by PublicABCP
Translated and reviewed by Matheus Lucas Hebling
The article “Congressional Amendments Earmarked for the Unified Health System and the Reelection of Municipal Mayors in Brazil in 2024,” authored by João Gabriel Ribeiro Pessanha Leal (Fiocruz-ENSP), Luciana Dias de Lima (Fiocruz-ENSP), Frederico Bertholini (UnB), and André Schimidt da Silva (Fiocruz-ENSP), analyzes the association between the allocation of congressional amendments (emendas parlamentares, EPs) to the Sistema Único de Saúde (SUS — Unified Health System) and the electoral performance of mayors in the 2024 municipal elections.
The research is situated in a context in which the legislative branch has assumed a more prominent role in defining the federal budget — particularly since 2016, with the expansion of mandatory execution of amendments — and in which EP-based transfers have come to constitute a significant share of decentralized health financing, against a backdrop of fiscal constraint.
The study aims to analyze the possible association between the volume of congressional amendments earmarked for the SUS and mayoral reelection in the 2024 municipal elections. It departs from the hypothesis that municipal administrators who secure substantial amendment funding enjoy competitive advantages in the electoral contest, by reinforcing their image as political brokers capable of attracting resources to their municipalities.
The research was conducted using publicly available data and encompassed 2,818 municipalities whose mayors completed the term that began in 2021 and ran for reelection. To test the hypothesis, the authors employed hierarchical logistic regression models, controlling for individual and political variables of the candidates as well as socioeconomic and demographic characteristics of the municipalities.
The results indicate a positive and statistically significant association between increases in per capita health-earmarked amendment funding and the probability of mayoral reelection. This relationship was observed across all models analyzed, including subsets stratified by population size. Municipalities with up to 20,000 inhabitants, in particular, displayed the highest mean amendment values and the highest reelection rates among the candidates evaluated.
The analysis also showed that reelected mayors, on the whole, received higher EP amounts compared to those who were not returned to office. According to the authors, these results suggest that securing amendment funding may contribute to strengthening the electoral position of municipal administrators by increasing their visibility and capacity to respond to local demands.
The study highlights that the growing importance of congressional amendments in the SUS financing structure occurs in a context of federal spending restraint, which makes the system more dependent on political brokerage to secure its resources.
The authors observe that the discretionary nature of EPs favors unequal allocation of funds, with greater concentration in municipalities with larger electorates or with mayors politically aligned with particular legislators. Moreover, they note that this process may weaken coordination by the Ministry of Health and alter the pattern of intergovernmental relations, since transfers via amendments do not necessarily pass through the established channels of federative negotiation.
The authors acknowledge some limitations in the scope of the research. The time frame, spanning January 2021 to October 2024, may restrict the analysis of short-term variations and specific political contexts. Another point noted is that the study considers only mayors who completed the term that began in 2021 and who ran for reelection, which may introduce selection bias.
Additionally, the exclusive focus on amendments earmarked for health disregards possible effects of EPs directed to other policy areas with electoral relevance. To deepen the understanding of the mechanisms underlying the identified association, the authors suggest that future research explore aspects such as the effective implementation of amendments in municipalities and the degree of public visibility of the funded actions — factors that may differentially influence electoral performance.
In doing so, the study broadens the debate on the political effects of public resource distribution and the challenges of equitable health financing in Brazil.
Author Profiles
João Gabriel Ribeiro Pessanha Leal is a doctoral candidate in Public Health at Fiocruz-ENSP. His research focuses primarily on the determinants of public policy in Brazil, with work spanning the subfields of social spending and petroleum revenues, political parties and the financing of social policies, with a focus on the Sistema Único de Saúde (SUS).
Luciana Dias de Lima is a professor and researcher in Public Health at Fiocruz-ENSP. She holds a medical degree from the Universidade Federal do Rio de Janeiro (1993), a residency in Preventive and Social Medicine from Fiocruz (1996), and a master’s degree (1999) and Ph.D. (2006) in Collective Health from the Instituto de Medicina Social at the Universidade do Estado do Rio de Janeiro.
Frederico Bertholini Santos Rodrigues is a professor of Political Science at the Universidade de Brasília (UnB — University of Brasília). He holds a Ph.D. in Public Administration (Institutions, Politics, and Government) from FGV, with a sandwich doctoral period at New York University. He previously served as Research Manager at Codeplan-DF and as an affiliated researcher at FGV/RJ.
André Schimidt da Silva holds a Ph.D. in Public Health from Fiocruz-ENSP. He earned his undergraduate degree in Psychology from the Universidade Federal do Rio de Janeiro, a specialization in Public Health from the Escola Nacional de Saúde Pública (ENSP/Fiocruz), and a master’s degree in Epidemiology in Public Health from ENSP/Fiocruz, in the subfield of Philosophy and Applied Social Sciences in Epidemiology.
PUBLICATION DETAILS
Title: Congressional Amendments Earmarked for the Unified Health System and the Reelection of Municipal Mayors in Brazil in 2024 (Emendas parlamentares destinadas ao Sistema Único de Saúde e a reeleição de prefeitos municipais do Brasil em 2024)
Authors: João Gabriel Ribeiro Pessanha Leal, Luciana Dias de Lima, Frederico Bertholini, and André Schimidt da Silva
Year of Publication: 2025
Available in: Cadernos de Saúde Pública, v. 41, no. 4
