Considering the great complexity of if identifying the causes of the difficulties and shunting lines of routes, it was opted to calling them, generically, of challenges. Challenges placed for Managers for the Council members of Health, in the vision of Participativa Management. The challenges presented here place the construction of the SUS under the angle of the estruturao of the new model of attention to the health, and not only of the increase of the efficiency of structures of the previous model that, although to hold desirable advances in the access, covering, fairness, completeness, decentralization and participation, are advances structurally limited and with less sustainable costs each time. The strategical conduction of these advances can be estruturante, breaching the old model, or enganosa, reproducing them and strengthening them with new appearances. The National Advice of Health recognizes the inconclusividades, shunting lines of routes, fragilities of management and the proper social control, without what he would distanciaria himself of the essential corrections. He recognizes, on the other hand, that the principles and lines of direction of the SUS and its attempt of concretion, in last the twelve years, meet made it difficult unequivocally for the effective economic policy in these last years, that privilege the financial system, the market and a paradigm of State of baixssimo commitment with redistributivistas, desenvolvimentistas public politics, of full job and intersetoriais actions, aiming at to the quality of life and the rights of citizenship, in what it refers to the feeding and alimentary security, sanitation, half-environment, education, work (urban and agricultural), job, income, habitation, public security, culture, leisure and, also, the health. The SUS, in this context, is a set of social and institucional actors that comes if developing in the against-hand of these politics controversas, today responsible for the biggest causes of the difficulties to its implantation and that they will have to be surpassed by the proper society. .