Promotion of mechanisms to strengthen vertical accountability in local governments: the case of health in Brazil

Abstract

Purpose: To analyze the influence of the political and professional profile of public officials on the provision of mechanisms that promote vertical accountability in the local health system in Brazil.

Methodology: This qualitative study employed a two-stage research design. In the first stage, a structured questionnaire composed of thematic blocks was administered to 83 Municipal Health Departments, with the purpose of characterizing managers’ professional backgrounds and political-party affiliations, as well as examining respondents’ perceptions of the existing instruments of vertical accountability. The second stage involved a systematic documentary analysis of the official websites of the corresponding 83 municipalities, focusing on the presence, accessibility, and functional performance of vertical accountability mechanisms. Data were analyzed through documentary analysis and descriptive statistical procedures, organized in electronic databases, systematically coded, and subsequently compared.

Results: The political and professional profile of public health managers influences the improvement of vertical accountability mechanisms in local governments. The study findings indicate that secretaries who are affiliated with a political party performed worse in offering or maintaining vertical accountability instruments when compared to those who are not affiliated with a political party. When it comes to professional profile, the results indicate better performance by health managers who have training related to health and a higher education degree.

Contributions of the Study: This study provides original empirical evidence on how individual characteristics of municipal health managers – particularly the absence of political-party affiliation and professional training in the health field – are positively associated with the existence and effective functioning of vertical accountability mechanisms. By triangulating self-reported data with documentary verification across 83 Brazilian municipalities, the research moves beyond normative debates to demonstrate that the politicization of appointments undermines not only the formal availability of these instruments but also their actual capacity to foster transparency, responsiveness, and social oversight. These findings reinforce the importance of decoupling technical competence from partisan loyalty in appointments to strategic positions within the Unified Health System (SUS), thereby contributing both to theoretical discussions on subnational governance and to policy recommendations aimed at strengthening democratic administration in public health.