Covid-19 and federative coordination in Brazil: consequences of federal dissonance for the pandemic response

ABSTRACT

This essay aimed to discuss the trajectory of federative coordination in the Unified Health System (SUS) and the coordination of response efforts to the Covid-19 pandemic. To support the discussion, it addresses a theoretical framework on the relationship between federalism and the implementation of public policies, and on the development of federative coordination in the SUS. It also discusses recent decisions by the Ministry of Health that resulted in the weakening of the system’s coordination instruments. It considers that the deficient federal coordination in the response to the pandemic is not due to the absence of federative coordination mechanisms of SUS or to the constraint of these mechanisms imposed by the other entities of the federation. What is observed is the deliberate weakening of these instruments by the federal government. It concludes that the health crisis accelerated the process of distancing the Ministry of Health from its role as national director of SUS and made explicit the decision of the federal government for inaction, relegating to the Ministry a secondary role in efforts against the pandemic, with serious consequences for access population to health care, especially intensive care, and for the effectiveness of actions in the field of health surveillance.

KEYWORDS
Federalism; Health services accessibility; Public health surveillance; Pandemics; Coronavirus