Mandatory legislative amendments in health

decentralization, administrative capacity, and outcomes in the SUS

Abstract

This article analyzes the allocation of mandatory congressional amendment funds within Brazil’s federal health budget between 2015 and 2023. Two main questions guide the study: How are these resources being allocated, and how do they influence subnational autonomy? Does greater local autonomy associated with these funds lead to improved health outcomes when administrative capacity is considered? Drawing on an original dataset constructed from public sources and Access to Information Law requests, the study combines descriptive analysis with a case study of four municipalities in Northeast Brazil. The findings indicate that the effectiveness of resource utilization is conditioned by prior administrative capacity. Municipalities with weaker administrative structures tend to exhibit lower effectiveness, even when they receive substantial funding. The article contributes to the debate on SUS financing by highlighting both the limits and the potential of the mandatory amendment model and by underscoring the need for stronger integration between technical allocation criteria and political decision-making in the distribution of public resources.