An older person who needs help with bathing, medication, mobility and meals does not experience Brazil's public systems as separate policy sectors. Her needs cross health, social assistance, family support, income, housing and community life at the same time. Yet the institutions responsible for those needs have historically developed through different laws, funding streams, professional structures and administrative systems.
That is the implementation challenge now sitting at the center of Brazil's care reform. The Brazil Aging, Long-Term Care & Community Support Knowledge Hub has examined the individual components of this landscape: SUS, SUAS, Primary Care, home-based support, unpaid caregiving, residential care, community services, workforce, rights, technology and evidence. The strategic question is increasingly how those components can operate as a more coherent care system.
Brazil took an important step with Law No. 15,069 of December 23, 2024, which established the Política Nacional de Cuidados. The policy recognizes the right to receive care, provide care and practice self-care, places responsibility on the state within the competencies of the Union, states, Federal District and municipalities, and recognizes co-responsibility with families, civil society and the private sector. The Plano Nacional de Cuidados Brasil que Cuida, regulated through subsequent federal measures, is the principal implementation mechanism.
But legislation does not itself create an integrated long-term care system. Integration has to be built through budgets, territorial planning, workforce capacity, referral relationships, data, governance and services that people can actually reach.
Brazil is building integration across existing systems rather than creating one new institution
The architecture of Brazilian care reform is important because integration is sometimes misunderstood as institutional merger.
Brazil already has large national systems with established constitutional and statutory responsibilities. SUS provides universal public healthcare through a decentralized health system involving the Union, states and municipalities. SUAS organizes non-contributory social assistance through Basic and Special Social Protection. Social-security arrangements, income benefits, education, housing, human-rights structures and labor policy occupy other parts of the care landscape.
The National Care Policy does not abolish these boundaries.
Instead, it creates an overarching policy framework through which existing sectors should act more coherently around people who need care and those who provide it.
This distinction matters operationally. A municipality does not need to create a parallel care bureaucracy that duplicates its Secretaria Municipal de Saúde and social-assistance structures. It needs to determine how existing responsibilities connect, where there are gaps, which department owns which decisions and how joint priorities are governed.
The strongest model is therefore not "one service for everything." It is a coordinated system in which different services remain professionally and legally distinct while people experience fewer gaps between them.
This aligns with wider principles of system integration and multi-agency working: integration succeeds when responsibility becomes clearer, not when institutional boundaries become invisible.
The National Care Policy creates a federative governance challenge
Brazil's federal structure makes local implementation unavoidable.
Law No. 15,069 establishes the Policy as a responsibility of the state across the Union, states, Federal District and municipalities within their respective competencies. It also provides for decentralized and coordinated implementation and enables states, the Federal District and municipalities to establish their own care policies consistent with the national framework.
This means the Federal Government can define policy, coordinate national strategy, provide technical assistance, fund federal actions and establish implementation mechanisms. It cannot simply operate every local service directly.
States have potentially important roles in regional coordination, technical support, planning and service networks that cross municipal boundaries. Municipalities are particularly important because many health, social-assistance and community services are experienced locally.
The governance question is therefore vertical as well as horizontal.
Vertical integration concerns the relationship between national, state and municipal responsibilities. Horizontal integration concerns relationships between health, social assistance, rights, employment, education, housing and other sectors operating at the same territorial level.
Weakness in either dimension can create implementation gaps.
A nationally funded program may have little impact if municipal capacity is insufficient. A municipality may develop an effective local service but struggle if regional specialist pathways are unavailable. A state may create a strategic plan without reliable mechanisms for coordinating multiple municipalities.
Integrated care therefore depends on cross-sector system leadership, not simply service coordination at the frontline.
Brasil que Cuida provides the implementation architecture
The Plano Nacional de Cuidados Brasil que Cuida translates the National Care Policy into a structured federal program.
The Plan contains 79 actions organized across five axes. These address rights and services for people needing care and unpaid caregivers; reconciliation of paid work, education and family responsibilities; decent work for paid care and domestic workers; cultural recognition and redistribution of care; and governance, information, monitoring and evaluation.
The breadth is deliberate. Brazil's care challenge cannot be solved by expanding older-person services alone.
Care capacity is affected by childcare, disability support, family working patterns, domestic labor, gender inequality, community infrastructure and the availability of public services. The Plan therefore treats care as a social and economic system rather than as a narrowly defined health intervention.
