over the past decade. Through incremental expansion of policy- and program-inducing mechanisms, developed in partnership with the National Council of Health Secretariats and the National Council of Municipal Health Secretariats, the Ministry progressively reconstitutes its role as the national coordinator of the SUS.