Federal funding of Primary Health Care in Brazil: Models, challenges, and potentialities

Modelos, desafíos y potenciales

Abstract

This article aims to analyze the transformations in the federal co-funding of Primary Health Care (PHC) in Brazil, between 1991 and 2024, focusing on the models adopted and their implications for strengthening the Brazilian Unified Health System (SUS). The different federal co-funding models were analyzed, highlighting the new funding proposal presented in 2024. Documentary research was conducted to systematize official, normative, and institutional sources to understand the historical evolution and regulatory frameworks of federal co-funding in PHC. As a result, the article highlights the various changes in co-funding over time and shows how the model introduced in 2024 seeks to reconcile budgetary predictability with the promotion of good practices, while emphasizing equity in resource allocation through the creation of the Equity and Scaling Index (IED), which combines the Social Vulnerability Index (IVS) with the population size of municipalities. Finally, this study indicates that the new model represents progress in aligning funding with the constitutional principles of the SUS, but that key challenges remain: ensuring articulation with other health policies, reducing dependency on congressional amendments, and monitoring the impact of population redistribution on the quality and effectiveness of care.