For long-term care, however, breadth introduces an important governance requirement: national leaders need to maintain a clear line of sight between the overall care agenda and the specific needs of older people with dependency.
A program may contribute to the care economy without increasing practical long-term support for an 82-year-old who cannot dress independently. Both objectives can be valid, but they are not interchangeable.
Implementation reporting consequently needs to distinguish population groups, service functions and outcomes rather than using one aggregate measure of "care investment."
The R$25 billion commitment needs to be understood correctly
The Federal Government has associated approximately R$25 billion of investment through 2027 with the 79 actions of the National Care Plan. This is substantial policy commitment, but it should not be interpreted as a dedicated R$25 billion Brazilian long-term care fund for older people.
The investment covers the broader Brasil que Cuida agenda across multiple populations, ministries, sectors and actions.
This distinction is central to understanding financing.
Brazil's emerging care system is not currently financed through a single long-term care insurance scheme or one national care budget. Funding remains distributed across the budgets and programs of participating federal bodies, alongside state and municipal resources and existing systems such as SUS and SUAS.
The National Care Policy itself provides for financing through:
- appropriations in the Federal Government's general budget allocated to participating federal bodies and entities, subject to financial and budgetary availability;
- resources provided by state, Federal District and municipal bodies, also subject to budgetary availability;
- donations from domestic or international individuals or legal entities; and
- other compatible national or international funding sources.
This is a flexible financing architecture, but it also creates a strategic challenge. Integration can be difficult when services serving the same person remain funded through separate systems with different rules, accountabilities and budget cycles.
Funding integration does not require one pooled budget
There is a temptation to assume that integrated care requires all resources to be combined into one fund. That is not necessarily the most realistic starting point for Brazil.
SUS funding carries health-system purposes and accountability. SUAS resources support defined social-assistance responsibilities. Workforce, rights and education programs operate under other legal frameworks.
Pooling everything could generate new administrative complexity without automatically improving care.
A more practical early objective is coordinated resource planning.
Municipal and state leaders should be able to see which services are funded, which populations they cover, where overlap exists and where no funding stream currently supports an identified care need.
For example, a dependent older person may have Primary Care, specialist healthcare and BPC income but no practical daytime support that allows a daughter to remain in employment. The problem is not that no public money reaches the household. It is that the mix of funded interventions does not meet the care requirement.
This is why long-term care financing needs to be analyzed through budget impact and affordability alongside service design.
The question is not simply how much is spent. It is whether expenditure across sectors produces a workable care pathway.
Operational scenario: three funded services still leave one major care gap
An 80-year-old man in a medium-sized Brazilian city lives with his daughter following a stroke. He receives follow-up through SUS and has regular contact with the local Primary Care team. His household also receives income support for which it is eligible. Rehabilitation has improved his mobility, but he continues to need assistance with bathing, meals and supervision for significant periods of the day.
His daughter works in retail. She initially rearranges her hours, then begins missing shifts because she cannot leave him alone safely.
From a departmental perspective, several systems are functioning. Healthcare is being delivered. Income support is in place. The family remains housed.
From a care-system perspective, the arrangement is becoming unsustainable.
An integrated response requires the municipality to understand whether social-assistance services, Centro-Dia provision, home support, community resources or another locally available intervention could complement the health pathway. It also requires consideration of caregiver strain rather than treating the daughter as an unlimited source of capacity.
If no appropriate local service exists, that absence becomes a planning issue rather than an individual family's private failure.
The scenario illustrates the central financing principle: fragmented expenditure can coexist with unmet care need. Building an integrated system requires authorities to identify the missing function, not merely demonstrate that each existing program spent its allocated budget.
Leaders examining comparable structural gaps can use the Digital Twin Scenario Modeler to explore how different combinations of workforce, demand and service capacity affect system stability. It is not a Brazilian planning instrument, but the scenario-based approach is useful when care needs cross several funding streams.
Territorial adhesion turns national policy into local responsibility
The territorial implementation model for Brasil que Cuida is particularly important.
The Federal Government has established an adhesion process through which states, the Federal District and municipalities can align local action with the National Care Plan and receive technical support for developing territorial care policies and plans.
The process has been phased, beginning with states, the Federal District and capitals, followed by larger municipalities and then extending progressively to smaller municipalities. By 2026, states and municipalities were already moving from formal adhesion into technical planning and development of local care strategies.
