NATIONAL POLICY ON SPECIALISED HEALTH CARE (PNAES): PROGRESS, CHALLENGES AND STRATEGIES FOR INTEGRATION

Abstract

The objective of this theoretical essay is to analyse the development of the National Policy for Specialised Health Care (PNAES), established by Ordinance GM/MS No. 1,604/2023, which aims to reorganise specialised care in the SUS, overcoming historical challenges of fragmentation, disarticulation, and unequal access. The results highlight advances in the integration between Primary Health Care (PHC) and specialised services through mechanisms such as bottom-up territorial planning, shared regulation, matrix support, teleconsultations and joint clinical protocols, in addition to the mandatory linking of specialised services to vulnerable territories. Experiences in states such as Ceará and municipalities in Bahia illustrate the effectiveness of regionalisation, consortium management, and regulation in increasing access and improving the quality of care. There has also been a strengthening of the More Access to Specialists Programme, with widespread adherence and a historic increase in the number of consultations and examinations. The discussion points out that, despite advances, structural challenges remain related to financial sustainability, technological modernisation, retention of professionals, and strengthening of municipal governance, which are essential for effective integration and continuity of care. The conclusion emphasises that the PNAES inaugurates an innovative phase of specialised care, focused on integration, co-responsibility and social justice, whose effectiveness depends on political commitment, social participation and strengthening.