BACKGROUND: The pursuit of equity in health care and universal entitlement to access of services, as health care reform concerns, were addressed at a Brazilian national health conference in 1986, in a new constitution in 1988, and in subsequent legislative and administrative actions. However, in the early 1990s, economic policies affected the federal government's ability to fund the necessary services. QUALITY IMPROVEMENT (QI): In 1994 the Ministry of Health introduced a formal QI program, whose main purpose was to disseminate a culture of QI among health care providers, payers, and users of health services. The minister of health then established a national commission on QI, which played an important role in making QI activities an important activity. A NATIONAL ACCREDITATION PROGRAM: Efforts to create an accreditation program began in 1986. Since 1994 work has proceeded on organization of a nongovernmental accreditation agency, development of national standards and procedures for the accreditation of health services, and dissemination of methods and procedures for health care quality management. QI PROGRAMS: Examples of QI programs that have been successfully implemented include those at the State of Rio de Janeiro Blood Center and the National Institute of Cancer. Since 1996, many national societies have begun to produce consensus statements and guidelines. Progress has also been made in consumer rights and protection. CONCLUSIONS: The public, health care professionals, providers, and the government are increasingly aware of the need to strengthen and develop QI initiatives for health care in Brazil. Awareness of the opportunities for improvements in health care which outcomes trigger should help contribute to their application.