Adhesion should not be understood as evidence that an integrated local system has already been created.
It is the beginning of implementation.
The real test comes afterward: local diagnosis, governance arrangements, mapping existing services, identifying gaps, engaging people who need care and caregivers, establishing priorities, securing resources and agreeing how sectors will work together.
This is why territorialization is potentially one of the strongest features of the reform. Brazil's demographic, economic and geographic diversity makes a uniform service template unrealistic.
A densely populated metropolitan municipality may be able to sustain several specialized day services. A small interior municipality may need mobile or shared regional provision. An Amazonian territory may require very different transport, outreach and digital arrangements.
National policy should define rights and direction. Territorial planning must determine workable delivery.
Local care planning should begin with functions rather than organizational charts
A municipality developing a local care plan can easily begin by listing departments and programs. That produces an institutional map, but not necessarily a care system.
A stronger approach starts with the functions residents need.
For older people with increasing dependency, those functions may include early identification of functional decline, help with personal activities, rehabilitation, medication support, social participation, caregiver relief, accessible transport, safeguarding, hospital-to-home coordination and residential support when community living is no longer appropriate or preferred.
The municipality can then map which existing service performs each function and where the gaps sit.
This exposes interfaces that organizational mapping may miss.
For example, responsibility for detecting functional decline may sit largely with Primary Care. A Centro-Dia may provide daytime social-care support. A rehabilitation team may work on mobility. A family member may provide all evening and weekend personal care. None of these actors individually owns the entire outcome.
Integrated planning therefore asks whether the combination is sustainable.
This is closely related to long-term care service models and pathways. The unit of analysis should be the person's journey through support, not simply the organizational units participating in it.
SUS and SUAS integration is foundational but should not become institutional confusion
For older people with long-term support needs, the relationship between SUS and SUAS is particularly important.
SUS brings universal health coverage, Primary Care, multidisciplinary teams, rehabilitation, specialist services, hospital care and specific forms of home healthcare. SUAS addresses social protection, family vulnerability, rights, community participation and defined services for older people and people with disabilities experiencing dependency and social risk.
The systems overlap around people without performing the same function.
A home visit from a Primary Care team is not equivalent to sustained daily personal care. A SUAS home social-protection service is not a substitute for clinical home healthcare. Centro-Dia is not an outpatient clinic.
Integration therefore depends on accurate role definition.
Useful interfaces include shared identification of functional and social vulnerability, clear referral routes, escalation when caregiver arrangements become unsafe, coordinated planning following hospitalization and proportionate exchange of relevant information.
The increasing use of functional assessment offers one practical bridge. The Ministry of Health has identified IVCF-20 as an instrument that can be used by health and SUAS professionals, creating the potential for a more common understanding of older-person vulnerability across systems.
Common assessment language is valuable precisely because institutional responsibilities remain different.
Home is where integration will be tested most visibly
Brazil's emerging home-based landscape illustrates both the opportunity and the complexity of integration.
Primary Care already reaches people in their communities. Melhor em Casa provides specialized SUS home healthcare for people whose clinical circumstances require frequent professional visits and who meet the program's criteria. Padi Brasil, established within Primary Care, adds a further structured approach to home-restricted older people with functional limitation, chronic conditions, frailty or clinical and social vulnerability.
SUAS also has forms of home-based social protection. Meanwhile, Cuidar em Casa is testing a more integrated model of support for vulnerable older people and unpaid caregivers in selected municipalities.
These developments should not be described as one nationwide comprehensive home-care entitlement. They have different purposes, eligibility and stages of development.
But together they demonstrate the direction of travel: the home is becoming a key interface between health, social support and family care.
The governance requirement is to prevent parallel teams from either duplicating work or assuming another service is providing support that is actually absent.
Referral closure matters. So does clarity about who remains responsible after referral.
Operational scenario: discharge exposes an integration failure before it becomes a crisis
An 84-year-old woman is admitted to hospital after pneumonia and significant deconditioning. Before admission she lived with her son and managed most personal activities independently. At discharge she can walk short distances but now needs help transferring, bathing and preparing meals.
The hospital records that she lives with family.
That fact alone is not a care plan.
A safe transition requires information about her new functional level, the son's actual capacity to provide care, Primary Care follow-up, rehabilitation needs, medication arrangements and whether social-assistance or community support is required.
