Accountability and Health Inequalities Decrease: The São Paulo Megacity Experience

Abstract

In the megacity of São Paulo health inequalities decreased between 2001 and 2016. These distributive results are striking given how difficult it is to reverse inequalities. The article focuses on the implementation of the primary health care policy in the city, highlighting the role of three accountability mechanisms in promoting these results: fierce electoral competition, health councils and contracts — between the federal government and the municipality, and between the latter and the oss.