Parliamentary amendments aimed at the Brazilian Unified National Health System and the reelection of municipal mayors in Brazil in 2024

In Brazil, as of 2016, there has been an increase in the share of parliamentary amendments (PAs) in the federal budget, transferred from the Brazilian Ministry of Health to municipalities to fund the Brazilian Unified National Health System (SUS). This article analyzes the association between PAs focused on SUS and the reelection of municipal mayors in 2024. The research used public secondary data, involving 2,818 municipalities. The reelection of mayors was related to the per capita average of amendments transferred from the Brazilian National Health Fund, from January 2021 to October 2024. Hierarchical logistic regression was used, controlling individual and political factors of candidates, and socioeconomic and demographic municipal factors. The results indicate a positive and statistically significant association between the increase in resources for health amendments and the probability of reelection of mayors in 2024 in all models and cutoffs. Note that the values of amendments were considerably higher in municipalities with up to 20,000 inhabitants compared to the other municipalities. Possibly, the amendments consolidate the image of city mayors as capable of attracting resources, strengthening their electoral support in a context of quota of federal expenses. The political use of the amendments contrasts with the criteria adopted for the transfer of resources from SUS programs and may weaken the coordination of the Brazilian Ministry of Health.