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Background: Brazil's Unified Health System (SUS) ensures universal, equitable, and excellent quality health coverage for all. The broad right to health, supported by the Constitution, has led to excessive litigation in the public sector. This has negatively impacted the financial stability of SUS, created inequality in children and adolescents' access to healthcare, and affected communication between the healthcare system and the judiciary. The enactment of Law Number 13.655 on 25 April 2018, proposed significant changes in judicial decisions. This study aimed to investigate decision-making changes in health litigation involving children and adolescents following the implementation of the new normative model. Methods: The study is cross-sectional, analyzing 3753 national judgment documents from all State Courts of Brazil, available on their respective websites from 2014 to 2020. It compares regional legal decisions before and after the promulgation of Law Number 13.655/2018. Data tabulation, statistical analysis, textual analysis, coding, and counting of significant units in the collected documents were performed. The results of data cross-referencing are presented in tables and diagrams. Results: The majority (96.86%) of legal claims (3635 cases) received partial or total provision of what was prescribed by the physician. The Judiciary predominantly handled these cases individually. The analysis indicates that the decisions made did not adhere to the norms established in 2018. Conclusion: Regional heterogeneity in health litigation was observed, and there was no significant variability in decisions during the studied period, even after the implementation of the new normative paradigm in 2018. Technical-scientific support was undervalued by the magistrates. Prioritizing litigants undermines equity in access to Universal Health Coverage for children and adolescents.

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OBJECTIVES: To analyze the fundamentals of the global health agenda from 1944 to 2018, especially regarding Universal Health Coverage, in order to unveil its relations with capital accumulation in health services and to contribute to world social mobilization to change this tendency. METHODS: A historical study was carried out based on a purposeful selection of primary sources on the global health agenda from multilateral organizations and secondary sources about the changes of capitalism from the study period. RESULTS: The global health agenda changed from the state responsibility for health to an insurance healthcare system based on markets. The medical-industrial complex pressured national economies, broke postwar pacts, and urged economic globalization. The neoliberal, neoclassical, and neo-institutional discourse that promoted a new state-market relationship eased the new capital accumulation in healthcare into financial and cognitive capitalism. CONCLUSIONS: Understanding these relationships allows us to provide elements for social mobilization geared to transform the healthcare sector toward a new vision of health with a nature-society relationship that contributes to socially constructing human and environmental health, rather than gaining profits based on illness and chronic suffering.

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The care of people and their health is a primary function of the family and of society as shown by studies on primitive humans, as well as in pre-Hispanic Peru. The conquest and subsequent centuries of colonization fractured the traditional way of caring for people, replacing social solidarity with charity actions mainly from religious orders that provided hospices later called hospitals. During the colony and until the beginning of the 20th century, the care of the sick continued to be the responsibility of charitable institutions, such as the Charities created after independence. Social rights such as education and health only emerged in the first decades of the last century and were enshrined in the 1933 Constitution. However, both in that Constitution as in those from 1979 and 1993, the right to education was recognized more fully, while the right to heath was limited. The Universal Health Coverage Act of 2009 propounds guaranteeing the right to access quality healthcare services for everybody, as part of the right to health in the broadest sense. The current limitations force us to redefine the right of every citizen to comprehensive care of their health and the State's guidance to guarantee it.

El cuidado de las personas y de su salud es una función primaria de la familia y de la sociedad como lo demuestran estudios sobre los humanos primitivos, así como en el Perú prehispánico. La conquista y los siglos posteriores de colonización quebraron la forma tradicional del cuidado de las personas, reemplazando la solidaridad social por acciones de caridad principalmente de órdenes religiosas que propiciaron hospicios luego denominados hospitales. Durante la colonia y hasta principios del siglo XX el cuidado de los enfermos siguió siendo responsabilidad de las instituciones de caridad, como las Beneficencias creadas luego de la independencia. Los derechos sociales como la educación y la salud recién surgen en las primeras décadas del pasado siglo, plasmándose en la Constitución de 1933. Sin embargo, tanto en esa Constitución como en la de 1979 y la de 1993 el derecho a la educación fue reconocido más plenamente, siendo más limitado en salud. La ley de Aseguramiento Universal en Salud del 2009 propone garantizar para todos el derecho al acceso a servicios de salud con calidad, como parte del derecho a la salud en sentido amplio. Las limitaciones actuales obligan a redefinir el derecho de todas las personas al cuidado integral de su salud y la rectoría del Estado para garantizarlo.

