Do bureaucrats matter? Evidence from municipal health secretary turnover in Brazil

This paper studies the effects of bureaucratic turnover on the functioning of local public administration. Focusing on municipal health secretaries in Brazil, we examine how changes in local high-level bureaucratic leadership affect fiscal dynamics within municipal health departments. We combine administrative data on health secretaries with fiscal outcomes and health indicators to construct a panel dataset of Brazilian municipalities between 2008 and 2016, and implement an empirical approach inspired by the stacked difference-in-differences event-study design, tailored to recurrent treatment settings. We find limited evidence of effects on total health spending in the full sample. However, when bureaucratic turnover occurs in the first year of the mayoral term without a change in the mayor, we document negative short-run effects on spending growth, consistent with temporary disruptions in fiscal execution. Examining expenditure composition, we find that pharmaceutical spending declines in the short run and partially recovers, while personnel spending increases in some specifications and investment remains unaffected. We find no short-run effects on child mortality. Overall, the results highlight the importance of local bureaucratic leadership in shaping short-run public sector performance and contribute to the literature on bureaucrats, political turnover, and, methodologically, to assessing dynamic effects of recurrent treatment.