ABSTRACT
Brazil is a complex federal system involving three levels of government, 27 states and over 5,000 municipalities. The public health system is a responsibility shared among the three levels of government, each with specific responsibilities. The system is unified and national, but states and municipalities have a reasonable degree of autonomy in managing their own systems of health care. On the other hand, as there are large disparities between regions, and between municipalities within each state (both in terms of funding capacity and in the provision of health services), cooperation is not only a guiding principle, but also a necessity for achieving health goals. However, there are important constraints which impede the balance between autonomy and cooperation that should govern health systems in Brazil’s federal state.
