Between Scales and Inequalities

Paths of SUS Regionalization in the Fluminense Context

Abstract

This article analyzes the process of health regionalization in the state of Rio de Janeiro following the implementation of the Brazilian Unified Health System (SUS). It adopts a periodization into three cycles that mark different stages of SUS's trajectory in the Fluminense territory: the first cycle (1990–2006) addresses the initial challenges of implementing SUS in the state; the second cycle (2007–2011) discusses the adherence to the Health Pact and the creation of regional management committees; finally, the third cycle (2011–2023) emphasizes the difficulties in advancing regional planning. The aim is to understand how SUS regionalization has developed over the years, highlighting its achievements, setbacks, and ongoing challenges. The methodology included data collection on health care provision in the state, analysis of the minutes of the Rio de Janeiro Regional Inter-Management Commission (CIR/RJ), interviews with managers from different levels of the health system, and a review of official documents, legislation, and specialized literature. The results reveal the challenges of health governance and, more broadly, offer insights for thinking about the challenges of universalizing SUS at the local scales.