Gobernanza local en la respuesta a COVID-19: Retos, estrategias y lecciones, una revisión integradora multinacional
DOI:
https://doi.org/10.33448/rsd-v14i7.49187Palabras clave:
Gobernanza local, Políticas públicas, Políticas de salud, COVID-19, Respuesta pandémica, Gestión de crisis sanitárias.Resumen
Esta revisión integradora tiene como objetivo examinar el papel de la gobernanza local en la respuesta a la pandemia de COVID-19 en diversos países. Basada en 39 artículos científicos publicados entre 2020 y abril de 2025 en las siguientes bases de datos: PubMed, Web of Science, Scopus, Science Direct y Google Scholar. Los hallazgos revelan que la efectividad de las respuestas a la crisis de salud pública estuvo intrínsecamente ligada a la capacidad adaptativa de los gobiernos locales, la coordinación intergubernamental y la participación social. Se identificaron seis categorías temáticas clave: (i) capacidad adaptativa y resiliencia; (ii) estructuras de coordinación; (iii) factores facilitadores (recursos, liderazgo); (iv) desafíos estructurales (fragmentación, subfinanciación); (v) participación social; y (vi) variaciones contextuales. Países como China, Corea del Sur y Bangladesh demostraron una articulación local-comunitaria efectiva, mientras que Brasil, Suecia y Zimbabue enfrentaron limitaciones debido a la centralización y debilidades federativas. El estudio concluye que la autonomía en la toma de decisiones, el financiamiento adecuado y la cooperación multinivel son críticos para respuestas efectivas ante crisis sanitarias. Recomienda fortalecer los arreglos institucionales locales para futuras emergencias. Como uno de los análisis comparativos multinacionales pioneros sobre gobernanza local durante la COVID-19, esta revisión proporciona un marco analítico aplicable a futuras crisis de salud, ofreciendo perspectivas prácticas para diseñar sistemas de gobernanza descentralizados resilientes.
Referencias
Al Farid Uddin, K., Rahman, A., Islam, M. R. & Parvin, M. (2024). A study of the decentralised administrative arrangements between the central and local governments in Bangladesh during the COVID-19 pandemic crisis. Public Administration and Policy. 27(1), 58–72.
Alam, E., Han, X., Islam, A. R. M. T., Alvarez, E., Islam, M. K. & Dominey‐Howes, D. (2024). The local governance of COVID‐19: Lessons learned and ways forward in rural Bangladesh. Asian Politics & Policy. 16(2), 165–90.
Alshoubaki, W. & Zemrani, A. (2022). Central-Local Government Coordination During the COVID-19 Response: A Case Study Analysis of Jordan and Morocco. Lex localis - Journal of Local Self-Government. 20(4), 1011–33. http://pub.lex-localis.info/index.php/LexLocalis/article/view/1900.
Andrade, M. C. T. (2012). Desenvolvimento e governação local: cidadania dimensões para a saúde. Comunicação e saúde: temas, questões e perspectivas latinoamericanas. https://www.reciis.icict.fiocruz.br/index.php/reciis/article/view/707.
Ansell, C. & Boin, A. (2004). Taming Deep Uncertainty: The Potential of Pragmatist Principles for Understanding and Improving Strategic Crisis Management. Administration and Society. 51(7), 1079–112.
Bache, I. & Flinders, M. (2004). Multi-Level Governance and the Study of the British State. Public Policy and Administration. 19(1), 31–51. https://journals.sagepub.com/doi/10.1177/095207670401900103.
Barrio, M. O. del, Simard, F. & Caprara, A. (2018). Supporting and strengthening research on urban health interventions for the prevention and control of vector-borne and other infectious diseases of poverty: scoping reviews and research gap analysis. Infectious Diseases of Poverty. 7(1), 94. https://idpjournal.biomedcentral.com/articles/10.1186/s40249-018-0462-z.
Belmon, L. S., Van Stralen, M. M., Harmsen, I. A., Den Hertog, K. E., Ruiter, R. A. C., Chinapaw, M. J. M. & Busch, V. (2022). Promoting children’s sleep health: Intervention Mapping meets Health in All Policies. Frontiers in Public Health. 16(10), 882384. doi: 10.3389/fpubh.2022.882384. eCollection 2022.
Bhide, A. (2025). Gaining agency? Pandemic governance and the Indian city. International Development Planning Review. 47(1). https://doi.org/10.3828/idpr.2024.1. https://www.liverpooluniversitypress.co.uk/doi/full/10.3828/idpr.2024.16.
