National priorities for strengthening health systems in the BRICS countries: the cases of Brazil, China and Russia

Introduction

At their first BRICS Health Ministers meeting in 2011 in Beijing, China, the group acknowledged several shared public health challenges, including unequal access to healthcare and medicines, rising healthcare costs, infectious diseases such as human immunodeficiency virus (HIV) and tuberculosis (TB), and increasing rates of chronic non-communicable diseases¹. At that time, their primary challenge was to provide healthcare to millions of people, particularly the most vulnerable population groups.

Since then, the same challenges have persisted. BRICS countries face various public health threats caused by shifts in lifestyle behaviors, environmental conditions, disease patterns, and population demographics. These include non-communicable diseases such as obesity, diabetes, cardiovascular diseases, cancer, and mental health issues [1], which are increasing in many nations, as well as ongoing infectious diseases like TB, HIV / acquired immunodeficiency syndrome (AIDS), and respiratory illnesses. Other major threats include diarrheal diseases, neglected tropical diseases common in many BRICS countries, and emerging infectious diseases, as seen with outbreaks like SARS in China (2002–2003) [2]; recurrent dengue (2000–2024) [3], and Zika (2015–2016) [4] in Brazil. These challenges are not exclusive to the Global South, as the COVID-19 pandemic has shown. Diseases do not respect borders.

Global health faced significant disruptions in 2025. Changes took place in the landscape of international health cooperation: the United States administration decided to withdraw from the World Health Organization (WHO)²; suspended its contributions to international health organizations such as Gavi, the Vaccine Alliance³; and restricted data-sharing between the US Centers for Disease Control and Prevention (CDC) and WHO⁴. Additionally, substantial cuts were made to American funding for biomedical research [5][6], to name but a few. These developments significantly undermined global health funding, forcing many countries to reallocate resources domestically and look for alternative solutions to address emerging challenges.

In this complex setting, BRICS countries see this as an opportunity to leverage their health expertise and experience in South—South cooperation as a means to engage in global health diplomacy. One example is the BRICS Network of Research in Public Health and Health Systems, established jointly under the presidencies of Russia and Brazil (2024–2025) [7]. The objective of this Network is to generate evidence to strengthen health systems through shared research, capacity building, and technical cooperation. At its second meeting, held on May 29, 2025, the Network invited its members to share examples of priority policies within their respective health systems. The aim was to encourage the exchange of experiences among BRICS countries and to promote technical cooperation between two or more member states.

The aim of this review is to present selected examples of priority policies recently implemented in Brazil, China, and Russia to strengthen public health systems and expand access to healthcare. This analysis aims to contribute to international technical cooperation in health among countries facing similar challenges. The documents used are from official government sources, and the bibliographic references cited were obtained from databases such as PubMed, SciELO, Springer Nature and the authors’ own archives.

Brazilian unified health system: strengthening primary health care and access to medicines

National priorities in healthcare include major public health programs such as the Family Health Strategy (Estratégia de Saúde da Família, ESF), the Popular Pharmacy Program of Brazil (Programa Farmácia Popular do Brasil, PFPB), the National Immunization Program, and well-known initiatives for HIV/AIDS control, organ transplantation, hepatitis C treatment, and tobacco control, among others⁵. Below are details on two exemplary programs: the ESF and the PFPB.

The Family Health Strategy

The Family Health Program, later renamed the ESF, was launched in 1994 to expand and organize primary health care (PHC) nationwide. The strategy initially relied on multiprofessional teams that included at least a physician, a nurse, a nurse technician, and Community Health Agents (Agente Comunitário de Saúde, ACS) – key players in connecting health teams with communities and supporting public health efforts within local territories. Later, oral health and other specialized healthcare professionals were added to support the core teams. The ESF places health at the centre of the individual’s, families’, and community’s needs and plays a crucial role in restructuring PHC in Brazil, fully aligned with the guiding principles of Unified Health System (Sistema Único de Saúde, SUS). The strategy has contributed to the expansion, improvement, and strengthening of PHC, transforming work processes with significant potential to enhance the quality of care. Besides increasing service effectiveness and leading to positive health outcomes for individuals and communities, ESF also stands out for its efficiency and excellent cost-effectiveness in the public health sector [8].

Designed to address Brazil’s diverse and unique health needs, ESF operates through multidisciplinary teams adapted to territorial, cultural, and social specificities. These teams develop health actions based on detailed knowledge of local realities and population needs. Different team configurations may be adopted, depending on the setting. They work together in an integrated and complementary way, expanding access, equity, and quality of care. The ESF model aims to strengthen connections and proximity between health units, users, and their families, thereby enhancing access and continuity of care [9].

