Integrative and Complementary Health Practices

The implementation of Integrative and Complementary Health Practices (PICS) in Brazil’s Unified Health System (SUS) is the result of longstanding social demands from managers, health workers and civil society movements. Since 1986, these actors have advocated for the recognition of PICS during the National Health Conferences. Drawing on a wide range of local experiences and ongoing debate, PICS were officially incorporated into SUS in 2006 through a Ministry of Health ordinance establishing the National Policy on Integrative and Complementary Health Practices and the National Policy on Medicinal Plants and Herbal Medicines.

The incorporation of these practices into SUS encouraged several federal health profession councils to develop specific regulations defining training requirements and professional practice criteria in both the public and private sectors.

Products, medicines, inputs and equipment used in Brazil are regulated by the National Health Surveillance Agency (ANVISA), which has made significant progress in regulating herbal medicines and products related to Traditional Chinese Medicine.

Practices Recognized in the Public Health System

In SUS, PICS comprise complex medical systems and therapeutic resources. Currently, 29 practices are recognized: homeopathy; Traditional Chinese Medicine/acupuncture; medicinal plants and herbal medicine; anthroposophic medicine; social thermalism/spa therapy; art therapy; Ayurveda; biodance; circle dance; meditation; music therapy; naturopathy; osteopathy; chiropractic; reflex therapy; reiki; shantala; integrative community therapy; yoga; aromatherapy; apitherapy; bioenergetics; family constellation therapy; chromotherapy; geotherapy; hypnotherapy; laying on of hands; ozone therapy; and flower essence therapy. These 29 practices broaden care approaches and therapeutic options for users, contributing to more comprehensive and effective health services.

These practices are offered within conventional health services and are delivered by health professionals such as physicians, nurses, physiotherapists and psychologists, among others. Some practices are carried out by professionals specifically trained in PICS—such as music therapists, art therapists, naturologists and holistic therapists—although their numbers remain limited.

More than 23,000 health teams provide these practices in approximately 21,000 primary health care facilities, over 350 public hospitals, and 2,000 medium-complexity services, including mental health services.

Source: Ministry of Health (2024). Monitoring Report of the Ministry of Health of Brazil.

In 2024, more than 9 million participants were registered in individual and group PICS activities. Among the most frequently recorded practices in SUS are those from Traditional Chinese Medicine, such as acupuncture, auriculotherapy, body practices and cupping therapy. These services were provided mainly in primary health care (56%) and also in specialized and hospital services (44%).

Source: Ministry of Health (2024). Monitoring Report of the Ministry of Health of Brazil.

The most widely provided practices in SUS are those of Traditional Chinese Medicine, followed by herbal medicine, massage therapy, yoga and meditation.

Source: Ministry of Health (2024). Monitoring Report of the Ministry of Health of Brazil.

Learn more about the provision of PICS in the Ministry of Health monitoring report:

See a message from the Ministry of Health: Integrative and Complementary Health Practices: Care and Health Promotion in Primary Health Care (PHC)

Professional Recognition

PICS in Brazil are delivered by a wide range of health professionals working in SUS. Physicians, nurses, psychologists, physiotherapists, occupational therapists, pharmacists, physical education professionals and others may offer different practices, provided they are properly trained and act in accordance with the regulations of their professional councils. This diversity reflects the multiprofessional and interdisciplinary nature of PICS.

In many areas, community health workers also play a central role in raising awareness, referring users and supporting group activities such as meditation and health-promotion practices. Their involvement helps strengthen community bonds and enhance locally based care.

In the private sector, the Ministry of Labour also recognizes other occupations—such as reiki therapists, yoga instructors, meditation instructors, bioenergetic movement facilitators and naturopaths. These roles are legally recognized but may not perform acts restricted to legally regulated health professions.

Required Training

Training requirements to practice PICS in SUS vary according to the specific modality. Some practices require long-term specialization programs recognized by professional councils, such as acupuncture, herbal medicine and homeopathy. Others—such as auriculotherapy, body practices from Traditional Chinese Medicine and meditation—may be offered after shorter training courses.

Some professions or occupations also require specific training, such as naturologists, art therapists, technologists in PICS and yoga instructors, who more commonly work in the private sector.

Expansion Strategy

The expansion of PICS in Brazil is guided by strategies implemented across different levels of the health system. A central component is the expansion of services in primary health care units, ensuring access to practices close to users’ communities as a routine part of care.

Another strategic axis is continuous professional training. Partnerships with universities and SUS training institutions have enabled in-person, hybrid and online courses that have trained hundreds of thousands of SUS workers, significantly expanding the number of professionals qualified to offer these practices. Notable initiatives include the national auriculotherapy training programme, which has trained more than 23,000 health professionals, and online courses on AVASUS, which have registered over 350,000 enrolments in modules on Traditional Chinese Medicine, medicinal plants and herbal medicines, aromatherapy, meditation, yoga and others.

Link: AVASUS | Educational Modules

A further area of action is the incorporation of PICS into technical guidance documents for managers and health workers, including manuals, guides, handbooks, protocols and briefs. These documents guide how PICS should be organized within the public health system and provide technical orientation to ensure safe and high-quality practice.

Recognized Protocols and Guidelines

The adoption of PICS in SUS is supported by clinical protocols, regulations and guidelines that ensure quality, safety and effectiveness. These documents guide activities ranging from the selection of medicinal plants to the implementation of techniques such as auriculotherapy, body practices, acupuncture and meditation. Standardization is essential to ensure that services are based on scientific evidence and comply with ethical and legal standards in health practice.

Scientific evidence has informed the Ministry of Health and state and municipal governments in the incorporation of PICS into clinical protocols and therapeutic guidelines for conditions such as chronic pain, hypertension, diabetes, overweight and obesity, and tobacco cessation, among others.

In addition to national documents, many municipalities have developed local PICS protocols tailored to their specific contexts. This process strengthens decentralized care and ensures that the national policy remains dynamic and responsive to community needs.

Ensuring Access to Inputs

One of the key pillars for strengthening PICS in SUS is ensuring the availability of quality inputs. In the case of herbal medicine, this includes the regulation of safe plant species and the establishment of medicinal plant gardens, “living pharmacies”, compounding pharmacies and industries that produce herbal medicines in line with defined technical standards.

The National List of Medicinal Plants of Interest to SUS (RENISUS) is the main reference, identifying species that should be prioritized for research and production. ANVISA establishes rules for the registration, production and commercialization of these products, ensuring safety and efficacy for users.

Sustaining the policy also requires strengthening local production chains. Many municipalities have developed partnerships with family farmers and cooperatives for medicinal plant cultivation, integrating health promotion with income generation and sustainable development. Ensuring access to inputs is therefore linked to a broader vision of health and citizenship.

Access the Ministry of Health website:
Integrative and Complementary Health Practices (PICS) – Ministry of Health