Latin America has made progress toward universal health coverage despite deep inequalities and structural fragmentation. This chapter examines Brazil’s Unified Health System (SUS)—created in 1988 around universality, comprehensiveness, and equity—as a regional benchmark. The analysis highlights major advances in primary health care expansion and equity, alongside enduring challenges such as chronic underfunding, workforce imbalance, and regional disparities in service provision. The COVID-19 pandemic tested SUS’s resilience, revealing both its capacity for coordinated primary care and its institutional weaknesses. The chapter concludes by outlining key priorities for consolidating universal health systems in unequal contexts: stable financing, stronger multilevel governance, equitable resource allocation, and integration between primary and specialized care.