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States and Capitals of Health: Multilevel Health Governance in Brazil

  • Jorge Antonio Alves (a1) and Christopher L. Gibson (a2)
Abstract

Scholars of Brazil’s public health system commonly note the intertwined roles that federal, state, and municipal governments play in delivering care, yet few studies systematically examine varying service performance in areas with overlapping mandates, such as state capitals. This study addresses that gap by developing and analyzing a novel measure of municipal primary care provision that accounts for the proportion of the population without access to private services in 11 large capital cities, then comparing them to the noncapital municipalities in their states. The study finds that capitals generally underperform the noncapital municipalities in primary service delivery. It then draws on a comparative case study in two major capitals, Salvador and Belo Horizonte, and their encompassing states to explore how a history of cooperative or adversarial relations between state and local governments conditions the impact of partisanship, participatory institutions, and public health activists on primary care delivery.

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Conselho Estadual de Saúde da Bahia (CES-BA). 2008. Interviews with multiple members. Salvador, 2008–10.
Conselho Municipal de Saúde, Belo Horizonte (CMS-BH). 2009–10. Personal communication with multiple members. Belo Horizonte.
Comissão Intergestores Bipartite da Bahia (CIB-BA). 2008. Interviews with multiple current and former members. Salvador, 2008–9.
Imbassahy, Antônio. 2009. Former Mayor of Salvador. Salvador, December 9.
Magalhães, Helvécio Miranda. 2010. Former Municipal Secretary of Health, SMS-BH. Belo Horizonte, November 22.
Malachias, Ivêta. 2010. Career civil servant, SES-MG. Belo Horizonte, February 23.
Paim, Jairnilson. 2008. Former Adjunct Secretary of Health, SESAB. Salvador, December 18.
Tonón, Lídia. 2010. Former Adjunct Secretary of Health, SMS-BH. Belo Horizonte, November 4.
Alves, Jorge A. 2015. (Un?)Healthy Politics: The Political Determinants of Subnational Health Systems in Brazil. Latin American Politics and Society 57, 4: 119142.
Alves, Jorge A., and Hunter, Wendy. 2017. From Right to Left in Brazil’s Northeast: Transformation or “Politics as Usual”? Comparative Politics 49, 4: 437455.
Andrade, Laíse R. 2009. A FE no SUS: fundação estatal como proposta de gestão do trabalho para a Estratégia Saúde da Família na Bahia. Master’s thesis. Rio de Janeiro: Fundação Oswaldo Cruz.
Arretche, Marta. 2004. Toward a Unified and More Equitable Health System: Health Reform in Brazil. In Crucial Needs, Weak Incentives: Social Sector Reform, Democratization, and Globalization in Latin America, ed. Robert R. Kaufman and Joan M. Nelson. Baltimore: Johns Hopkins University Press. 155188.
Arretche, Marta, and Marques, Eduardo. 2002. Municipalização da saúde no Brasil: diferenças regionais, poder de voto e estratégias de governo. Ciência e Saúde Coletiva 7, 3: 455479.
A Tarde (Salvador). 2005a. João vai fazer auditoria na saúde. April 1. http://atarde.uol.com.br
A Tarde (Salvador). 2005b. Devassa na saúde, só no fim do mês. July 7. http://atarde.uol.com.br
Avritzer, Leonardo. 2009. Participatory Institutions in Democratic Brazil. Baltimore: Johns Hopkins University Press.
Bahia, Ligia. 2008. As contradições entre o SUS universal e as transferências de recursos públicos para os planos e seguros privados de saúde. Ciência e Saúde Coletiva 13, 5: 13851397.
Bahia, Ligia, Scheffer, Mario, dal Poz, Mario, and Travassos, Claudia. 2016. Planos privados de saúde com cobertura restrita: atualização da agenda privatizante no contexto da crise política e econômica brasileira. Cadernos de Saúde Pública 32, 12: 15.
Baiocchi, Gianpaolo, and Corrado, Lisa. 2010. The Politics of Habitus: Publics, Blackness, and Community Activism in Salvador, Brazil. Qualitative Sociology 33, 3: 369388.
Bertholini, Frederico, Pereira, Carlos, and Renno, Lucio. 2018. Pork Is Policy: Dissipative Inclusion at the Local Level. Governance 31, 4: 701720.
Brollo, Fernanda, and Nannicini, Tommaso. 2012. Tying Your Enemy’s Hands in Close Races: The Politics of Federal Transfers in Brazil. American Political Science Review 106, 4: 742761.