Bonita, R., Beaglehole, R. & Kjellström, T. (2006). Epidemiologia Básica. (2ed). Editora GEN / Ed.Santos / WHO.
Bosa, I., Castelli, A., Castelli, M., Ciani, O., Compagni, A., Galizzi, M. M., Garofano, M., Ghislandi, S., Giannoni, M., Marini, G. & Vainieri, M. (2021). Corona-regionalism? Differences in regional responses to COVID-19 in Italy. Health Policy. 125(9), 1179–87. https://linkinghub.elsevier.com/retrieve/pii/S0168851021001974.
Capano, G. & Lippi, A. (2021). Decentralization, policy capacities, and varieties of first health response to the COVID-19 outbreak: evidence from three regions in Italy. Journal of European Public Policy. 28(8), 1197–218. https://www.tandfonline.com/doi/full/10.1080/13501763.2021.1942156.
Casula, M. (2017). Quem governa na governança ( local )? Reflexões teóricas e evidências empíricas. Revista de Administração Pública. 51(6), 1122–38.
Censon, D. & Barcelos, M. (2020). O Papel Do Estado Na Gestão Da Crise Ocasionada Pela Covid-19: Visões Distintas Sobre Federalismo E As Relações Entre União E Municípios. Revista Brasileira de Gestão e Desenvolvimento Regional. 16(4), 49–63. https://www.rbgdr.com.br/revista/index.php/rbgdr/article/view/5977.
Chaparro, R., Melendi, S., Santero, M., Seijo, M., Elorriaga, N., Belizan, M., Rubinstein, A. & Irazola, V. (2020). A review of assessment indicators used by Healthy Municipalities and Communities Program in Latin America and the Caribbean region. Health Promotion International. 35 (4), 714–29. Chatterjee, V. & Arapis, T. (2023). Examining COVID-19 response among local governments through the political market framework. Journal of Emergency Management. 21(7), 111–31. https://wmpllc.org/ojs/index.php/jem/article/view/3379.
Chavehpour, Y., Rashidian, A., Woldemichael, A. & Takian, A. (2019). Inequality in geographical distribution of hospitals and hospital beds in densely populated metropolitan cities of Iran. BMC Health Services Research. 19(1), 1–8.
Chikerema, A., Chakunda, V. & Mukunyadze, T. (2024). Exploring the impact of locking down citizen’s voice on citizen participation in local government budgeting during COVID-19 public restrictions in Zimbabwe. Discover global society. 2(1). https://link.springer.com/article/10.1007/s44282-024-00094-0.
Chung, K. H., Kim, D. & Shim, D. C. (2025). The capacities of local government in early response to Covid 19: Evidence from South Korea. Public Money & Management. 45(1). https://ideas.repec.org/a/taf/pubmmg/v45y2025i1p34-44.html
Dam, J. L., Nagorka-Smith, P., Waddell, A., Wright, A., Bos, J. J. & Bragge, P. (2023). Research evidence use in local government-led public health interventions: a systematic review. Health Research Policy and Systems. 21(1), 1–15. https://doi.org/10.1186/s12961-023-01009-2.
De Vocht, F., Heron, J., Angus, C., Brennan, A., Mooney, J., Lock, K., Campbell, R. & Hichman, M. (2016). Measurable effects of local alcohol licensing policies on population health in England. Journal of Epidemiology and Community Health. 70(3), 231–7.
Dougherty, S., Vammalle, C., Formam, K. & De Biase, P. (2020). COVID-19 e as relações fiscais entre os níveis de governo. OCDE. 19, 1–25. Dutta, A. & Fischer, H. W. (2021). The local governance of COVID-19: Disease prevention and social security in rural India. World Development. 138, 105234. https://linkinghub.elsevier.com/retrieve/pii/S0305750X20303612.
Fernandes, G. A. A. L. & Pereira, B. L. S. (2020). Os desafios do financiamento do enfrentamento à COVID-19 no SUS dentro do pacto federativo. Revista de Administração Pública. 54 (4), 595–613. Filho, N. A. & Barreto, M. L. (2011). Epidemiologia & Saúde:Fundamentos, Métodos, Aplicações. Guanabara Koogan, 2011. 700 p.
Fredriksson, M. & Health, A. H. (2021). COVID-19 Testing in Sweden During 2020–Split Responsibilities and Multi-Level Challenges. Frontiers in Public Health. 9, 1–17.
Fridayani, H. D. & Soong, J. J. (2021). The Emergent Role of Local Government On Covid-19 Outbreak In Indonesia: A New State-Society Perspective. Journal of Governance. 6(1). https://jurnal.untirta.ac.id/index.php/jog/article/view/10287.
