This article analyzes Brazilian policies applied to the field of health in the 1990s from two contradictory angles: the mandate of the 1988 Federal Constitution and the 1990 National Health Act (LOAS) on the one hand and the neoliberal wave that influenced public sector reforms throughout Latin America on the other. The paper discusses pathways and obstacles in the health sector during the implementation of a decentralization agenda based on the constitutional principles of universal access, equity, and citizens' participation. It concludes that the health reform provided for under the National Health Act is being achieved with ups and downs that express contradictions related to changes in the role of the Brazilian public sector beginning in the 1990s. The state lost its capacity to formulate and implement national development policies, focused on fiscal adjustment, and is permeated by pressure from globalization of capital.
Implementation of the Unified Health System (SUS); Health policy; Public sector reform; Decentralization