The key objectives and guidelines of the ESF include expanding PHC coverage; contributing to the regulation and management of care flows; fostering community mobilization and participation; promoting bonds and population follow-up; encouraging good practices and continuous monitoring; ensuring comprehensive health care for enrolled populations; and increasing access to health services [8][9].

Over the past 31 years, the Strategy has achieved the following: 54,742 Family Health Teams (equipes de Saúde da Família, eSF) currently active in the country’s Basic Health Units (Unidades Básicas de Saúde, UBS), serving the population; 990,120 PHC professionals; 103,042 teams co-funded by the Ministry of Health (MoH) 26,756 doctors participating in the More Doctors Program; and a federal budget allocation of R$ 54.9 billion in 2024).

The eSF is the core unit of PHC. It is responsible for creating individual, family, and community health actions that include health promotion, prevention, protection, diagnosis, treatment, rehabilitation, harm reduction, palliative care, and health surveillance – delivered through coordinated care practices and skilled management. Each team serves a specific geographic area and is responsible for the health of that population⁶.

These teams serve as the main entry point for the population into the health system, aiming to provide continuous care within their communities. They identify and address the factors and determinants behind the most common health conditions and needs. In doing so, they bring health care closer to the social and daily realities of the people they serve.

Key activities performed by eSF include both individual and group interventions – such as medical visits, vaccinations, procedures, home visits, group activities, and other initiatives that promote comprehensive care. These actions take place in UBS, in people’s homes, and in community spaces like schools and associations, based on local health needs and following national priorities and guideline⁷.

Federal funding is crucial in shaping and influencing health policy, with significant potential to reorganize the health care model [10]. Currently, there are 277,341 ACS, along with 54,742 eSF teams financed by the MoH⁸. The minimum composition required to implement an eSF includes a doctor, nurse, nursing assistant and/or technician, and ACS. Additional federal resources may be available if PHC includes other health professionals, such as dentists, psychologists, physiotherapists, and nutritionists⁹.

The implementation of the ESF was associated with relevant effects on the reduction of infant and under-5 mortality, especially in the postnatal period and for infectious diseases, and on mortality and hospitalizations for the general population and specific age groups, with emphasis on preventable causes by PHC actions and services, although the association of ESF with reduction in hospitalizations and some causes of mortality in the adult population has not been observed in some studies [11] During the COVID-19 pandemic, areas with high ESF coverage recorded lower mortality rates compared to low-coverage areas [12]. Regions with stronger primary care networks also carried out more home visits and health promotion activities, underscoring the vital role of primary care in Brazil’s effective pandemic response and recovery.

Pharmaceutical care in Brazilian unified health system: the Popular Pharmacy Program of Brazil

During the 20th century, the first public pharmaceutical care initiatives in Brazil aimed to ensure medicines availability through programs targeting specific infectious diseases [13]. In the 1970s and 1980s, efforts to boost domestic production intensified, and a national List of Essential Medicines was established to ensure access of basic medicines in public health facilities [14].

Since the 1990s, within the scope of SUS, pharmaceutical care policies have been broadened and diversified. Programs were established to supply basic medicines (for PHC), strategic medicines (to manage specific diseases like HIV/AIDS and TB), and specialized medicines (for rare or costly diseases, including cancers). Policies were introduced to encourage the use of generic medicines and to regulate the incorporation of medicines into the SUS. However, limitations remained, including high out-of-pocket medication expenses [15].

In the 2000s, additional strategies were implemented to increase the national production of medicines and other health supplies. In 2004, the country launched the PFPB to address the urgent need for all citizens – regardless of their financial situation – to access essential medicines for treating both chronic and acute illnesses within PHC [15]. From the beginning, the program was integrated into the National Pharmaceutical Care Policy, which goes beyond just dispensing medicines and is based on the principles of the SUS¹⁰.

As of February 14, 2025, the PFPB started offering all listed medicines and supplies free of charge to the Brazilian population through partnerships with private pharmacies¹¹. Previously, access depended on a co-payment system where the government covered 90% of the medicine’s reference price, and individuals paid the remaining amount, which varied based on the pharmacy’s prices and the official reference value.