Gutiérrez, A. C., Campos, G. W. S., Cunha, M. S., Mattos, M. P., Costa, P. S., Silva, R. O. L., Pereira, A. C. S. R., Campos, A. R & Guerra, C. A. (2023). Organised groups, social activism and narratives of the pandemic in vulnerable territories in the city of Rio de Janeiro, Brazil. Ciência & Saúde Coletiva. 28(12), 3533–42. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232023001203533&tlng=en.
Heilbrunn-Lang, A. Y., Carpenter, L. M., Powell, S. M., Kearney, S. L., Cole, D. & De Silva, A. M. (2016). Reviewing public policy for promoting population oral health in Victoria, Australia (2007-12). Australian Health Review. 40 (1), 19–26. Hoekman, L. M., Smits, M. M. V. & Koolman, X. (2020). The Dutch COVID-19 approach: Regional differences in a small country. Health Policy and Technology. 9(4), 613–22. https://linkinghub.elsevier.com/retrieve/pii/S2211883720300800.
Holt, D. H., Frohlich, K. L., Tjørnhøj-Thomsen, T. & Clavier, C. (2017). Intersectoriality in Danish municipalities: Corrupting the social determinants of health? Health Promotion International. 32(5), 881–90.
Hoornbeek, J., Morris, M., Libbey, P. & Pezzino, G. (2019). Consolidating Local Health Departments in the United States: Challenges, Evidence, and Thoughts for the Future. Public Health Reports. 134(2), 103–8.
Idiculla, M. & Mukherjee, G. (2023). Local Governments, Federalism, and the Governance of Public Health in India. In: AG, S. N. S. Local Governance in Multi-Layered Systems. Ius Gentium: Comparative Perspectives on Law and Justice. [s.l.] Springer Nature Switzerland AG, 2023. p. 417–38.
Indriani, I. K. (2022). The effect of local government budget capacity on covid-19 cases handling: study in district government of kalimantan island (projection in facing pandemic). Jurnal Ilmu Pemerintahan Widya Praja. 48(1), 37–54. https://ejournal.ipdn.ac.id/JIPWP/article/view/2292.
Kapologwe, N. A., Kalolo, A., Kengia, J., Swai, I. L., Kesale, A. M., Kacholi, G., Jiyenze, M. K. & Anasel, M. G. (2023). Community Health Systems Management and Governance. In: CRC PRESS EBOOKS. Leadership and Governance in Primary Healthcare. CRC Press eBooks. p. 91–106.
Kinner, K. & Pellegrini, C. (2009). Expenditures for public health: Assessing historical and prospective trends. American Journal of Public Health. 99(10), 1780–91.
Lacerda, L. B. N. & Silva, C. M. (2019). Participação popular no contexto da governança local. Brazilian Journal of Development Participação. 5(9), 16284–96.
Le Loup, G., De Assis, A., Costa-Couto, M. H., Thoenig, J. C.. Fleury, S., De Camargo, K. & Larouzé, B. (2009). A public policy approach to local models of HIV/AIDS control in Brazil. American Journal of Public Health. 99(6), 1108–15.
Lee, R. B., Nacionales, L. P. & Pedroso, L. (2009). The influence of local policy on contraceptive provision and use in three locales in the Philippines. Reproductive Health Matters. 17(340), 99–107.
Li, L., Zhang, S., Wang, J., Yang,X. & Wang, L. (2023). Governing public health emergencies during the coronavirus disease outbreak: Lessons from four Chinese cities in the first wave. Urban Studies. 60(9), 1750–70. https://journals.sagepub.com/doi/10.1177/00420980211049350.
Lilly, K., Kean, B., Hallett, J., Robinson, S. & Selvey, L. A. (2023). Factors of the policy process influencing Health in All Policies in local government: A scoping review. Frontiers in Public Health. 11(3). https://doi.org/10.3389/fpubh.2023.1010335.
Machado, C. V., Maria, A., Pereira, M., Freitas, C. M. & Oliveira, S. C. (2024). A resposta à COVID-19 na Argentina , no Brasil e no México : desafios à coordenação federativa das políticas de saúde. Cadernos de Saude Publica. 40(6), 1–16.
Mao, Y. (2023). What accounts for the different regional responses to COVID-19 in China ? Exploring the role of institutional environment , governance capacity, and legitimacy. Health Policy Plan. 38(4): 552-66. doi: 10.1093/heapol/czad007.
Manrique, B., Burgos, D. & Zapata, C. (2013). Applying linguistic methods for a semiautomatic analysis of corporative documents: Standard operating procedure. Universidad de Medellín - Ciencia y Libertad. https://investigaciones-pure.udemedellin.edu.co/en/publications/applying-linguistic-methods-for-a-semiautomatic-analysis-of-corpo.
