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      The response to COVID-19 in Argentina, Brazil, and Mexico: challenges to national coordination of health policies Translated title: La respuesta al COVID-19 en Argentina, Brasil y México: los desafíos a la coordinación federativa de las políticas de salud

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          Abstract:

          The article analyzes the fight against COVID-19 in three Latin American countries: Argentina, Brazil, and Mexico. A multiple case study was carried out in a comparative perspective, based on a bibliographic review, documentary analysis, and secondary data, considering characteristics of the countries and the health system, evolution of COVID-19, national governance, containment and mitigation measures, health systems response, constraints, positive aspects and limits of responses. The three countries had distinct health systems but were marked by insufficient funding and inequalities when hit by the pandemic and recorded high-COVID-19 mortality. Structural, institutional, and political factors influenced national responses. In Argentina, national leadership and intergovernmental political agreements favored the initial adoption of centralized control measures, which were not sustained. In Brazil, there were limits in national coordination and leadership related to the President’s denialism and federative, political, and expert conflicts, despite a universal health system with intergovernmental commissions and participatory councils, which were little used during the pandemic. In Mexico, structural difficulties were associated with the Federal Government’s initial reluctance to adopt restrictive measures, limits on testing, and relative slowness in immunization. In conclusion, facing health emergencies requires strengthening public health systems associated with federative, intersectoral, and civil society coordination mechanisms and effective global solidarity mechanisms.

          Resumen:

          El artículo analiza la lucha contra el COVID-19 en tres federaciones latinoamericanas: Argentina, Brasil y México. Se realizó un estudio de casos múltiple en perspectiva comparada, basado en revisión bibliográfica, análisis documental y de datos secundarios, teniendo en cuenta: las características de los países y del sistema de salud, la evolución del COVID-19, la gobernanza nacional, las medidas de contención y mitigación, la respuesta de los sistemas de salud, los factores condicionantes, los aspectos positivos y los límites de las respuestas. Los tres países tenían sistemas de salud diferentes, pero marcados por financiación insuficiente y desigualdades, cuando afectados por la pandemia, y registraron una alta mortalidad por COVID-19. Las respuestas nacionales se influyeron por factores condicionantes estructurales, institucionales y políticos. En Argentina, el liderazgo nacional y los acuerdos políticos intergubernamentales favorecieron la adopción inicial de medidas de control centralizadas, que no se sustentaron. En Brasil, hubo límites en la coordinación y liderazgo nacional, relacionados con el negacionismo del presidente y los conflictos federativos, políticos y con expertos, a pesar de existir un sistema de salud universal que tiene comisiones intergubernamentales y consejos participativos, poco utilizados en la pandemia. En México, las dificultades estructurales se asociaron con la renuencia inicial del gobierno nacional en adoptar medidas restrictivas, límites en las pruebas y relativa lentitud en la vacunación. Se concluye que para enfrentar emergencias sanitarias hay que fortalecer los sistemas públicos de salud asociados con mecanismos de coordinación federativa, intersectorial y con la sociedad civil, así como mecanismos efectivos de solidaridad global.

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          Most cited references41

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          Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries

          Health systems resilience is key to learning lessons from country responses to crises such as coronavirus disease 2019 (COVID-19). In this perspective, we review COVID-19 responses in 28 countries using a new health systems resilience framework. Through a combination of literature review, national government submissions and interviews with experts, we conducted a comparative analysis of national responses. We report on domains addressing governance and financing, health workforce, medical products and technologies, public health functions, health service delivery and community engagement to prevent and mitigate the spread of COVID-19. We then synthesize four salient elements that underlie highly effective national responses and offer recommendations toward strengthening health systems resilience globally.
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            Comparative Historical Analysis in the Social Sciences

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              Atenção primária à saúde em tempos de COVID-19: o que fazer?

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                Author and article information

                Contributors
                Role: contributed with the study conception, analysisRole: writing, and reviewRole: approved the final version
                Role: contributed with the study conception, analysisRole: writing, and reviewRole: approved the final version
                Role: contributed with the study conception, analysisRole: writing, and reviewRole: approved the final version
                Role: contributed with the study conceptionRole: writing, and reviewRole: approved the final version
                Role: contributed with the study conceptionRole: writing, and reviewRole: approved the final version
                Role: contributed with the analysis and reviewRole: approved the final version
                Journal
                Cad Saude Publica
                Cad Saude Publica
                csp
                Cadernos de Saúde Pública
                Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz
                0102-311X
                1678-4464
                29 July 2024
                2024
                : 40
                : 6
                : e00055023
                Affiliations
                [1 ] Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
                [2 ] Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.
                [3 ] Centro de Relações Internacionais em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
                [4 ] Universidade do Grande Rio, Mesquita, Brasil.
                [1 ] Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
                [2 ] Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.
                [3 ] Centro de Relações Internacionais em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
                [4 ] Universidade do Grande Rio, Mesquita, Brasil.
                Author notes
                [Correspondence ] C. V. Machado Departamento de Administração e Planejamento em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. Rua Leopoldo Bulhões 1480, 7º andar, Rio de Janeiro, RJ 21041-210, Brasil. cristiani.machado@ 123456fiocruz.br

                Additional information: ORCID: Cristiani Vieira Machado (0000-0002-9577-0301); Adelyne Maria Mendes Pereira (0000-0002-2497-9861); Carlos Machado de Freitas (0000-0001-6626-9908); Michele Souza e Souza (0000-0002-8014-8528); Sebastián Tobar (0000-0002-2966-0219); Suelen Carlos de Oliveira (0000-0002-0090-2341).

                [Correspondência ] C. V. Machado Departamento de Administração e Planejamento em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. Rua Leopoldo Bulhões 1480, 7º andar, Rio de Janeiro, RJ 21041-210, Brasil. cristiani.machado@ 123456fiocruz.br

                Informações adicionais: ORCID: Cristiani Vieira Machado (0000-0002-9577-0301); Adelyne Maria Mendes Pereira (0000-0002-2497-9861); Carlos Machado de Freitas (0000-0001-6626-9908); Michele Souza e Souza (0000-0002-8014-8528); Sebastián Tobar (0000-0002-2966-0219); Suelen Carlos de Oliveira (0000-0002-0090-2341).

                Author information
                https://orcid.org/0000-0002-9577-0301
                https://orcid.org/0000-0002-2497-9861
                https://orcid.org/0000-0001-6626-9908
                https://orcid.org/0000-0002-8014-8528
                https://orcid.org/0000-0002-2966-0219
                https://orcid.org/0000-0002-0090-2341
                Article
                01404
                10.1590/0102-311XEN055023
                11290836
                39082560
                6c583262-eb98-4004-a2e0-dc271ed6044f

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                : 23 March 2023
                : 18 January 2024
                : 22 January 2024
                Page count
                Figures: 2, Tables: 8, Equations: 0, References: 42
                Categories
                Article

                pandemics,covid-19,health policies,federalism,pandemias,políticas de salud,federalismo

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