State management of primary health care in response to COVID-19 in Bahia, Brazil

This is an analysis of state manage-ment of Primary Health Care in response to the COVID-19 pandemic in Bahia. It is a qualitative case study with interviews with managers and regulatory documents analyzed according to the categories of government project and government capacity. State PHC proposals were debated in the Bipartite Intermanagerial Commission and in the Public Health Operational Emergency Committee. The scope of the PHC project focused on the definition of specific actions to manage the health crisis with the municipalities. The institu-tional support of the state to the municipalities modulated inter-federative relations and was de-cisive in the elaboration of municipal contingency plans, training of teams and production and dis-semination of technical standards. The capacity of the state government was dependent upon the degree of municipal autonomy and the availa-bility of state technical references in the regions. The state strengthened institutional partnerships for dialogue with municipal managers, but me-chanisms for articulation with the federal level and social control were not identified. This study contributes to the analysis of the role of states in the formulation and implementation of PHC ac-tions mediated by inter-federative relationships in emergency public health contexts.