Recentralization of Health Systems: The Strengthening of Central Health Authorities in Brazil and Spain

ABSTRACT The article analyzes the dynamics behind the recentralization of health systems in Brazil and Spain. Recentralization in Brazil and Spain occurred after a long decentralization process when central governments stepped up their monitoring and coordination roles over the health system as a response to the shortcomings of decentralization. The analysis herein explains why Brazil shows a higher degree of recentralization than Spain and reveals two causes of this outcome: first, the different strategies of central governments to sideline at least one subnational level of government during decentralization, and second, the type of opposition these governments faced in the approval of recentralizing measures. This article contributes to the literature on health reforms in two ways: first, it allows for a better grasp on the main factors affecting the advancement of recentralization, and second, it aids in identifying how temporality and territoriality interfere in the recentralization of health systems.