GOVERNANCE, FINANCING, AND REGIONAL INEQUALITIES IN PUBLIC HEALTH MANAGEMENT: AN INTEGRATIVE REVIEW OF THE BRAZILIAN LITERATURE
DOI:
https://doi.org/10.66104/twcha467Keywords:
Health governance; Public health management; SUS financing; Regional inequalities; Public health policies; Unified Health System.Abstract
The study examines how public health management constitutes one of the main challenges to the consolidation of universal health systems, especially in contexts marked by budgetary constraints, regional inequalities, and growing demand for healthcare services. In Brazil, these challenges directly impact the management capacity of the Unified Health System (SUS), affecting administrative efficiency, equity in access, and the quality of care provided to the population. Given this scenario, the present study aimed to critically analyze the scientific evidence regarding the main challenges related to governance, financing, and regional inequalities in Brazilian public health management. This is an integrative literature review, conducted through searches in national and international databases, covering scientific publications related to public health management, health governance, SUS financing, and inequalities in access to health services. The analysis of the studies identified three central categories: 1) limitations in governance and managerial capacity; 2) insufficiency and unequal distribution of public financing; and 3) persistence of regional inequalities in the provision of resources, infrastructure, and health professionals. The results show that administrative fragmentation, poor managerial skills, financial dependence on subnational entities, and regional socioeconomic disparities undermine the effectiveness of public health policies. It was also observed that strategies based on collaborative governance, regionalization of care, management capacity building, and strengthening of transparency and social control mechanisms contribute to improving the institutional performance of the SUS. It is concluded that addressing the challenges of public health management requires integrated actions aimed at strengthening state capacity, reducing regional disparities, and enhancing the system’s financial sustainability, which are essential elements for promoting equity and efficiency in the provision of health services.
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