Brazil has made remarkable progress in health over the last decades and improved access to healthcare has reduced inequalities. The backbone of Brazil’s success is the public Unified Health System (SUS), which entitles every Brazilian citizen to integrated healthcare free of charge. The SUS is facing severe capacity constraints, leading to long waiting times for specialised medical services, and access to medicines and specialist care can be difficult, particularly in poorer areas. A complex governance structure involving several levels of government is complicating an efficient provision of healthcare provision. To facilitate access to health care, Brazil should train more doctors and nurses, especially in family medicine, and strengthen incentives for them to move into underserved areas. Explicit targets for expanding capacity to reduce waiting times could also help to ease difficulties in access. Improving the governance of the system requires strengthening the role of regional networks and a better co-ordination of health care services, especially beyond primary care. Improving performance indicators and strengthening incentives to meet targets could lead to efficiency improvements at all levels of care. As Brazil's population ages, public health spending is set to increase and the associated challenges could best be anticipated by providing more home-based long-term care services for the elderly under the SUS.