Resilience in the Brazilian health system: impacts of the COVID-19 pandemic

Brazil has one of the most comprehensive and largest public health systems in the world, called the Unified Health System (SUS). Despite the SUS’s great knowledge acquired in previous epidemics and primary health care (PHC) capillarity in the territory, Brazil suffered with the COVID-19 pandemic shock and the absence of federal government coordination and leadership. In this chapter we analyze the resilience of the Brazilian health system in the COVID-19 pandemic based on the public administration and health system literature. We use the health system performance assessment dimensions as a framework to analyze the SUS’s resilience - governance and leadership; financing; resources; and service delivery. Among the results, we point out that i) the federal government did not use the previous knowledge and it was absent in SUS coordination while also spreading misinformation - however, the state government assumed responsibility and created a strong partnership with the social mechanism (Conass); ii) the national congress, pressured by society, provided additional funds to the SUS response due to the federal absence; iii) previous inequalities in the SUS workforce, infrastructure and medicines and technology were evident in the COVID-19 response, affecting the most vulnerable; and iv) the SUS had still not recovered from the decrease in its procedures at the beginning of the COVID-19 pandemic in 2022. Therefore, our chapter shows that even with the federal political obstacles presented during the COVID-19 pandemic, the SUS’s decentralization and its social participation mechanisms, and the frontline health workforce spread throughout all the territory, kept the health system resilient.