Introduction

This chapter addresses the policy analysis that underpinned the Brazilian Sanitary Reform (SR), responsible for defining the Unified Health System (Sistema Único Saúde; SUS) and for the proposal to make universal health care a right under the Federal Constitution of 1988 (FC1988). The expert community that produced the policy analysis of the health sector reform has been referred to as the sanitaristas (Weyland, 1995; Arretche, 2010). In the social sciences, the ‘policy community’ of experts is defined as the set of individuals spread across government agencies, research departments and institutes, political parties, non-governmental organisations, and interest groups that act within a specific public policy area (Majone, 1989). The sanitaristas exhibited the features of a policy community as described in the literature, in light of their specific role in the national debate on reorganisation of the health system.

From the perspective of social status, the more relevant sanitarista trait was their position as teachers and researchers at public agencies and universities. In the 1980s, the sanitaristas held a very special place in the state structure: they enjoyed the conditions of a Weberian organisational bureaucracy (particularly job stability), combined with the decision-making autonomy typical of professional and academic bureaucracies. Their professional isolation was reinforced by the expressive participation of medical doctors from the academic sphere who were at the helm of the SR. The influence wielded by the sanitaristas’ social and professional status was crucial to the scope of the SR.

As analysts of the Brazilian health system, the sanitaristas displayed singular attributes: they worked in a specialised area and shared the worldview and independence of a professional public bureaucracy. Their policy analysis, which led to the adoption of a project of a universalist right to health within the 1980s’ atmosphere of democratic transition, was undertaken inside the state apparatus and not based on any mobilisation of civil society or social movements. The international literature has not ignored the role of policy analysis by the specialised public bureaucracy (Dobuzinskis et al, 2007).

It should also be emphasised that the sanitaristas carried influence primarily because their policy analysis was opportune, timely and propositional. Nevertheless, their successful formation and implementation of a political agenda was not grounded in the mass dissemination of long-standing, consolidated ‘scientific evidence’ that lent legitimacy to the proposed health system reform.