• Budget Data Collection: The data used to support this study were extracted from the Statement of Tax Revenues and Own Expenses for Public Health Actions and Services, included in the Summary Report on Budget Execution, in the Fiscal Responsibility Law statement, for the period from January 1, 2023 to December 31, 2023.

• The data were extracted according to the reference table and refer to approved data with respective dates and times of approval. All data contained are declared by the federated entities, stored, and processed through Digital Certification, thus establishing the integrity and consolidation of information in reliable reference bases.

• The data provided are organized and made available on the internet, at http://siops.datasus.gov.br, in the form of various types of queries and reports.

• To extract data from the SIOPS (Public Health Budget Information System) database, individual searches were performed for each state and each of the 5,570 municipalities. The data source was accessed and the data required for analysis was collected, involving database searches and file downloads, without the use of any tool, such as a “bot” or any API integration, allowing critical analyses based on data extraction and processing.

• Budget Distribution: Dashboard reports were analyzed and produced with careful assessments of the distribution of budget resources at all levels of care, primary, secondary and tertiary, and across all spheres, federal, state and municipal.

• Temporal and Regional Comparisons: Compare budget evolution over time and between different regions of Brazil (North, Northeast, Southeast, South and Central-West), identifying possible disparities.

• Comparisons between states and municipalities with special breakdowns by macro-regions and health regions, with individualized observation of the health subfunctions that comprise care in the SUS: basic care, outpatient and hospital care, prophylactic and therapeutic support, health surveillance, epidemiological surveillance, food and nutrition and other subfunctions.

Budget Analysis

• All physical structures available in each of the 5,570 municipalities were identified by applying an index of the number of beds in relation to budgetary and structural availability. Responsibilities by type of management were observed, with a critical analysis of the participation of each sphere of government in the composition of expenditure in relation to their responsibility.

• Assessment of personnel availability with a special focus on the management responsibility of each professional, the participation, by type of management, of professionals available in the municipal system in relation to the responsibility for hiring them, allowing the separation of budget execution.

• Health Infrastructure: The distribution of health units (hospitals, UPAs, UBSs) throughout the country was mapped, including the number of beds, medical equipment, and installed capacity for care.

• Human Resources: The number of health professionals by state, municipality, macro-region and health region of the following professionals were mapped: doctors, nurses, physiotherapists, dentists, among others, their distribution and care capacity.v

Assessment of Available Structure

Mortality

• All deaths during the period were assessed, by state and municipality, comparing the number of deaths in different regions of the country and also applying the mortality rate per thousand inhabitants, aiming at an analysis with the outcome, death, identifying areas with greater vulnerability, disparities in access to health or adverse conditions.

• Considering the need to measure the promotion of equity in light of population needs and social vulnerability, the Human Development Index and the Human Income Development Index were applied, which are intrinsically linked to health, and are important in the qualitative assessment of budgetary data on the application of resources in health, considering better health conditions, access to medical services and infrastructure.

Human Development Index

• Considering the assessments of the amounts of resources applied to health at all levels, complementary and comparative analyses were carried out between the volume of resources executed and distributed and the ceilings established annually by the Ministry of Health, based on the production of the year prior to the exercise evaluated, both in primary care and in medium and high complexity.

• With the assessment of the resources applied to primary care, in comparison with the established ceiling comprising the resources necessary to maintain essential programs and services, it is therefore essential to compare the amount of resources applied by municipalities and states with the resources recognized as approved by the Ministry of Health and established as a reference by Ordinance.

Production Ceilings

Statement of Resources

• Considering the need to evaluate and comparatively consider the resource declared by each municipality in SIOPS, the resources transferred by the Union were evaluated, with broad data from each bank order executed, by program and purpose of the transfer and also considering the balance existing on the last day of the year under analysis.

• Health Indicators: The health indicators established for the period by the Ministry of Health were considered, considering: Prenatal (6 consultations) (%), Prenatal (Syphilis and HIV) (%), Pregnant Women Oral Health (%), Cytopathological Coverage (%), Polio and Penta Coverage (%), Hypertension (Measured BP) (%) and Diabetes (Glycated Hemoglobin) (%).

• Efficiency Analysis: In addition to the indicators above, indexes were produced that allow the assessment of structural availability in relation to the availability of resources.

Health Outcomes