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In 1988, the Brazilian Constitution defined health as a universal right and a state responsibility. Progress towards universal health coverage in Brazil has been achieved through a unified health system (Sistema Único de Saúde [SUS]), created in 1990. With successes and setbacks in the implementation of health programmes and the organisation of its health system, Brazil has achieved nearly universal access to health-care services for the population. The trajectory of the development and expansion of the SUS offers valuable lessons on how to scale universal health coverage in a highly unequal country with relatively low resources allocated to health-care services by the government compared with that in middle-income and high-income countries. Analysis of the past 30 years since the inception of the SUS shows that innovations extend beyond the development of new models of care and highlights the importance of establishing political, legal, organisational, and management-related structures, with clearly defined roles for both the federal and local governments in the governance, planning, financing, and provision of health-care services. The expansion of the SUS has allowed Brazil to rapidly address the changing health needs of the population, with dramatic upscaling of health service coverage in just three decades. However, despite its successes, analysis of future scenarios suggests the urgent need to address lingering geographical inequalities, insufficient funding, and suboptimal private sector-public sector collaboration. Fiscal policies implemented in 2016 ushered in austerity measures that, alongside the new environmental, educational, and health policies of the Brazilian government, could reverse the hard-earned achievements of the SUS and threaten its sustainability and ability to fulfil its constitutional mandate of providing health care for all.

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RESUMEN El cuidado de las personas y de su salud es una función primaria de la familia y de la sociedad como lo demuestran estudios sobre los humanos primitivos, así como en el Perú prehispánico. La conquista y los siglos posteriores de colonización quebraron la forma tradicional del cuidado de las personas, reemplazando la solidaridad social por acciones de caridad principalmente de órdenes religiosas que propiciaron hospicios luego denominados hospitales. Durante la colonia y hasta principios del siglo XX el cuidado de los enfermos siguió siendo responsabilidad de las instituciones de caridad, como las Beneficencias creadas luego de la independencia. Los derechos sociales como la educación y la salud recién surgen en las primeras décadas del pasado siglo, plasmándose en la Constitución de 1933. Sin embargo, tanto en esa Constitución como en la de 1979 y la de 1993 el derecho a la educación fue reconocido más plenamente, siendo más limitado en salud. La ley de Aseguramiento Universal en Salud del 2009 propone garantizar para todos el derecho al acceso a servicios de salud con calidad, como parte del derecho a la salud en sentido amplio. Las limitaciones actuales obligan a redefinir el derecho de todas las personas al cuidado integral de su salud y la rectoría del Estado para garantizarlo.

ABSTRACT The care of people and their health is a primary function of the family and of society as shown by studies on primitive humans, as well as in pre-Hispanic Peru. The conquest and subsequent centuries of colonization fractured the traditional way of caring for people, replacing social solidarity with charity actions mainly from religious orders that provided hospices later called hospitals. During the colony and until the beginning of the 20th century, the care of the sick continued to be the responsibility of charitable institutions, such as the Charities created after independence. Social rights such as education and health only emerged in the first decades of the last century and were enshrined in the 1933 Constitution. However, both in that Constitution as in those from 1979 and 1993, the right to education was recognized more fully, while the right to heath was limited. The Universal Health Coverage Act of 2009 propounds guaranteeing the right to access quality healthcare services for everybody, as part of the right to health in the broadest sense. The current limitations force us to redefine the right of every citizen to comprehensive care of their health and the State's guidance to guarantee it.

