What hospitals can learn from the Brazilian Hospital Federation’s approach to advocacy, qualification, and system strengthening
The Brazilian Hospital Federation (FBH) is one of Latin America’s most influential hospital associations, representing over 4500 healthcare establishments across 17 states. As FBH marks its 60th anniversary in 2026, the organization offers a compelling model of how national hospital federations can combine technical expertise, political advocacy, and sector-wide qualification to strengthen healthcare systems at scale.
An IHF Full Member, FBH’s experience holds valuable lessons for hospital associations and health systems around the world.
Build representation around diversity and decentralization
FBH represents a deliberately broad and diverse ecosystem. More than 50% of its member institutions are located outside major urban centres, playing an essential role in regional healthcare delivery. Approximately 70% are small and medium-sized hospitals with up to 100 beds, and more than half maintain contracts with Brazil’s public health system, the Sistema Único de Saúde (SUS).
This structure reflects a strategic choice to defend a decentralized system in which smaller institutions are not marginalized but recognized as fundamental to national healthcare coverage. FBH’s model demonstrates the value of building representation that reflects the full range of providers.
Use evidence to shape public debate
FBH has distinguished itself through a consistent investment in high-quality technical knowledge production. Publications such as “The scenario of Hospitals in Brazil and the taxation landscape in the healthcare sector” have become reference materials for managers, policymakers, and oversight bodies. Practical tools such as the Hospital Manager’s Manual and regulatory compliance guides extend this knowledge directly to member institutions.
FBH’s presence on Brazil’s National Health Council, the country’s main social oversight body, translates this technical credibility into direct institutional influence. This shows that sustained investment in rigorous, independent analysis strengthens an organization’s voice in policy processes.
Advocacy with structured sector qualification
One of FBH’s most distinctive contributions is the FBHQualifica Programme, a strategic initiative designed to raise quality and management standards across the hospital network, with particular focus on small and medium-sized institutions. The programme conducts technical assessments, establishes objective evaluation criteria, and guides the implementation of best practices in clinical care, operations, and regulatory compliance.
Rather than functioning as a standalone certification process, FBHQualifica is conceived as a continuous improvement journey that fosters a culture of quality, patient safety, and management efficiency.
Active engagement in legislative and executive processes
FBH maintains structured dialogue with Brazil’s Congress and cooperates with national public health management bodies, to align the interests of service providers with those of public health managers. This double engagement allows the federation to contribute technical input at multiple points of the policy process.
For example, during the debate over Brazil’s Tax Reform, coordinated sector advocacy secured recognition of the essential nature of healthcare services and mitigated significant fiscal risks. In the debate over a national nursing salary floor, FBH’s technical studies helped ensure that regional inequalities and system sustainability were well-considered in the discussions.
International engagement to strengthen local impact
FBH’s participation with the IHF shows that global dialogue and local strengthening are mutually reinforcing. International membership enables access to emerging trends, exchange of experiences with peer organizations, and the development of solutions inspired by international best practices. For an organization whose mandate is rooted in the Brazilian context, this global perspective supports more forward-looking strategies.
Looking ahead
FBH’s priorities for the coming years reflect the pressures facing hospital sectors globally: financial sustainability, digital transformation, and the responsible use of new technologies. Under the leadership of President Dr Reginaldo Teófanes, the federation is focused on ensuring that the sector’s gains are distributed equitably, promoting both economic efficiency and quality of care.
“Our commitment is not only to continue, but to advance in a management guided by innovation, institutional strengthening, and the expansion of the representation of small and medium-sized hospitals on the national stage.” Dr Teófanes
By combining technical credibility, structured sector qualification, active legislative engagement, and international collaboration, FBH demonstrates how hospital federations can serve as system-strengthening actors. Hospital federations can be active contributors to the overall quality, equity, and sustainability of the health systems they operate within.