The program currently covers 12 medical conditions and provides 41 types of medicines used to treat hypertension, diabetes mellitus and diabetes mellitus associated with cardiovascular diseases, asthma, osteoporosis, high cholesterol, rhinitis, Parkinson’s disease, and glaucoma, as well as contraceptives, sanitary pads, and geriatric diapers for people with incontinence¹².

The program has played a key role in advancing Brazil’s public policy for access to medicines. In 2012, the WHO recognized it as a successful model for expanding access to essential drugs¹³. It has also been consistently rated among the most well-regarded social programs in the country, with approval from more than 80% of Brazilians, according to data from the MoH.

In 2024, the program served 24 million people¹⁴. It is currently available in 4,823 municipalities, covering 86% of Brazilian cities and reaching approximately 97% of the population through a network of more than 31,000 accredited pharmacies¹⁵.

The PFPB has enabled patients to continue treatment without interruption. The program has been associated with reductions in hospital admissions for conditions such as diabetes, hypertension, as well as a decrease in mortality from circulatory diseases. Its positive effects have increased with age, being most significant among older adults [16].

The program has eased the financial burden on families. It also increased the use of generic medicines from 51% in January 2011 to 85% in 2024 of the medicines dispensed under the Aqui Tem Farmácia Popular initiative¹⁶. Regarding diabetes medications, the PFPB accounted for 70% of generic sales between 2005 and 2011 [17]. This expansion stimulated the national pharmaceutical industry, generating positive effects within Brazil’s Health Economic-Industrial Complex [18]. Estimates indicate that the program’s benefits – such as reduced hospitalization costs and lives saved – outweigh its implementation costs [19].

China’s health system: priority policies and strategic directions

Strategic framework and primary pare development

China’s priority health policies in recent years have centred on strengthening universal health coverage, advancing PHC, deepening public hospital reform, and accelerating digital transformation. The Healthy China 2030 strategy provides the overarching framework, emphasising disease prevention, health promotion, and intersectoral governance. Strengthening primary care has been a persistent policy focus, reflected in the expansion of family-doctor contracting services, chronic disease management programmes, and the development of regional integrated delivery networks, particularly medical consortia (yi-lian-ti) linking tertiary hospitals with county hospitals and township health centres [20].

Public hospital reform remains central to China’s health system transformation. The Sanming Model introduced integrated governance restructuring, centralized drug procurement, and strict cost controls, providing a template for national reforms [21]. A core component is the Three Medical Linkage (san-yi-lian-dong) reform, which aligns medical services, medical insurance, and pharmaceutical policy to correct distorted provider incentives and address the legacy of financing care through drug-markups [22]. Since 2017, this approach has strengthened National Healthcare Security Administration’s role as a strategic purchaser, unified price-setting for services, advanced centralized procurement of medicines and consumables, and expanded Diagnosis-Related Group / Diagnosis-Intervention Packet (DRG/DIP) payment reforms. Together, these measures aim to enhance clinical appropriateness, improve efficiency, and enhance transparency and accountability across the public-hospital sector. In parallel, digital health has accelerated, supported by the National Health Information Platform, cross-provincial electronic health records [23], telemedicine networks serving rural and remote areas, and the integration of artificial intelligence into diagnostics and population surveillance [24].

Disease prevention, control and integrated service delivery

Aligning with the WHO’s Multisectoral Accountability Framework for TB (MAF-TB), China’s TB control practices focus on integrating patient-centered care with strong government commitment, supported by health insurance and coordinated systems [25]. China has established robust policies to integrate TB services into health insurance to reduce catastrophic costs, and subsidies for impoverished patients. A collaborative network was established to link CDC, designated TB hospitals, and PHC for seamless continuum of care from screening through treatment completion. To improve case detection, China has implemented mass screening among high-risk groups (e.g., students, the elderly, and the poor) and general populations in high-prevalence areas. This effort, underpinned by multi-departmental coordination, ensures universal access to health care. The strategy emphasizes protecting vulnerable populations, enabling early diagnosis and drug resistance screening, and delivering standardized treatment coupled with rigorous health management [25].

In 2024, China launched several national campaigns to address service gaps in key public-health domains. The Year of Pediatric and Mental Health Services aims to expand availability, accessibility, and quality of pediatric and mental-health care. By 2027, the initiative seeks to ensure that most common childhood illnesses can be treated at the municipal or county level, that major pediatric diseases receive timely care within regional centres, and that continuity and convenience of pediatric services are substantially enhanced. Mental-health reforms require psychiatric hospitals and large general hospitals to establish psychological and sleep clinics, while clinicians across specialties are encouraged to integrate routine mental-health assessment into clinical practice. Public education campaigns are being institutionalized to raise awareness of common psychological problems, reduce stigma, and promote earlier care-seeking¹⁷.

