Brazil’s flagship effort to cut waiting lists in the public health system has expanded specialist care but has not proved that patients are waiting less time, according to an audit reported by Folha de S.Paulo. The finding matters politically for President Luiz Inácio Lula da Silva, whose government has made the program a central health-care promise ahead of the 2026 election cycle.
The program, Agora Tem Especialistas, targets delays in consultations, exams and surgeries inside the Unified Health System (SUS), Brazil’s universal public health network. It received R$3.3 billion in 2025, roughly USD 640 million at recent exchange rates, after being created to increase surgical and outpatient capacity.
What the Audit Found
Brazil’s Federal Court of Accounts (TCU), the audit body that oversees federal spending, analyzed more than 768 million health records from 2023 to 2025. According to Folha’s single-source reporting, the court found that surgical output rose and returned to pre-pandemic levels in several specialties, but said higher volume alone does not show that queues are falling.
The audit said one-quarter of patients face lengthening waits, in some cases longer than a year, for complex procedures. Examples cited in the report include surgery for thyroid cancer, vascular neurosurgery, scoliosis correction and parathyroidectomy, a procedure involving glands that regulate calcium in the body.
For the TCU, these cases point to structural bottlenecks: too few specialists, services concentrated in a small number of referral centers and weak coordination across regional health networks. The report also said production growth slowed sharply, from 45.6% in 2022 to 20.3% in 2023 and 2024, then to 4.5% in 2025. The court interpreted that slowdown as a sign that the system may be approaching its operational ceiling.
Data Gaps
The audit identified weaknesses in information systems, management and transparency. It said the Health Ministry still lacks a national database able to follow a patient from entry into a waiting list through completion of treatment. Without that, the government cannot reliably measure real demand or assess the program’s impact.
The report, signed by TCU minister Bruno Dantas, ordered the ministry to monitor and disclose the program’s spending and present an action plan with deadlines and named officials responsible for correcting the problems.
Mozart Julio Tabosa Sales, the Health Ministry’s secretary for specialized care, acknowledged that data integration remains insufficient. He told Folha that the next phase of the program will focus on improving the quality of state-level data and linking state regulation systems. The ministry expects Brazil to have a national dashboard tracking waiting times and patient pathways by the end of 2026.
Integrated Care
A central part of the new model is the OCI, or Integrated Care Offer, which groups consultations, tests, diagnosis and treatment into a single care pathway rather than treating each procedure separately. The TCU found wide regional inequality in the rollout. Although nearly 90% of municipalities had joined the OCI strategy, only 6.9% of planned offers had been carried out during the period reviewed. In seven states, none had been executed.
Mozart disputed part of the audit’s scope, saying the TCU examined only two components of the broader program: integrated care offers and surgeries. He said the review left out radiotherapy expansion, specialist hiring, equipment purchases, health transport and cancer-diagnosis reorganization.
The São Paulo state municipality of Americana was cited by Folha as a successful case. Between July 2025 and May 2026, the city delivered more than 16,000 integrated care offers. Its cardiology queue for a first consultation reportedly fell from one year to about 30 days after the city reorganized care pathways and automated parts of the authorization process.
Health economist André Medici, director of Universal Health Monitor, told Folha the audit confirms concerns raised when the program began. He argued that increasing production is not enough because queues start before surgery, in specialist consultations, diagnostic exams, clinical regulation and priority setting. Without integrated networks and comparable historical data, he said, Brazil risks relying on repeated task forces rather than permanent gains.