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Health is a universal human right, which should be safeguarded by government responsibility and included in all social policies. Only as such it is possible to ensure effective responses to the health needs of an entire population. The Cuban Constitution recognizes the right to health, and the country's single, free, uni-versal public health system and high-level political commitment promote intersectorality as a strategy to address health problems. Intersectorality is refiected in national regulations that encourage participation by all social sectors in health promotion/disease prevention/treatment/rehabilitation policies and programs. The strategy has increased the response capacity of Cuba's health system to face challenges in the national and international so-cioeconomic context and has helped improve the country's main health indicators. New challenges (sociocultural, economic and environmental), due to their effects on the population's health, well-being and quality of life, now require improved intersectoral coordination in the primary health care framework to sustain achievements made thus far. KEYWORDS Universal coverage, public health, health policy, social planning, intersectoral collaboration, Cuba.

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RESUMEN La política pública de salud ha estado guiada en Colombia por el propósito de alcanzar la cobertura universal. La Ley 100 de 1993 planteó la meta de garantizar a toda la población el acceso a los servicios de salud en todos los niveles de atención, con un plan de beneficios igual para todos. No obstante esta promesa, la cobertura universal no se logró en el año 2000 como estaba establecido, y han existido barreras para el acceso efectivo, por lo que los ciudadanos han acudido a la acción de tutela como un mecanismo por el cual los jueces protegen el derecho a la salud. En 2008, en medio de un crecimiento desbordado de las tutelas, la Corte Constitucional profirió la Sentencia T-760 por la cual reconoció la salud como derecho fundamental y estableció órdenes a varios organismos del Estado para garantizar su goce efectivo y hacer cumplir la cobertura universal y el acceso efectivo. Después de diez años, el cumplimiento de estas órdenes es medio, con avances importantes en cuanto a cobertura e igualación del plan de beneficios, pero persisten barreras al acceso y preocupaciones respecto a la sostenibilidad y el flujo de recursos.(AU)

ABSTRACT Public health policy in Colombia has been guided by the purpose of achieving universal coverage. Law 100 of 1993 set the goal of guaranteeing access to health services for the entire population, at all levels of care, with a plan of equal benefits for all. Despite this promise, universal coverage was not achieved in the year 2000 as established, and there have been barriers to effective access. In consequence, citizens have resorted to tutela (writ for the protection of fundamental rights) as a mechanism by which judges protect the right to health. In 2008, amidst an overwhelming growth in the number of actions for immediate protection of constitutional rights, the Constitutional Court issued Sentence T-760, by which health was recognized as a fundamental right and ordered several State agencies to guarantee its effective enjoyment and enforce universal coverage and effective access. After ten years, compliance with these orders is medium, with important advances in terms of coverage and equalization of the benefits plan, but there are still barriers to access and concerns regarding sustainability and the flow of resources.(AU)

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Public health policy in Colombia has been guided by the purpose of achieving universal coverage. Law 100 of 1993 set the goal of guaranteeing access to health services for the entire population, at all levels of care, with a plan of equal benefits for all. Despite this promise, universal coverage was not achieved in the year 2000 as established, and there have been barriers to effective access. In consequence, citizens have resorted to tutela (writ for the protection of fundamental rights) as a mechanism by which judges protect the right to health. In 2008, amidst an overwhelming growth in the number of actions for immediate protection of constitutional rights, the Constitutional Court issued Sentence T-760, by which health was recognized as a fundamental right and ordered several State agencies to guarantee its effective enjoyment and enforce universal coverage and effective access. After ten years, compliance with these orders is medium, with important advances in terms of coverage and equalization of the benefits plan, but there are still barriers to access and concerns regarding sustainability and the flow of resources.

La política pública de salud ha estado guiada en Colombia por el propósito de alcanzar la cobertura universal. La Ley 100 de 1993 planteó la meta de garantizar a toda la población el acceso a los servicios de salud en todos los niveles de atención, con un plan de beneficios igual para todos. No obstante esta promesa, la cobertura universal no se logró en el año 2000 como estaba establecido, y han existido barreras para el acceso efectivo, por lo que los ciudadanos han acudido a la acción de tutela como un mecanismo por el cual los jueces protegen el derecho a la salud. En 2008, en medio de un crecimiento desbordado de las tutelas, la Corte Constitucional profirió la Sentencia T-760 por la cual reconoció la salud como derecho fundamental y estableció órdenes a varios organismos del Estado para garantizar su goce efectivo y hacer cumplir la cobertura universal y el acceso efectivo. Después de diez años, el cumplimiento de estas órdenes es medio, con avances importantes en cuanto a cobertura e igualación del plan de beneficios, pero persisten barreras al acceso y preocupaciones respecto a la sostenibilidad y el flujo de recursos.

