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The (re)construction of the Unified National Health System (SUS) in the Municipality of São Paulo, Brazil, from 2001 to 2008 was analyzed by means of a case study, using different sources: documents, interviews with key informants, and participant observation. Health policy and health management were used as the analytical categories. The study selected and analyzed only the policies that were prioritized by the administration that took office in 2001 and that were maintained until 2008. The article discusses challenges for (re)construction of the SUS in São Paulo, related to the political and institutional context and including the structural changes as implemented. Reorganization of the Municipal Health Secretariat in São Paulo enabled constituting and maintaining two municipal subsystems (one hospital-based and the other outpatient). Negotiations between the Municipal, State, and Federal levels failed to make headway in order for the city of São Paulo to assume the de facto management of the entire health system, so that three public health subsystems coexisted (two Municipal and one State). The Family Health Program was sustained politically, mainly because it was a Federal government priority and was not a trademark of the first Municipal administration.

Política de saúde e gestão no processo de (re)construção do SUS em município de grande porte: um estudo de caso de São Paulo, Brasil