If the son works full time and the municipality has no immediate home-support option, the risk does not disappear because a relative shares the address.
An integrated local pathway would identify the change in function before discharge, notify the appropriate Primary Care team, establish the relevant health follow-up and ensure that family-care capacity is actively considered. Where eligible services exist, referral to social or community support should be completed rather than simply suggested.
The operational outcome is not "discharged successfully." It is whether the person can remain safely at home without an avoidable cycle of deterioration, caregiver exhaustion and readmission.
This is why closed-loop referral and follow-up should become part of integrated-care governance.
Workforce integration requires capability across professional boundaries
Brazil does not need every professional to become a long-term care specialist. It does need more professionals to understand the wider care system surrounding their own role.
A Community Health Agent may notice that a previously independent older person is no longer preparing meals. A nurse may identify increasing functional vulnerability. A social worker may recognize that a daughter is close to abandoning paid work. A paid caregiver may notice repeated swallowing difficulty. A Centro-Dia worker may observe a rapid change in cognition.
Each observation can become important if there is a route for appropriate action.
This shifts workforce development beyond technical competence within one profession.
Integrated systems require:
- clear understanding of neighboring services and referral criteria;
- shared recognition of functional and caregiver risk;
- defined escalation routes;
- communication skills across professional and organizational boundaries;
- appropriate information-sharing practice; and
- supervision that supports judgment rather than procedural referral alone.
The workforce challenge is therefore partly one of capability and skill mix.
More staff matter, but so does the ability of existing staff to operate within a coordinated care pathway.
Governance must make shared responsibility more precise, not less
Integrated care can create a paradox.
The more organizations are described as jointly responsible, the easier it can become for nobody to be clearly accountable for a particular action.
Brazil's care governance therefore needs explicit decision rights.
At national level, the Plano Nacional de Cuidados has a strategic and management governance structure. The federal actions themselves are assigned to responsible ministries or bodies and include defined activities, targets and implementation expectations.
At territorial level, equivalent clarity is needed.
Who owns the local care plan? Who coordinates cross-sector implementation? Who can resolve a dispute between departments? Who monitors unmet need? Who decides whether a pilot should be expanded? Who receives evidence that a pathway repeatedly breaks down?
These are governance questions rather than frontline practice questions.
Organizations examining similar multi-agency arrangements can use the Governance Maturity Assessment to structure questions about accountability, escalation and assurance. It does not define Brazilian statutory responsibilities, but it can help leaders test whether shared governance has translated into clear ownership.
Implementation should be governed through outcomes as well as delivery milestones
Brasil que Cuida gives Brazil an important mechanism for tracking action. Federal initiatives can be associated with responsible bodies, targets, deadlines and deliveries.
This is necessary, but long-term care implementation will eventually need a second layer of evidence.
A new program can be delivered on schedule without reducing unmet care need. A training program can reach thousands of participants without improving workforce retention. A municipality can establish a care committee without creating any practical change for residents.
Implementation therefore needs both delivery and outcome evidence.
Useful questions include whether people obtain support earlier, whether functional decline is identified, whether family caregiver strain is reduced, whether territorial coverage improves and whether people move between services with greater continuity.
Data should also reveal persistent variation. If similar municipalities produce consistently different access or outcome patterns, governance should investigate why.
The objective is not to punish local difference. Brazil's territories genuinely differ. It is to identify variation that signals avoidable inequality or an implementation problem.
Regional inequality makes implementation capacity part of the reform
One of the central risks in decentralized reform is that the areas with the greatest need may have the least administrative or service capacity to implement new policy quickly.
Large metropolitan governments may have specialist planning teams, established service networks and stronger digital infrastructure. Smaller municipalities may operate with limited specialist workforce, constrained budgets and dependence on regional services.
Remote and Amazonian territories face additional challenges involving distance, transport, workforce distribution and connectivity.
A national care policy that simply delegates responsibility without strengthening implementation capacity could therefore reproduce existing inequality.
Federal technical assistance and state-level coordination are particularly important for this reason.
Smaller municipalities may benefit from shared regional services, mobile teams, telehealth support, common workforce development and joint planning rather than attempting to reproduce metropolitan service architecture at a smaller scale.
This is where rural and underserved community planning becomes part of system design rather than a specialist equity issue.
