the constitution established health as a fundamental right and the responsibility of states which resulted in increased access to primary and emergency care in addition to achieving universal coverage of vaccination and prenatal care paim et al service delivery is strongly decentralised which has led to a fragmentation in the delivery of services and inequalities in the distribution of health system resources as not all municipalities are capable of delivering services to people and economies of scale are often not exploited sufficiently brazil s public sector invests about of gdp in health compared to almost of gdp in oecd countries this shortage of medical staff leads to insufficient access to basic health care services despite recent increases in training capacity brazil is currently not training enough doctors and nurses to keep up with demand the measure to require new medical graduates to serve in the sus for two years before their degree becomes officially valid discussed in july can be useful if supervision is ensured as it would boost the number of doctors available to the public system in the short term