This article deals with the management of the decentralization process in the Brazilian Unified Health System (SUS) in the 1990s, relating it to the establishment and application of the so-called Basic Operational Norms (NOB) in force from 1991 to 1996. The author highlights the usefulness of these instruments for orienting the three levels of government and their negotiation, while also discussing their limits, particularly those pertaining to the complexity and different degrees of progress experienced by the various States and municipalities in implementing the Unified Health System. For this very reason he contends that the NOBs have run their course in terms of the current dynamics of health sector decentralization. He focuses attention on another instrument, the so-called Health Care Operational Norm (NOAS SUS 01/01), around which a working consensus is currently being sought among the key actors in health sector reform: the Ministry of Health, the Bipartisan and Tripartisan Committees, and the National Health Council. Based on the critique of the NOB-96, the author favors further promoting the logic of guaranteeing the population's access to health services and programs at all levels.
Decentralization; Implementation of the Unified Health System; Public sector reform