The article argues that local governments had already taken over the management of health care policy in Brazil. Yet, there's no guarantee that local management will necessarily imply accountability, efficiency, as well as universal and equitable access to health care. It heavily depends on the incentives and controls upon local governments. Those are related to public policies institutional design. SUS built up, between 1988 and 1993, a complex institutional structure through decisions are to be taken, in order to accomplish health policy goals and answer new problems posed by reform implementation. The article analyses the SUS's institutional tools to induce local government actions committed to citizens welfare and health care quality. It concludes that although these mechanisms are not yet in their full operation, the challenge consists more in making them work better than replacing them by any other else.
Intergovernmental relations; Local governments; Institutions