Martineau, F. P., Graff, H., Mitchell, C. & Lock, K. (2014). Responsibility without legal authority? Tackling alcohol-related health harms through licensing and planning policy in local government. Journal of Public Health (United Kingdom). 36(3), 435–42.
Martinelli, N. L., Schenkman, S., Duarte, E., Martins, C. L., Barbalho, R. E., Fausto, M. C. R. & Bosquat, Martinelli, M. L. et al. (2024). Organização dos sistemas locais de saúde em municípios rurais remotos brasileiros no enfrentamento da pandemia de COVID-19. Cadernos de Saude Publica. 40(6). Doi: https://doi.org/10.1590/0102-311XPT170723.
Martinho, F. A. M., Oliveira, T. H. V., Pereira, C. M., Filho, C. R. C., De Brito, C. R., Lucena, R. O., Junior, A. C. M., Rezende, O. L. & Sebastiani, R. T. (2025). A Efetividade Das Políticas Públicas De Saúde Nos Municípios : Desafios Para A Gestão Local E O Acesso À Saúde. Journal of Humanities and Social Science. 30(10), 45–9.
Mayanja, H. H. & Akunda, D. (2023). East African Journal of Health and Science Administrative Decentralisation and Health Service Delivery in Ibanda District Local Government , Uganda.. 6(1), 450–9.
Medina, M. G., Bousquat, A. & Aquino, R. (2020). Primary healthcare in times of COVID-19 : what to do? 36(8). Doi: https://doi.org/10.1590/0102-311X00149720.
Montel, L. (2023). Harnessing the power of the law’: a qualitative analysis of the legal determinants of health in English urban planning and recommendations for fairer and healthier decision-making. BMC Public Health. 23(1), 1–9. https://doi.org/10.1186/s12889-023-15166-0.
Noonan, K., Miller, D., Sell, K. & Rubin, D. (2013). A procurement-based pathway for promoting public health: Innovative purchasing approaches for state and local government agencies. Journal of Public Health Policy. 34(4), 528–37.
Oyalowo, B. (2025). Urban services and the invisibility of local governments in Nigeria in a COVID-19 pandemic context. International Development Planning Review. 47(1). Doi: https://doi.org/10.3828/idpr.2024.13.
Paim, J. S. & Teixeira, C. F. (2006). Política, planejamento e gestão em saúde: balanço do estado da arte. https://www.scielo.br/j/rsp/a/T59CdBgDQyGf3hqLpZCjyks/?format=pdf&lang=pt.
Pokharel, K., Devkota, K., Fischer, H. & Khatri, D. B. (2023). Implications of decentralisation for disaster governance in Nepal’s federalism: Case study of COVID-19 response of four selected local governments. Doi: http://doi.org/10.53037/na.v8i1.70.
Pereira A. S. et al. (2018). Metodologia da pesquisa científica. [free e-book]. Santa Maria/RS. Ed. UAB/NTE/UFSM. Pradana, M., Rubiyanti, N. S. W., Hasbi, I. & Utami, D. G. (2020). Indonesia’s fight against COVID-19: the roles of local government units and community organisations. Local Environment. 25(9), 741–3. https://www.tandfonline.com/doi/full/10.1080/13549839.2020.1811960.
Prado, N. M. B. L., Freitas, C. A. M., Nunes, F. G., Figueroa, C. D. O., Pereira, G. E., Morais, M. B., Santos, H. L. P. C., Vilasbôas, A. L. Q. & Aquino, R. (2023). Respostas governamentais heterogêneas no enfrentamento da pandemia da COVID-19 por países da América Latina. Ciência & Saúde Coletiva. 28(3), 665–83. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232023000300665&tlng=pt.
Ratto, M. C., Cabrera, J. M., Zacharias, D. & Azerrat, J. M. (2021). The effectiveness of government measures during the first wave of the outbreak. Social Science Quarterly. 102(5), 2088–105.
Ritsatakis, A. (2009). Equity and social determinants of health at a city level. Health Promotion International. 24 (Suppl 1), 81–90. Rodríguez, D. C.; et al. (2023). Political economy analysis of subnational health management in Kenya, Malawi, and Uganda. Health Policy and Planning. 38(50), 631–47.
Roesler, A. et al. (2022). Conducting a rapid health promotion audit in suburban Adelaide, South Australia: Can it contribute to revitalising health promotion? Health Promotion Journal of Australia. 33(2), 488–98.
