INTRODUCTION:
Women’s participation in the governance of health policies in Brazil has expanded over recent decades within the Unified Health System (Sistema Único de Saúde – SUS). Despite being historically underrepresented in formal spaces of power, women have played a central role in the management of the SUS at the municipal level. This study analyzes women’s leadership in the governance of health policies in Brazil, considering gender inequalities and structural challenges identified in health management contexts.

METHODS:
This is a qualitative and analytical study grounded in a systematic literature review, longitudinal analysis, and semi-structured interviews with women serving as Municipal Health Secretaries. The methodological approach sought to identify trajectories, experiences, and structural conditions shaping women’s leadership in health policy governance.

RESULTS:
The findings indicate a growing presence of women in the position of Municipal Health Secretary across Brazilian municipalities. However, this leadership often unfolds in contexts marked by work overload, invisibility of decision-making power, and the persistence of symbolic and institutional barriers associated with gender inequalities. Despite these constraints, women have demonstrated strong commitment to the management of health systems and to the strengthening of public health policies at the local level.

CONCLUSIONS:
Women’s leadership is fundamental to the democratization of power structures and to the governance of health policies in Brazil. Nevertheless, it continues to face significant structural and institutional limitations. Overcoming these barriers is essential for consolidating a Unified Health System that is more democratic, equitable, and responsive to social diversity.