At the same time, China initiated the nationwide Weight Management Year as part of the Healthy China (2019–2030) Action Plan. Recognising overweight and obesity as major risk factors for cardiovascular disease, diabetes, and certain cancers, the initiative focuses on strengthening health literacy, improving access to supportive environments for healthy lifestyles, and fostering behavioural change. From 2024, the campaign aims – within approximately three years – to build a comprehensive social foundation for weight management, improve national awareness and practical skills in diet and physical activity, and reduce the prevalence of abnormal weight patterns among key population groups [26].

Systemic challenges and future directions

Collectively, these policies – spanning financing reform, digital health, integrated service delivery, child and mental health services, and healthy lifestyle promotion – reflect China’s shift toward a prevention-oriented, people-centred, and system-wide approach to population health.

Despite long-term progress in expanding coverage, strengthening service capacity, and improving financial protection, China’s health system continues to face substantial structural pressures [24]. Non-communicable diseases now constitute the dominant burden of morbidity and mortality, with cardiovascular disease, cancer, chronic obstructive pulmonary disease, and diabetes shaped by rapid population ageing, behavioural risks, and environmental exposures [27]. Although major infectious diseases are generally well controlled, conditions such as tuberculosis, HIV, and hepatitis B still require sustained public-health attention [28]. Persistent inequalities across regions, income groups, and between urban and rural areas reflect the uneven distribution of high-quality medical resources and ongoing shortages in primary care and support services for the elderly, particularly affecting internal migrant populations. Systemic challenges – characterized by a predominant reliance on hospital-based care, developing gatekeeping mechanisms, heterogeneity in service standards, and insufficient integration between clinical care and public health – continue to constrain performance [29]. Rising costs associated with advanced technologies, pharmaceuticals, and long-term care further underscore the need for stronger primary care, improved coordination mechanisms, and long-term workforce development [26][30].

Russia’s health system: strategic directions in Russia’s healthcare policy

Russia follows a strategic agenda focused on improving the quality of life and longevity, developing human potential, and ensuring technological independence. This strategy is aligned with national priorities mandated by the President of the Russian Federation¹⁸ [31]. To achieve these goals, the nation relies on many national projects, which include federal initiatives detailing precise methods, tools, and measurable outcomes.

One prominent national project was Healthcare, implemented from 2019 to 2024. Besides aiming to boost life expectancy, it addressed the following key objectives: decreasing overall mortality rates, infant mortality, resolving staff shortages in PHC facilities, providing universal preventive medical screenings, improve access to PHC, simplifying doctor appointment bookings, and expanding exports of medical services¹⁹.

The national project comprised nine federal initiatives: the export of medical services, diabetes control (from 2023 onwards), modernizing PHC delivery, pediatric healthcare and modern childcare infrastructure, building up national medical research center networks and introducing innovative medical technologies, recruiting qualified healthcare staff, oncology care, cardiovascular diseases control, and unified digital ecosystem in healthcare anchored by the Unified State Information System in Healthcare²⁰ [32].

Under the umbrella of the national project Healthcare (2019–2024), progress was reported, including in reduced infant mortality rates, greater uptake of preventive medical checkups, extensive involvement of specialists in continuing professional development, and growth in medical service exports. Additional highlights include construction and renovation of over 10,000 medical facilities, procurement of 230,000 medical devices, preventive health checks for 109 million individuals in 2024 and 1.5 million fee-free high-tech surgical interventions²¹.

Maternal and child health included expanding neonatal screening to cover 40 pathologies and opening 21 new hospitals. More than 2,500 clinics were upgraded during the years 2019–2024, and in 2024, 58,000 children with diabetes received free continuous glucose monitoring systems. Support for medical professionals was another focal point, with over 12,000 newly trained specialists joining the workforce in 2023–2024. Additionally, 450,000 rural healthcare workers received augmented social benefits in 2024, while more than one million medical employees now enjoy supplementary salary incentives²².