Rossi, T. R. A., Soares, C. L. M., Silva, G. A., Paim, J. S. & Vieira-da-Silva, L. M. (2022). The response by South Korea to the COVID-19 pandemic: lessons learned and recommendations for policymakers. Cadernos de Saude Publica. 38(1), 1–19.
Savignon, A. B., Costumato, L., Scalabrini, F. & Sanchietti, M. (2024). Towards performance governance in healthcare: An analysis of Italian local health units. International Journal of Health Planning and Management. 39(6), 1819-39. doi: 10.1002/hpm.3844. Epub 2024 Aug 13.
Scheffler, R. & Smith, R. B. (2006). The impact of government decentralization on county health spending for the uninsured in California. International Journal of Health Care Finance and Economics. 6(30, 237–58.
Schultz, S., Zorbas, C., Peeters, A., Yoong, S. & Backholer, K. (2023). Strengthening local government policies to address health inequities: perspectives from Australian local government stakeholders. International Journal for Equity in Health. 22(1), 1–14.
Semensato, C. A. G. (2021). O município como unidade de governo. Monografia. MBA em Gestão e Políticas Públicas Municipais. UNIASSELVI-PÓS.
Sestelo, J. A. F., Vasco, M. D., Santos, T. B. S., Lisboa, E. S. & Souza, L. E. P. F. (2020). Hospitais no contexto de pandemia de COVID-19: problemas e estratégias de enfrentamento. In: Construção de conhecimento no curso da pandemia de COVID-19: aspectos biomédicos, clínico-assistenciais, epidemiológicos e sociais. [s.l.] EDUFBA, 2020.
Shen, A. K., Hughes, R., Dewald, E., Rosenbaum, S.. Pisani, A. & Orenstein, W. (2021). Ensuring equitable access to COVID-19 vaccines in the us: Current system challenges and opportunities. Health Affairs. 40(1), 62–9.
Shi, C., Xu, T., Ying, Z. & Li, H. (2022). How Policy Mix Choices Affect the COVID-19 Pandemic Response Outcomes in Chinese Cities: An Empirical Analysis. International Journal of Environmental Research and Public Health. 19(13). Doi: http://doi.org/10.3390/ijerph19138094.
Snyder, H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of business research, 104, 333-339.
Teixeira, C. F. & Solla, J. P. (2006). Modelo de atenção à saúde no SUS: trajetória do debate conceitual, situação atual, desafios e perspectivas. In: EDUFBA. Modelo de atenção à saúde: vigilância e saúde da família. Salvador- Bahia: EDUFBA. p. 129–67.
Torrens, A. C. (2012). Representação política, inovações institucionais e novas subjetividades. Revista de informação legislativa. 49(196), 149-63. https://www2.senado.leg.br/bdsf/item/id/496621.
Touchton, M., Knaul, F. M., Arreola-Ornelas, H., Porteny, T., Sánchez, M., Méndez, O., Faganello, M., Edelson, V., Gygi, B., Hummel, C., Otero, S., Insua, J., Undurraga, E. & Rosado, J. A. (2021). A Partisan Pandemic: State Government Public Health Policies to Combat COVID-19 in Brazil. BMJ Global Health. 6(6), e005223. doi: 10.1136/bmjgh-2021-005223.
Van der Mierden, S., Tsaioun, K., Bleich, A. & Leenaars, C. H. C. (2019). Software tools for literature screening in systematic reviews in biomedical research. Altex. 36 (3), 508–17. Whittemore, R. & Knafl, K. (2005). The integrative review: updated methodology. J Adv Nurs. 52(5): 546-53. doi: 10.1111/j.1365-2648.2005.03621.x.
Xu, Z., Sridhar, K. S., Xu, Q. & Ravie, V. (2024). Governing pandemics: Resilience and community responses for COVID-19 in Bengaluru and Shanghai. Journal of Urban Affairs. https://nyuscholars.nyu.edu/en/publications/governing-pandemics-resilience-and-community-responses-for-covid-.
Zaleski, J., Genauch, C. D., Cecilia, S. & Herzog, M. (2024). O papel do estado no desenvolvimento regional: uma análise a partir dos municípios. p. 1–20. Revista Contribuiciones a las ciências sociales. Doi: https://doi.org/10.55905/revconv.17n.3-214.
Zhang, Y. N., Chen, Y., Wang, Y., Li, F., Pender, M., Wang, N., Yan, F.. Ying, X. H., Tang, S. L. & Fu, C. W. (2020). Reduction in healthcare services during the COVID-19 pandemic in China. BMJ Global Health. 5(11), 1–10. 11)
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