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Universal health coverage aims to increase equity in access to quality health care services and to reduce financial risk due to health care costs. It is a key component of international health agenda and has been a subject of worldwide debate. Despite differing views on its scope and pathways to reach it, there is a global consensus that all countries should work toward universal health coverage. The goal remains distant for many African countries, including Nigeria. This is mostly due to lack of political will and commitment among political actors and policymakers. Evidence from countries such as Ghana, Chile, Mexico, China, Thailand, Turkey, Rwanda, Vietnam and Indonesia, which have introduced at least some form of universal health coverage scheme, shows that political will and commitment are key to the adoption of new laws and regulations for reforming coverage. For Nigeria to improve people's health, reduce poverty and achieve prosperity, universal health coverage must be vigorously pursued at all levels. Political will and commitment to these goals must be expressed in legal mandates and be translated into policies that ensure increased public health care financing for the benefit of all Nigerians. Nigeria, as part of a global system, cannot afford to lag behind in striving for this overarching health goal.

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OBJECTIVE:: To analyze the process of design and implementation of AUGE. MATERIALS AND METHODS:: Literature review of pre-reform background, architecture design and implementation process of reform AUGE and complementary interviews to eight informants involved in its development. RESULTS:: The assessment of health equity was a key element in pre-reform, there are four fundamental dimensions in the design, and the implementation has nine phases. CONCLUSION:: The results show AUGE strengthening public health by investing in equipment for cost-effective treatments, and also through clinical guidelines that standardize and guide the management of health professionals with patients.

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Resumen: Objetivo: Analizar el proceso de diseño e implementación del Acceso Universal con Garantías Explícitas (AUGE). Material y métodos: Revisión de bibliografía sobre antecedentes prerreforma, arquitectura de diseño y proceso de implementación de la reforma AUGE y, complementariamente, entrevistas a ocho informantes involucrados en su desarrollo. Resultados: La valoración de la equidad en la salud fue un elemento clave prerreforma; existen cuatro dimensiones fundamentales en el diseño y nueve fases en la implementación. Conclusión: Los resultados del AUGE muestran un fortalecimiento en la salud pública por la inversión en equipamiento para tratamientos costo-efectivos; también por las guías clínicas que estandarizan y orientan la gestión de los profesionales de la salud con los pacientes.

Abstract: Objective: To analyze the process of design and implementation of AUGE. Materials and methods: Literature review of pre-reform background, architecture design and implementation process of reform AUGE and complementary interviews to eight informants involved in its development. Results: The assessment of health equity was a key element in pre-reform, there are four fundamental dimensions in the design, and the implementation has nine phases. Conclusion: The results show AUGE strengthening public health by investing in equipment for cost-effective treatments, and also through clinical guidelines that standardize and guide the management of health professionals with patients.

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Health in Colombia is now a fundamental right that has to be provided and protected by the government. We evaluated the strengths and difficulties of the health system with respect to the statutory law enacted in February 2015, using methodologies for analysis of health systems proposed by the WHO and the World Bank. The challenges include the fragmentation and specialization of services, access barriers and incentives that are not aligned with the quality, weak governance, multiple actors with little coordination and information system that does not measure results. The government needs to find a necessary social agreement, a balance between the particular and the collective benefit.

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La salud en Colombia es ahora un derecho fundamental que tiene que ser provisto y protegido por el Estado. A partir de metodologías de análisis de sistemas de salud propuestos por la OMS y el Banco Mundial, se evidencian las falencias, fortalezas y dificultades del sistema de salud con respecto a la ley estatutaria aprobada en febrero de 2015. Éstas incluyen la fragmentación y especialización de los servicios, barreras de acceso, incentivos no alineados con la calidad, débil gobernanza, múltiples actores con poca coordinación y sistema de información que no mide resultados. Es necesario un acuerdo social, un equilibrio y control de la tensión por parte del Estado entre el beneficio particular y el beneficio colectivo.

