This report is based on a series of interviews conducted in early 2022 with state health secretaries and other important stakeholders in Brazil’s public health system and aims to inform and support state administrations in the country. It explores lessons on coordination arising from the pandemic period and outlines pathways for greater productive coordination moving forward in order to address the challenges of building back from COVID-19 and regionalisation of health.

After analysing the behaviour of state health secretaries during the pandemic, and recognising the immense challenges they had to overcome, this report recommends that state administrations when possible select health secretaries that are likely to remain for at least one entire term. This would allow for greater learning, trust-building, and for relationships among state health secretaries to develop over longer periods of time, facilitating coordination.

The experience of coordination during the pandemic also shows that despite great advancements, state administrations will need to maintain efforts to make health data more robust and integrated. It also advises that the structures which successfully managed coordination during the pandemic – and particularly CONASS – should continue to be strengthened in order to push forward new agendas.

This report also highlights the five areas within public health that Brazilian policymakers should pay greater attention to, in order to build back from the COVID-19 pandemic: the backlog of elective surgeries and missed diagnosis, changes in risk factors for chronic diseases, mental health, long-COVID, and immunisation.