Coelho, Thereza Cristina B., and Paim, Jairnilson S.. 2005. Processo decisório e práticas de gestão: dirigindo a Secretaria da Saúde do Estado da Bahia, Brasil. Cadernos de Saúde Pública 21, 5: 13731382.
Coelho, Vera Schattan. 2006. Democratization of Brazilian Health Councils: The Paradox of Bringing the Other Side into the Tent. International Journal of Urban and Regional Research 30, 3: 656671.
Coelho, Vera Schattan, and Dias, Marcelo F.. 2015. Saúde e desigualdade no Brasil. In Trajetórias das desigualdades: como o Brasil mudou nos últimos 50 anos, ed. Marta Arretche. São Paulo: Editora UNESP. 249276.
Dantas Neto, Paulo Fábio. 2006. Surf nas ondas do tempo: do carlismo histórico ao carlismo pós-carlista. Caderno CRH 39: 213235.
Dickovick, J. Tyler, and Eaton, Kent. 2013. Latin America’s Resurgent Centre: National Government Strategies after Decentralisation. Journal of Development Studies 49, 11: 14531466.
Falleti, Tulia G. 2010. Infiltrating the State: The Evolution of Health Care Reforms in Brazil, 1964–1988. In Explaining Institutional Change: Ambiguity, Agency, and Power, ed. James Mahoney and Kathleen Thelen. New York: Cambridge University Press. 3862.
Garcia, Leila P., Ocké-Reis, Carlos O., de Magalhães, Luís C. G., Sant’Anna, Ana Claudia, and de Freitas, Lúcia R. S.. 2015. Gastos com planos de saúde das famílias brasileiras: estudo descritivo com dados das pesquisas de orçamentos familiares 2002–2003 e 2008–2009. Ciência e Saúde Coletiva 20, 5: 14251434.
Gibson, Christopher L. 2017. The Consequences of Movement Office-Holding for Health Policy Implementation and Social Development in Urban Brazil. Social Forces 96, 2: 751778.
Giovanella, Ligia, et al. 2010. Potencialidades e obstáculos para a consolidação da Estratégia Saúde da Família em grandes centros urbanos. Saúde em Debate 34, 85: 248264.
Giraudy, Agustina, Moncada, Eduardo, and Snyder, Richard, eds. Forthcoming. Inside Countries: Subnational Research in Comparative Politics. New York: Cambridge University Press.
González, Lucas. 2016. Presidential Popularity and the Politics of Distributing Federal Funds in Argentina. Publius 46, 2: 199223.
Guanais, Frederico C. 2015. The Combined Effects of the Expansion of Primary Health Care and Conditional Cash Transfers on Infant Mortality in Brazil, 1998–2010. American Journal of Public Health 105, 4: S593S599.
Guimarães, Maria do Carmo. 2003. Processo decisório e conflitos de interesse na implementação da descentralização da saúde: um estudo das instâncias colegiadas na Bahia. Cadernos CRH 39: 105132.
Johannessen, Peter G. 2016. Programmatic Parties and Local Governance: Evidence from Brazil. Paper presented at the 2016 Annual Meeting of the American Political Science Association, Philadelphia. September 1–4.
Lieberman, Evan S. 2005. Nested Analysis as a Mixed-Method Strategy for Comparative Research. American Political Science Review 99, 3: 435452.
Machado, Cristiani V., de Lima, Luciana Dias, and Baptista, Tatiana. 2017. Health Policies in Brazil in Times of Contradiction: Paths and Pitfalls in the Construction of a Universal System. Cadernos de Saúde Pública 33, suppl. 2: S143S161.
Macinko, James, Oliveira, Veneza, Turci, Maria Aparecida, Guanais, Frederico C., Bonolo, Palmira F., and Lima-Costa, Maria Fernanda. 2011. The Influence of Primary Care and Hospital Supply on Ambulatory Care: Sensitive Hospitalizations Among Adults in Brazil, 1999–2007. American Journal of Public Health 101, 10: 19631970.
McGuire, James W. 2010. Wealth, Health, and Democracy in East Asia and Latin America. New York: Cambridge University Press.
Mendes, Áquilas, and Marques, Rosa M.. 2014. O financiamento da Atenção Básica e da Estratégia Sáude da Família no Sistem Único de Saúde. Saúde Debate 38, 103: 900916.