Health in Colombia is now a fundamental right that has to be provided and protected by the government. We evaluated the strengths and difficulties of the health system with respect to the statutory law enacted in February 2015, using methodologies for analysis of health systems proposed by the WHO and the World Bank. The challenges include the fragmentation and specialization of services, access barriers and incentives that are not aligned with the quality, weak governance, multiple actors with little coordination and information system that does not measure results. The government needs to find a necessary social agreement, a balance between the particular and the collective benefit.

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The Chilean health care system is in crisis. Since the recent ruling of the Constitutional Court that declared the risk rating (actuarial insurance) of private health insurers unconstitutional, all of the social actors related to health care have tried to agree on a legislative reform that would overcome the existing highly segmented and inequitable system, which is a legacy of Pinochet's dictatorship. Here we demonstrate how the social and political demands for legislative reform in the health care sector have been supported by the decisions of the courts. To achieve its goals of reducing equity gaps in health and ending the judicialization of health care (claims for protection represent almost 70% of total resources of the courts), the National Congress of Chile is trying to create a new national health insurance system that guarantees the right to a minimum level of health care. Part of this effort involves obtaining the constitutional approval of the courts. In Chile, justice has the final word on health care.

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O trabalho busca caracterizar e analisar as ideias que sustentam as posições das comunidades epistêmicas dominantes que atuam na definição e implementação da proposta de agenda mundial pela Cobertura Universal em Saúde ou Universal Health Coverage (UHC). A análise desenvolvida buscou responder à pergunta se a UHC seria um avanço ou retrocesso na luta pelo direito humano à saúde. A UHC emergiu com força avassaladora na agenda mundial da saúde desde 2010, carregando um conjunto de ambiguidades ou indefinições. Colocando os direitos humanos e o direito humano e social à saúde como referência para a análise dos conceitos e ideias em jogo, pretende-se identificar o perfil de pensamento das comunidades epistêmicas no âmbito da UHC. A análise focou na classificação de conteúdos de documentos selecionados dentre aqueles produzidos, e muitos formalmente adotados, pelas organizações internacionais que possuem liderança no tema – OIT, OMS, Banco Mundial e Assembleia Geral da ONU, e publicados entre 2010 e 2014. Os critérios de classificação dos conteúdos obedeceram ao ordenamento de díades de oposição entre um perfil que foi assumido como afirmativo dos direitos – universalidade, integralidade, igualdade e financiamento por impostos gerais progressivos – e sua oposição representada pela focalização, pacotes de mínimos sociais, equidade exclusiva e financiamento por seguros segmentados. O resultado permite identificar um alinhamento das definições e agendas da UHC no campo conservador das políticas sociais derivados do neoliberalismo, com declarações universalistas e integrais, mas uma forma de implementação centrada na focalização e financiamento por seguros de pacotes mínimos. Identificaram-se nuances na posição entre as instituições examinadas, mas como variações dentro do campo hegemônico...

This study intends to characterize and analyse the ideas that support the positions of the dominant epistemic communities that have been engaged in the definition and implementation of the proposal for a global agenda for the Universal Health Coverage (UHC). The analysis aimed at answering the question if UHC would be a step forwards or backwards in the fight for the human right to health. UHC has emerged with remarkable force in the global agenda for health since 2010, presenting a set of ambiguities or uncertainties. By placing human rights and human and social right to health as reference for the analysis of concepts and ideas at stake, this study proposed to identify the thinking pattern of epistemic communities within UHC. The analysis focused on the classification of contents of some selected documents produced, and formally adopted, by international organizations that play an important role in this area – namely, ILO, WHO, World Bank and General Assembly of the United Nations, published between 2010 and 2014. The classification were based on dyads of opposition between criteria from the human rights perspective – universality, integrality, equality, and funding through progressive taxation –, and opposing criteria represented by targeting, minimum social packages, excluding equity, and funding through segmented insurances. The result shows an alignment of UHC definitions and agendas in the conservative field of social policies originated from neoliberalism, which, although including universal and integral perspective in their statements, argue that UHC implementation should focus on targeting and funding through minimum package insurances. There are nuances in the position of these international organizations, but as variations within the hegemonic field...

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