Brazil's health system reform is one of the most successful examples of a non-centralized process of institutional building. Nevertheless, this was a limited process and those limits are related both with the nature of the institutions in charge of health services supply and with the population's demands, heavily committed with political democracy, considering that health is a citizenship right. This right placed the issues related to health services access to a central place in the Brazilian political debate; the poli ti cal and institutional reform of the State were guided to an empowerment of local government, now the main supplier of health services, since the 1988 Brazilian Constitution, a universal right to local health services. This thesis focuses on the relationship between demand and supply in health services, within the perspective of the daily life of the different social actors. The case of Volta Redonda - a historical birth land of the Brazilian steel metallurgy - is the basis of a local experience related to the health system reform. The building of the "Unified Health System (SUS)" - the new health system created by 1988's BraziIian Constitution - in Volta Redonda was very successful, with the model named "Em Defesa da Vida" (In Defense of Life ) that reached the four main institutional principies of the national health reform, also adopting a very efficient family's health program, along with a homeopathy medical assistance program at the local level. The Volta Redonda success had been a limited one, because of non-biological factors. That means that social, political and economical variables were also very actively present on that scene.
demand and supply in health services; health assistance models; health system reform; local health system