Equality of rights does not require identical delivery models. It requires credible routes to comparable protection and support.
Operational scenario: a small municipality cannot build every service itself
A municipality of 35,000 residents identifies a growing older population and increasing numbers of families supporting relatives with substantial dependency. Local leaders conclude that a specialized day service would be useful, but projected demand is insufficient to sustain a large standalone facility and specialist workforce.
A literal interpretation of metropolitan service design would leave two unattractive options: build an underused facility or provide nothing.
Integrated territorial planning creates alternatives.
The municipality works with neighboring localities and the state to examine a shared regional model. Transport needs are analyzed alongside staffing. Some support can be provided locally through Primary Care and SUAS. More specialized daytime provision is organized on defined days across a wider catchment. Digital consultation supports professional teams, while it does not replace hands-on care.
The result is not identical to provision in São Paulo or Belo Horizonte, nor should it be.
The governance test is whether residents can access an appropriate pathway without disproportionate delay or travel, whether families understand how to obtain support and whether outcomes are monitored.
This illustrates a broader principle for Brazil: decentralization should enable adaptation, but adaptation needs regional infrastructure when individual municipalities cannot efficiently supply every component of long-term care.
Technology can support integration, but interoperability is not the same as integrated care
Digital development creates significant opportunities for Brazil's care system.
Electronic Primary Care records, functional assessment, digital social-assistance records, telehealth and emerging care-data platforms can improve visibility across a person's journey.
But technical connection alone does not produce coordinated practice.
A referral can move electronically and still sit unanswered. Two systems can exchange data without professionals knowing who should act. A dashboard can identify caregiver strain without any available service to respond.
Digital integration therefore has three layers:
- technical interoperability — systems can exchange appropriate information;
- operational interoperability — services understand how to act on that information; and
- governance interoperability — responsibility, consent, privacy and escalation are defined.
The third layer becomes increasingly important as more sensitive health, social and family data are connected.
Organizations exploring similar digital transitions can use the Digital Transformation, AI and Cybersecurity Readiness Assessment to examine whether technology, workforce and governance are advancing together. Technology should make coordination easier without turning data sharing into unrestricted surveillance.
Rights should remain the organizing principle as systems become more complex
Integrated systems can become administratively sophisticated while still being difficult for people to navigate.
Brazil's National Care Policy provides a useful corrective because it begins with the right to care.
That requires implementation to remain person-centered.
An older person should not have to understand which ministry funds a service before obtaining help. Families should not become the default coordinators of disconnected public systems. People with cognitive or communication difficulties should not be excluded because navigation is complex.
Integration should therefore reduce administrative burden on households.
Rights also matter in risk decisions. Greater dependency does not automatically remove autonomy. Home monitoring technology should not be introduced solely for organizational convenience. Family involvement should not override the older person's preferences without proper legal and ethical justification.
The wider framework of rights, consent and decision-making remains integral to system integration.
A system is not person-centered merely because several agencies share information about the person.
Caregiver support should become core infrastructure rather than an informal contingency
Brazil's long-term care system will remain heavily dependent on families for the foreseeable future. The policy question is whether that contribution remains largely unsupported or becomes part of a more balanced care settlement.
The National Care Policy explicitly recognizes unpaid care workers and seeks to reduce the unequal burden of unpaid care, particularly on women.
This has major implications for integrated-system design.
Caregiver capacity should be assessed rather than assumed. Services should recognize when employment, health or family relationships are becoming unsustainable. Day services, home support, training and respite-related interventions should be understood partly through the capacity they release for families.
Programs such as Cuidar em Casa are particularly relevant because they test whether integrated support can enable unpaid caregivers to work, study or rest while an older relative receives assistance.
Early implementation should not be overstated as national universal provision. Its strategic importance lies in demonstrating a different policy logic: family care is not a free and limitless resource.
This is essential to the broader caregiver-burden agenda.
Scaling should follow evidence rather than political visibility
Brazil will inevitably develop local models at different speeds.
Some municipalities already possess mature integrated initiatives. Belo Horizonte's Programa Maior Cuidado is often relevant because it demonstrates long-standing local coordination between health and social assistance around vulnerable older people. Newer initiatives are testing other approaches.
The temptation in national reform is to identify a visible local success and replicate it rapidly.
That should be approached carefully.
