The Political Dimension of Health Systems Resilience: Brazil's Health Sector Reform Movement and the Unified Health System.

Abstract

The scientific production on health systems resilience reveals a major debate as to the concept, its dimensions and applications, as well as criticisms of, for example, the distance separating studies of the topic from those addressing Brazil's health reform sector movement, the Movimento da Reforma Sanitária Brasileira (MRSB). This article aims to close that gap and also to bring political analysis to bear on a study of health systems resilience. It takes a qualitative approach, first offering a brief review of the literature on resilience, exploring its dimensions as regards health systems and Brazil's national health system, the Sistema Único de Saúde (SUS), and then identifying the critical conjunctures in which the MRSB has operated, to form a case study of this movement's political action as a precondition for a resilient SUS. The results point to various moments at which the presence, organisation and collective action of the MRSB were crucial to increasing the SUS's resilience: the MRSB has been fundamental as a component in the construction and maintenance of the SUS, from its very conception, in resistance to attempts at dismantling the public system, through to its ability to learn and innovate.