The article brings an analysis since the authors lived experiences about the setting of the Sistema Único de Saúde - SUS - the Brazilian national health policy - in the city of São Paulo, Brazil. It takes into consideration both technical and politics issues over the public management of local health system in a city of large geographic and populational proportions, poorly fair in territorial equity. The article describes the meaning of decentralization process as the key to achieve the aims of local health system as well as shows the first results from a local health index. At the end, the authors set an agenda for the SUS development pointing essential debate in order to achieve better results in the health and social status of the Brazilian population and the needs to make the health policies long standing.
