Brazilian municipal health policies during the COVID-19 pandemic

Brazil was one of the countries most impacted by the COVID-19 pandemic in Latin America and the world considering the number of cases, deaths, and the duration of lockdowns. Between 2020 and 2022, both pharmacological and non-pharmacological interventions (NPIs) were adopted at the municipal level, with 5,568 municipalities and the Federal District taking health-related actions. We present a new dataset revealing the complexity of this situation by reporting data based on thirty-seven surveys taken by mayors between 23 March 2021 and 24 March 2022.

The number of participating municipalities in each survey varied over time. The database indicates in which rounds each municipality participated. The minimum number of participating municipalities was 1,328 (23.8%), while the maximum reached 3,591 (64.49%), showing significant variation. The median was 2,461 (44.19%), and the mean of 2,482 (44.57%) suggests that, in general, municipal participation was close to the median, suggesting the data are representative. Finally, the first quartile was 2,063, and the third quartile was 2,831. The table titled “participation” presents the participation percentages for each of the rounds.

This dataset deals with the need to monitor and share information about fragmented policies designed to tackle health crises like the COVID-19 pandemic. Quantifying these initiatives and how they varied across municipalities can help us to understand the effectiveness of interventions in reducing virus transmission. We offer information over time on a series of measures to encourage social distancing, implement the vaccination programme, provide infrastructure to treat infected people, and facilitate how local governments would eventually ease these measures. This information can contribute to the institutional learning of health systems worldwide, assisting in future situations where a highly contagious virus challenges society.

Methods
Information on local NPI policies related to COVID-19 was collected through a telephone survey conducted directly with mayors, who had the option of receiving a password-protected link to respond to the online questionnaire later or to update previous responses. We focused on information concerning three essential dimensions related to the pandemic response: the monitoring of restrictive measures, infrastructure to treat infected people, and the implementation of the vaccination programme. We have included the week that respondents received the questionnaire, the initial date the questionnaire was presented to respondents, and the final date of questionnaire submission.

We collaborated with the Brazilian Confederation of Municipalities (CNM) to collect these data. The cooperation was formalised in a meeting with the CNM on 9 April 2020, and a written agreement was signed by the first and last authors of this article. The authors were given permission to describe, publish, and analyse the dataset. Prior to this current dataset with information from 2021 and 2022, the first and last authors of this dataset had already shared an initial dataset with lockdown measures in Brazil that refer to a survey conducted on October 19 2020, https://doi.org/10.5061/dryad.vdncjsxs2. Similar to our previous dataset that refers to a single survey in the initial days of COVID-19 pandemic, the data we now share on 37 surveys, are freely available to the public and to other academics for analysis.

As Brazil’s largest association of municipalities, the CNM has the email and phone numbers of all elected mayors in the country; the wide reach of the association makes it an ideal partner for large-scale data collection. The partnership was established to study the impact of decentralised measures in Brazil and the effects of decentralisation on the spread of infectious diseases. After the establishment of the cooperation agreement, the CNM added other questions to the questionnaire that were of interest to its municipal monitoring, such as questions related to the possible impact of the pandemic on municipal budgets.

Thirty-seven rounds of questionnaires were conducted, totalling 239 questions. Our database has 15 columns related to municipal identification, 4 on waiting for a bed, 6 on stock and yield of vaccines, 5 on intubation sets, 6 on restrictive measures, 3 on oxygen stocks in hospitals, COVID-19 centres, and other facilities, 4 on the stock of vaccines, 1 on financial resources, 3 on the situation in the UPAs, 3 on the social consequences of the pandemic, 2 on the care of people with health consequences resulting from COVID-19 infection, and 198 on vaccination.

Usage notes

As not all municipal authorities answered all the questions, we suggest that users of this dataset consider additional sources of information to document the implementation of missing policies, preferably using official sources of information such as local decrees. However, as decrees are not always available online, secondary sources, such as media reports, may need to be consulted.

We invite researchers to use these data to deepen their understanding of the pandemic and support health policymakers’ efforts in other health emergencies. Additionally, by combining our database with other government sources, such as those from the Superior Electoral Court, we offer tools to investigate effects of politics on public health policies during the pandemic and thus generate institutional learning for health systems, empirically demonstrating how political decisions influence public health policies. For example, we can analyse how the alignment of a particular mayor with the former president, elected in 2018, their party affiliation, and other such factors affected political decisions relating to pandemic response measures.