What works in one municipality may depend on local workforce, political continuity, neighborhood infrastructure, service density and budget capacity.
Scaling should therefore separate the transferable mechanism from the local form.
For example, the transferable principle may be joint health-social assessment and caregiver support. The exact staffing model or service facility may not be transferable.
Evaluation should examine implementation fidelity, population characteristics, cost, workforce requirements, outcomes and the adaptations made in different territories.
This makes scaling what works a governance discipline rather than a replication exercise.
The next financing challenge is sustainability beyond program launches
Initial investment can create services. Long-term care systems depend on recurring expenditure.
This is one of the most important issues Brazil will eventually need to resolve.
A day center requires annual staffing and operating costs. Home support must be available week after week. Workforce training needs renewal. Digital systems require maintenance. Population aging means demand can increase even where provision is successful.
Capital or pilot funding cannot therefore substitute for sustainable revenue arrangements.
Brazil's current framework allows federal, state and municipal contributions through multiple sources, which creates flexibility. Over time, however, greater clarity may be needed around which level of government finances which elements of an expanding care continuum and how poorer territories are protected from disproportionate fiscal pressure.
The future debate may involve new transfers, dedicated programs, stronger cofinancing arrangements or other mechanisms. Those possibilities should be distinguished from the current framework rather than presented as existing national entitlements.
The policy principle is already clear: declaring care a right progressively increases the importance of making the underlying financial architecture capable of supporting that right.
Governance needs a feedback loop from households to national policy
An integrated care system cannot be governed only from Brasília.
Frontline evidence needs to travel upward.
Municipalities should identify recurring pathway failures and unmet needs. States can identify patterns that cross local boundaries. National governance can then determine whether problems require technical assistance, financing changes, policy clarification or redesign of federal actions.
The reverse flow matters equally. National policy needs to become operational guidance that local teams can use.
This creates a continuous implementation cycle:
- national direction defines rights, objectives and priorities;
- territories assess population need and existing capacity;
- local systems implement appropriate service responses;
- data and lived experience reveal performance and gaps;
- governance reviews persistent variation;
- policy, funding or delivery is adjusted where evidence supports change.
This is how decentralized governance can become a learning system rather than a hierarchy of reporting.
International learning: integration is an implementation discipline
Brazil's emerging model offers a useful international lesson because many countries attempt to integrate systems whose legal and financial structures developed separately.
The Brazilian institutions are specific. Other countries may operate social insurance, municipal care entitlements, regional health authorities or dedicated long-term care agencies. Brasil que Cuida cannot be lifted out of Brazil's federal, social and institutional context.
The transferable principle lies elsewhere.
Integration does not begin by drawing a new organizational chart. It begins by identifying the person whose needs cross existing structures and asking whether responsibility, money, workforce and information combine into a workable pathway.
Brazil also illustrates the importance of linking integration to the care economy. Supporting an older person and protecting the capacity of an unpaid caregiver are not separate policy outcomes. They are interdependent.
Finally, national rights require territorial implementation. Central government can establish ambition and financial mechanisms, but integrated care becomes real only through local services, regional capacity and day-to-day professional decisions.
Conclusion
Brazil has moved beyond debating whether care deserves national policy recognition. The Política Nacional de Cuidados and Brasil que Cuida now provide a legislative, strategic and governance framework through which a more coherent care system can be built.
The harder stage is implementation.
Brazil's long-term care architecture will continue to draw on SUS, SUAS, income protection, community services, families, private provision and emerging care programs rather than being replaced immediately by one national long-term care institution. Integration therefore depends on making those components work together: clarifying responsibilities, coordinating funding, identifying territorial gaps, strengthening workforce capability, closing referrals and using evidence to determine whether people's outcomes improve.
Financing will remain central. The R$25 billion associated with Brasil que Cuida represents broad investment across the National Care Plan, not a dedicated older-person long-term care budget. Sustainable long-term support will require continuing federal, state and municipal resources and progressively clearer answers about how recurring care costs are shared.
The strongest opportunity lies in Brazil's territorial approach. If national rights are combined with local needs assessment, state and federal support, accountable governance and genuine participation by people who need care and those who provide it, integration can become something more substantial than institutional coordination.
It can become the mechanism through which Brazil moves from a landscape in which families connect fragmented services themselves toward a system in which public policy increasingly assumes responsibility for making care coherent, accessible and sustainable.