The challenges of funding the Brazilian health system in fighting the COVID-19 pandemic in the context of the federative pact

Abstract The improvement of rules to fund the Brazilian health system (SUS) in states and municipalities is one of the major public health challenges in Brazil. The purpose of this article is to contribute to this broad debate, analyzing the government's response to the challenge of combating COVID-19, from the perspective of public financing of health services of Brazilian subnational governments. A qualitative and quantitative approach is adopted, combining documentary analysis and regression analysis. The results show that there was no substantive change in the criteria for transfers, which are not sensitive to epidemiological factors. Adjustments to the application rules were made to speed up spending. Population size, production of local wealth, and the number of hospital beds are the main factors that define the distribution of resources. The funding design for combating COVID-19, as well as the volume of resources, are insufficient in view of the scale of the crisis.