Unveiling conflicting strategies in the Brazilian response to COVID-19: A cross-sectional study using the Functional Resonance Analysis Method

Maintenance of medium- and high-complexity health services in the context of high patient transition: a time series ecological study of the state of Rio de Janeiro, Brazil

The study addresses the historical disparities in the distribution of the medium- and high-complexity health network and the limits to budget adjustments between the municipality of Rio de Janeiro and its neighboring municipalities of the Metropolitan region 1. An ecological study was conducted with data related to the municipality of Rio de Janeiro, chosen because it has a large assistance network, while located on the borders of vulnerable and underprivileged areas, characterizing a locus that is representative of the situations faced throughout the country. A decrease in the gross values of the programmed quotas in all municipalities of Rio de Janeiro was observed from 2016 onwards. The temporal trend of the programmed quotas remained stable for all municipalities in the Metropolitan Region 1, even with significant increases in the accomplished quotas for neighboring municipalities. The resulting overload in local expenditure prevents the increase of capacity to anticipate fluctuations in demand, both known and unexpected ones, compromising the responsiveness of the health system regarding its regular operation, as well as the ability to adjust to cope with extraordinary events, essential characteristics of resilience.

Transformative dimensions of resilience and brittleness during health systems' collapse: a case study in Brazil using the Functional Resonance Analysis Method

BACKGROUND

As health systems struggle to tackle the spread of Covid-19, resilience becomes an especially relevant attribute and research topic. More than strength or preparedness, to perform resiliently to emerging shocks, health systems must develop specific abilities that aim to increase their potential to adapt to extraordinary situations while maintaining their regular functioning. Brazil has been one of the most affected countries during the pandemic. In January 2021, the Amazonas state's health system collapsed, especially in the city of Manaus, where acute Covid-19 patients died due to scarcity of medical supplies for respiratory therapy.

METHODS

This paper explores the case of the health system's collapse in Manaus to uncover the elements that prevented the system from performing resiliently to the pandemic, by carrying out a grounded-based systems analysis of the performance of health authorities in Brazil using the Functional Resonance Analysis Method. The major source of information for this study was the reports from the congressional investigation carried out to unveil the Brazilian response to the pandemic.

RESULTS

Poor cohesion between the different levels of government disrupted essential functions for managing the pandemic. Moreover, the political agenda interfered in the abilities of the system to monitor, respond, anticipate, and learn, essential aspects of resilient performance.

CONCLUSIONS

Through a systems analysis approach, this study describes the implicit strategy of "living with Covid-19", and an in-depth view of the measures that hampered the resilience of the Brazilian health system to the spread of Covid-19.