The World Bank and the Brazilian National Health System in the beginning of the 21st century

This essay has the aim of updating discussions on the political perspective and the role played by the World Bank in the development of public health policies in Brazil, seeking to identify continuities and changes in the way this institution acts and suggest hypotheses about action strategies in this new century. To do this, we analyzed a 2007 and a 2013 document published by that institution, and gather data on projects funded by the World Bank from 2000 to 2015 in Brazil, with emphasis on the healthcare industry. We concluded that the traditional mechanisms of action have not changed from those used in the 1980s and 1990s, as well as the guiding principles; what we observed is that the World Bank's actions have shifted from the national level to the state and municipal level. We indicate the need for specific studies of the agreements between the Bank and subnational governments, since the Brazilian federative model and the national health system itself allow implementing decentralized management mechanisms that can alter the setting of the Unified Health System.