Decentralization in the PNAB: expressions of Brazilian conservative liberalism in the political health

Abstract

This article analyses Brazil’s 2017 National Primary Care Policy (PNAB) within the broader context of democratic erosion. Situated within the liberal paradigm of fiscal austerity, the alterations made to the national primary health care guidelines appear to be designed to weaken the federal government’s capacity to coordinate primary health care policy. The reduction in the Ministry of Health’s (MH) role in establishing national standards reflects an intentional shift towards enhancing municipal autonomy in policy implementation. By mapping the involved stakeholders and political entities, this study examines the implications of the changes introduced since the 2011 PNAB. It is argued that the 2017 PNAB promotes a more restrictive understanding of Primary Health Care (PHC) by creating direct and indirect incentives for the establishment of traditional Basic Care teams, thereby diminishing the role of the Family Health Strategy as a tool for expanding and consolidating PHC across the country. In conclusion, this paper argues that federal oversight of health policy is a crucial political and programmatic factor in advancing the authority of Unified Health System, while a conservative liberal agenda risks undermining democratic principles.