Internal audit of the SUS and the commitment to improving the quality and effectiveness of health policies

Abstract

This critical-propositional essay discusses the limits and possibilities of internal audit in Brazil’s Unified Health System, focusing on how audit practices can contribute to policy improvement in a complex federal context. The objective is to critically revisit the current audit model and propose guidelines to redirect audit work toward the quality, effectiveness, and outcomes of health policies. The central argument is that punitive and compliance-driven approaches constrain organizational learning and the generation of public value. Three guidelines are advanced: i) linking audit findings to policy improvement mechanisms; ii) establishing nationally standardized and technically consistent audit processes; and iii) clearly defining the institutional role of audit units within the Ministry of Health and in coordinating the National Health Audit System. Examples and institutional experiences are used for illustrative and analytical purposes rather than evaluative inference.