Health reform in Brazil: The sanitaristas as programmatic actors

Brazil has one of the largest public health systems in the world. By applying the Programmatic Action Framework (PAF), this study provides an endogenous explanation for the health reform and brings new lenses to understand one of the most successful cases of social protection expansion. It demonstrates the relevance of a group of professionals who had a common perception of why the policy should change and a coherent policy change program. Cognitive frameworks, organizational resources, and strong professional culture allowed the sanitaristas occupying key positions in the state apparatus, behaving strategically as a collective actor. The evidence provided suggests the approach's relevance to this case due to considerations of political-institutional specificities. Treating the sanitaristas as a programmatic actor is helpful to explain their role in promoting change and the endurance of the programmatic consensus they have built, which has been crucial to support the universal healthcare model in the country.