Health Systems in the Global South: A Comparative Political–Institutional Analysis of BRICS Countries
1
National School of Public Health (ENSP), FIOCRUZ - Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A1842
ABSTRACT
BACKGROUND:
The BRICS countries—Brazil, Russia, India, China, and South Africa—constitute a strategic grouping within the Global South, marked by significant demographic and economic weight, persistent structural inequalities, and heterogeneous health system arrangements1. Since 2011, the bloc has increasingly positioned itself within global health debates2. However, comparative analyses that examine health systems through a critical and theoretically informed lens remain limited3. This study seeks to contribute to this gap by analyzing BRICS health systems from a Global South perspective, emphasizing the structural and institutional determinants that shape health outcomes.
METHODS:
Drawing on a historical-institutional and political economy approach4,5, this comparative study examines how state structures, policy legacies, and socio-economic inequalities influence the configuration, governance, and performance of BRICS health systems between 2012 and 2025. A multiple case study design was employed6, structured around three analytical dimensions: (1) the geopolitical and socio-economic contexts of the BRICS; (2) institutional arrangements of health systems, including financing, regulation, and service provision; and (3) cross-national comparison of patterns of inequality, state intervention, and prospects for South–South cooperation. Data sources included scholarly literature, policy documents, and secondary indicators.
RESULTS:
The findings reveal both convergence and divergence among BRICS health systems. Despite distinct institutional trajectories, Brazil, Russia, and China exhibit stronger state involvement in health system governance, financing, and regulation,7–9 whereas India and South Africa rely more heavily on mixed and market-oriented arrangements.10,11 Across all cases, structural inequalities related to income, territory, and social stratification shape health system performance12,13. These inequalities intersect with a dual burden of chronic and infectious diseases, constraining equity and universality14,15.
CONCLUSIONS:
A theoretically grounded comparative analysis reveals that strengthening state capacity and public health systems is central to addressing health inequalities in the Global South. BRICS cooperation provides a strategic arena for advancing principles of universality, solidarity, and health promotion.
The BRICS countries—Brazil, Russia, India, China, and South Africa—constitute a strategic grouping within the Global South, marked by significant demographic and economic weight, persistent structural inequalities, and heterogeneous health system arrangements1. Since 2011, the bloc has increasingly positioned itself within global health debates2. However, comparative analyses that examine health systems through a critical and theoretically informed lens remain limited3. This study seeks to contribute to this gap by analyzing BRICS health systems from a Global South perspective, emphasizing the structural and institutional determinants that shape health outcomes.
METHODS:
Drawing on a historical-institutional and political economy approach4,5, this comparative study examines how state structures, policy legacies, and socio-economic inequalities influence the configuration, governance, and performance of BRICS health systems between 2012 and 2025. A multiple case study design was employed6, structured around three analytical dimensions: (1) the geopolitical and socio-economic contexts of the BRICS; (2) institutional arrangements of health systems, including financing, regulation, and service provision; and (3) cross-national comparison of patterns of inequality, state intervention, and prospects for South–South cooperation. Data sources included scholarly literature, policy documents, and secondary indicators.
RESULTS:
The findings reveal both convergence and divergence among BRICS health systems. Despite distinct institutional trajectories, Brazil, Russia, and China exhibit stronger state involvement in health system governance, financing, and regulation,7–9 whereas India and South Africa rely more heavily on mixed and market-oriented arrangements.10,11 Across all cases, structural inequalities related to income, territory, and social stratification shape health system performance12,13. These inequalities intersect with a dual burden of chronic and infectious diseases, constraining equity and universality14,15.
CONCLUSIONS:
A theoretically grounded comparative analysis reveals that strengthening state capacity and public health systems is central to addressing health inequalities in the Global South. BRICS cooperation provides a strategic arena for advancing principles of universality, solidarity, and health promotion.
| eISSN: | 2654-1459 |
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