Ministry of Health. Sistema de informações ambulatoriais do SUS (SIA/SUS). Primary health service data. http://sia.datasus.gov.br
Ministry of Health. DATASUS. 2013. Indicadores básicos de saúde. http://tabnet.datasus.gov.br/cgi/idb2012/matriz.htm
Ministry of Health. DATASUS. Intercensus population estimates. http://tabnet.datasus.gov.br/cgi/deftohtm.exe?novapop/cnv/popbr.def. [Now offline]
Ministry of Health. Departamento de Atenção Básica (MS/DAB). 2018. Histórico de cobertura saúde da família. http://dab.saude.gov.br/portaldab/historico_cobertura_sf.php. Accessed April 2018.
Ministry of Health. Supplemental Health Agency (Agência Nacional de Saúde Suplementar). Private health care coverage data. http://www.ans.gov.br/anstabnet/cgi-bin/tabnet?dados/tabnet_02.def. [Now offline]
Moscovich, Lorena, and Brusco, Valeria. 2018. Political Alignments and Distributive Politics at the Municipal Level in Federal Countries. Revista Brasileira de Ciência Política 26: 63105.
Niedzwiecki, Sara. 2015. Social Policies, Attribution of Responsibility, and Political Alignments: A Subnational Analysis of Argentina and Brazil. Comparative Political Studies 49, 4: 457498.
Paim, Jairnilson. 1989. A gestão do SUDS no Estado da Bahia. Cadernos de Saúde Pública 5, 4: 365375.
Paim, Jairnilson. 2008. Reforma sanitária brasileira: contribuição para a compreensão e crítica. Salvador: EDUFBA.
Paim, Jairnilson, Travassos, Claudia, Almeida, Celia, Bahia, Ligia, and Macinko, James. 2011. The Brazilian Health System: History, Advances, and Challenges. Lancet 377, 9779: 17781797.
Pessôa, Luisa, Santos, Isabela, Machado, Juliana, Martins, Ana Cristina, and Lima, Claudia de Araújo. 2016. Realocar a oferta do SUS para atender problemas do futuro: o caso do trauma no Brasil. Saúde em Debate 40, 110: 919.
Power, Timothy J. n.d. The Contrasting Trajectories of Brazil’s Two Authoritarian Successor Parties. Unpublished mss.
Pribble, Jennifer. 2013. Welfare and Party Politics in Latin America. New York: Cambridge University Press.
Rasella, Davide, Harhay, Michael O., Pamponet, Marina L., Aquino, Rosana, and Barreto, Mauricio L.. 2014. Impact of Primary Health Care on Mortality from Heart and Cerebrovascular Diseases in Brazil: A Nationwide Analysis of Longitudinal Data. Bmj 349: g4014.
Rasella, Davide, Aquino, Rosana, Santos, Carlos, Paes-Sousa, Rômulo, and Barreto, Mauricio L.. 2013. Effect of a Conditional Cash Transfer Programme on Childhood Mortality: A Nationwide Analysis of Brazilian Municipalities. Lancet 382, 9886: 5764.
Reiter, Bernd. 2008. The Limits of Popular Participation in Salvador, Brazil. Journal of Developing Societies 24, 3: 337354.
Secretaria Municipal de Saúde de Belo Horizonte (SMS-BH). 2001. Plano municipal de saúde 2001. Belo Horizonte.
Secretaria Municipal de Saúde de Belo Horizonte (SMS-BH). 2010. Plano municipal de saúde 2010. Belo Horizonte.
Souza, Celina M. 1997. Constitutional Engineering in Brazil: The Politics of Federalism and Decentralization. New York: St. Martin’s Press.
Sugiyama, Natasha Borges. 2012. Diffusion of Good Government: Social Sector Reforms in Brazil. Notre Dame: University of Notre Dame Press.
Touchton, Michael, and Wampler, Brian. 2014. Improving Social Well-being Through New Democratic Institutions. Comparative Political Studies 47, 10: 14421469.
Touchton, Michael, Sugiyama, Natasha Borges, and Wampler, Brian. 2017. Democracy at Work: Moving Beyond Elections to Improve Well-being. American Political Science Review 111, 1: 6882.
Viana, Ana L. d’Ávila, and de Lima, Luciana Dias, eds. 2011. Regionalização e relações federativas na política de saúde no Brasil. Rio de Janeiro: Contra Capa.
Wampler, Brian. 2015. Activating Democracy in Brazil: Popular Participation, Social Justice, and Interlocking Institutions. Notre Dame: University of Notre Dame Press.
World Bank. n.d. Health Nutrition and Population Statistics. Database. http://databank.worldbank.org/. Accessed May 2018.
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