An equally significant national endeavor was the Demography project, spanning 2019–2024. Like Healthcare, its primary national goal centered on raising life expectancy. Its core objectives involved elevating healthy-life expectancy, uplifting birth rates, and advocating healthier lifestyle choices and encouraging regular physical exercise among citizens. It incorporated several federal initiatives such as Financial Aid for New Parents, Assisting Women’s Reentry Into the Job Market – Establishing Early Learning Opportunities for Children Up to Age Three, Designing and Implementing a Plan for Systematically Supporting Seniors and Enhancing Their Quality of Life, Fostering Positive Habits Around Diet and Fitness, Curbing Harmful Practices, and Enabling Broad Participation in Sport Activities Nationwide, Increasing Accessibility of Sports Venues, and Cultivating Future Athletic Talent Reserves²³ [33].

By the end of 2023, the Demography project led to the establishment of 83 regional geriatric centres, exceeding the initial target of 80, delivery of care to 211,300 senior citizens through geriatric wards, an increase in the percentage of citizens participating in regular physical activity and sports, reaching 56.8%²⁴.

Holistic approach to combating non-communicable diseases

In addition to national projects, Russia adopts specific practices aimed at addressing systemic healthcare challenges. Notably, efforts to combat non-communicable diseases follow a holistic approach involving multi-sectoral strategies, including launching mass-screening programs, reducing excessive salt and sugar intake, promoting physical activity, restricting tobacco and alcohol consumption. This approach also shows that prevention of non-communicable diseases cannot be done by the health sector only. It needs joint actions in public-health regulation, food policy, education, local communities and workplaces, because many risk factors are connected not only with personal choice, but also with everyday environment [34][35].

Tobacco control legislation

Curtailing smoking – one of the foremost causes of non-communicable diseases and premature death – is especially prioritized. In 2013, Federal Law No. 15-FZ introduced rigorous anti-smoking measures which were subsequently expanded to cover nicotine-containing products²⁵. These measures include a ban on smoking tobacco or using nicotine-containing products in public places, including healthcare, educational and residential facilities; service establishments; sports and fitness venues; retail premises; all forms of public transport; children’s playgrounds; elevators, etc. They also include price and tax measures to reduce demand; regulation of product composition, disclosure, packaging and labelling; ban on advertising, sponsorship and sales promotion; restrictions on the retail trade, including point-of-sale displays and merchandising. Also, enforcement measures to combat illicit trade in tobacco products and nicotine-containing items and a ban on the sale of tobacco products, nicotine goods, hookahs and vaping devices to minors, and a prohibition on their use by minors or any involvement of children in tobacco or nicotine consumption. Public information campaigns also highlight the health dangers of tobacco and nicotine use and of exposure to second-hand smoke and aerosol emissions [36][37].

These legislative measures have been effective. Tobacco consumption has declined by 23% over the past five years, with behavioural habits shifting decisively away from smoking. Since 2009, the number of adult smokers (aged 15+) has dramatically declined, dropping from 39.5% in 2009 to just 18.6% in 2024²⁶.

Supporting ageing populations and developing geriatrics

Demographic shifts have prompted integrated geriatric-care models. Multidisciplinary hospitals now host geriatric offices that assess fall, delirium and frailty risks, develop individual care plans and reduce polypharmacy thus enhancing the functional independence of older patients. Federal support covers geriatric training, primary-care integration and clear referral pathways [38].

Alongside clinical care, a healthy lifestyle is promoted among older adults through free programmes delivered under the Active Longevity initiative, which is linked to Russia’s new national project Family. These programs include therapeutic exercise classes; Nordic walking and other sports activities; creative clubs and community events; and educational courses²⁷.

Together, these measures support functional independence and quality of life. These programs now cover millions of older citizens nationwide. Participants pursue self-development and help others discover new interests. The responsible authorities are the Ministry of Health of the Russian Federation and the Ministry of Labor and Social Protection of the Russian Federation²⁸.

Strengthening primary care and prevention

The federal project Development of the Primary Health-Care System was designed to remove territorial and infrastructure barriers to medical services. Between 2019 and 2024, more than 10,000 medical facilities were built or renovated, and 230,000 pieces of medical equipment were procured. In 2024, 109 million people underwent preventive examinations, and 1.5 million high-tech procedures were provided free of charge²⁹.

In parallel, new outpatient care models are being introduced, including optimized patient pathways, shorter waiting times and better coordination among facilities, digital-health tools and continuous federal monitoring through so-called “initiatives” (targeted pilot projects addressing specific bottlenecks). For example, Initiative No. 38 – launched in September 2022 – aims to make online appointments as easy as possible³⁰, while Initiative No. 7 – launched in 2023 – focuses on introducing electronic sanitary medical certificates, as evidenced by a sustained rise in public satisfaction with service quality³¹.

