Adelyne Maria Mendes Pereira, PhD, Researcher, Department of Health Administration andPlanning; Professor, Public Health Graduate Program; Coordinator, BRICS Network of Research inPublic Health and Health Systems in Brazil, Sergio Arouca National School of Public Health (ENSP),Oswaldo Cruz Foundation (Fiocruz)
Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro, Brazil, 21041-210
Claudia Hoirisch, MSc, Researcher, Vice-Presidency of Global Health and International Relations;Coordinator, BRICS Network of Research in Public Health and Health Systems in Brazil
Brasil Ave., 4365, Manguinhos, Rio de Janeiro, Brazil, 21040-900
Maria Shevchenko, MBA, Head of International Relations Department
11, Dobrolyubova str., Moscow, 127254
Cui Ying, PhD, Research Fellow, Director, Office of Policy Planning and Evaluation
Changbai Road, 155, Changping District, Beijing, China, 102206
Wang Xiaoqi, MSc, Associate Research Fellow, Director, Office of International CooperationChangbai Road, 155, Changping District, Beijing, China, 102206
Chen Hao, MPH, Research Fellow, Deputy director, Office of Policy Planning and Evaluation
Changbai Road, 155, Changping District, Beijing, China, 102206
Huang Fei, MD, Research Fellow, Director, Applied Technology Department, National Center for TBcontrol and prevention
Changbai Road, 155, Changping District, Beijing, China, 102206
Hu Jingran, MPH, MA, Associate Research Fellow, Senior Program Officer, Office of InternationalCooperation
Changbai Road, 155, Changping District, Beijing, China, 102206
Lai Chengyu, LLM, Assistant Researcher, Office of Policy Planning and Evaluation
Changbai Road, 155, Changping District, Beijing, China, 102206
Wang Yuan, MPH, Associate Research Fellow, Office of Policy Planning and Evaluation
Changbai Road, 155, Changping District, Beijing, China, 102206
Liu Kaixuan, MPH, Assistant Researcher, Office of Policy Planning and Evaluation
Changbai Road, 155, Changping District, Beijing, China, 102206
Cristiani Vieira Machado, PhD, Visiting Scholar at the Center for Advanced Study in the BehavioralSciences (CASBS), Stanford University (2025-2026); Professor and Researcher, Sergio AroucaNational School of Public Health (ENSP),
Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro, Brazil, 21041-210
Health systems in emerging economies face the dual challenge of expanding access while ensuring equity, quality, and financial sustainability amid demographic, epidemiological, and geopolitical changes. This article analyzes the health systems of Brazil, China, and Russia, three key members of the BRICS group with large populations and diverse institutional paths. Using policy documents, official statistics, and secondary literature, we examine their historical foundations, governance structures, financing mechanisms, service delivery models, and recent reforms. Despite differing political, economic, and administrative traditions, these countries share a strong state role in stewardship and a formal commitment to universal access. Brazil’s tax-funded Unified Health System is rooted in constitutional rights, decentralization, and social participation. China has achieved near-universal insurance coverage through consolidated social health insurance schemes under strengthened central regulation, alongside ongoing payment and disease-control reforms. Russia maintains universal coverage through mandatory health insurance within a territorially organized, hierarchical delivery system rooted in the Semashko model. Major challenges include regional inequalities, hospital-centered care patterns, fiscal pressures, demographic ageing, and the rising burden of chronic diseases. The comparative analysis reveals multiple institutional pathways toward universal health coverage and highlights the strategic importance of public stewardship, primary health care, and domestic production capacity. These findings contribute to debates on health system strengthening and South–South cooperation within BRICS and the broader global health agenda.
The authors declare that there are no conflicts of interest present.