[Fiscal austerity, COVID-19 and metropolises: a case study on the funding resilience of public health actions and services in Brazil].

Abstract

The article describes the pattern of resilience of municipal governments in funding public health actions and services (PHAS) in the 2000s and 2020s in the context of disseminating the fiscal austerity and health emergency agenda in Brazil. Funding resilience identifies the mechanisms for mobilizing resources to support the institutional capacity of health systems. The article analyzes the allocation of municipal resources to the PHAS of 17 metropolises (cities with more than 900 thousand inhabitants) from 2002 to 2021. Based on the values observed in the budget allocation of own revenues, the article calculates the Municipal Budget Resilience Index (IROM). It shows the support of municipal expenditure on PHAS during the two COVID-19 pandemic cycles (2020-2021). The budgetary allocation pact was crucial for sustaining funding in most metropolises, enabling a resilient response in critical years for the Unified Health System (UHS).