Through the Healthcare project (and from 2025 the new Long and Active Life project) Russia has expanded preventive follow-ups and screenings, improved rural access, through feldsher-midwife stations and rolled out telemedicine and digital health tools. More than 6.7 million people aged 18–49 underwent reproductive health screening; more than 96 percent of newborns received expanded neonatal screening; 74.7 percent of citizens underwent preventive exams; and 112.4 million people were informed about prevention options^32,33 [39].

Patient satisfaction as a system priority

Research shows that higher patient satisfaction is associated with better treatment adherence, improved clinical outcomes, fewer complaints and greater trust in the healthcare system³⁴. Accordingly, patient-experience metrics are embedded in national targets, specifically as targets in the federal project Modernisation of Primary Health Care under National Healthcare Project.

Building on the methodological guidelines and the Patient Satisfaction Survey approved by MoH Order No. 495 (19 July 2022) “On Approving the Methodology for Calculating the Additional Indicator ‘Public Opinion Assessment of Satisfaction with Medical Care, %” Russian Research Institute of Health has developed and rolled out the STIMUL (СТИМУЛ) Management Standard – an organisation-wide framework specifically designed to raise patient satisfaction levels [31]. The STIMUL management standard, focuses on communication quality, service comfort/accessibility and rapid feedback response. In several regions, the standard has been scaled up to the level of the constituent entity, enabling uniform, region-wide approaches to managing the patient experience.

Obtained results include deploying the STIMUL management standard in over 40 regions. In healthcare facilities where the Standard was implemented, patient complaints halved within three years. Patient satisfaction increased and was associated with better adherence and reduced unnecessary hospital visits, better accessibility due to streamlined processes. Overall, national patient satisfaction scores reportedly increased 1.4-fold over a two-year period³⁵.

Digitalisation and data-driven decision-making

The rapid expansion of the Unified State Health Information System has become a cornerstone of health-system governance at every level [40]. Thanks to real-time dashboards, artificial-intelligence tools and predictive analytics, regional authorities can now forecast trends, assess risks and apply truly personalised population-health management [41].

One striking success is the creation of dedicated situation centres [42]. These hubs integrate digital dashboards with AI-driven decision-support, enabling health administrators to monitor key indicators, spot emerging issues early and deploy resources proactively. These situation centres enhance inter-regional coordination, transparency and rapid public-health response.

Conclusion

This article examines a few select priority policies implemented in the health systems of Brazil, China, and Russia, highlighting national strategies aimed at strengthening public health systems and expanding access to health services. Despite differences in institutional design, financing and governance, the experiences discussed reveal shared commitments to equity, system resilience, and state leadership in health system development.

In Brazil, priority policies have focused on reinforcing the SUS by expanding access to comprehensive PHC and specialized care, strengthen regionalized networks, and improve coordination across levels of care. These policies reflect long-standing efforts to address territorial inequalities and ensure universal access in a highly decentralized system.

China’s experience highlights system integration, stronger PHC, and digital transformation. Priority policies have combined large-scale public investments with governance reforms aimed at increasing efficiency, expanding coverage, and improving service quality. Digital health tools and data-driven management has played a key role in enhancing access and continuity of care.

In Russia, priority health policies are integrated into nationally coordinated programs, characterized by strong federal leadership, clear strategic planning, and long-term public investment. National initiatives focusing on healthcare modernization, demographic changes, and population health have prioritized infrastructure improvements, technological modernization, and workforce capacity.

Across the three countries, common challenges emerge, including demographic transitions, growing demand for specialized and long-term care, health workforce shortages, and the need to strengthen PHC as the foundation of resilient health systems. At the same time, these shared challenges create opportunities for cooperation among BRICS countries.

Cooperation within the BRICS framework can facilitate the exchange of policy experiences, technical knowledge, and institutional innovations, particularly in health system governance, digital health, workforce training, and strategies to reduce regional inequalities. The BRICS Network of Research in Public Health and Health Systems represents a promising platform for comparative research, capacity building, and joint initiatives tailored to the realities of middle-income countries with large and diverse populations.

By fostering structured dialogue and technical cooperation, BRICS countries can contribute to mutual learning and the broader global health agenda, offering alternative pathways for strengthening public health systems grounded in equity, solidarity, and state responsibility. The experiences discussed in this article underscore the relevance of South—South cooperation in addressing shared health system challenges and advancing universal health coverage and access.