Objective:

Analyze governance in the Mexican health system, with regards to policies to combat the Covid-19 pandemic.

Materials and methods:

Qualitative, analytic study carried out from June to November, 2020. Forty-one semi-structured interviews with key actors in the health system were analyzed and organized in ATLAS.ti-v.9 software. The analysis followed theoretical-methodological principles of the Governance Analytical Framework.

Results:

The problem: the policy-making was centralized; the actors: only high level actors participated in the decisions; decision-making: high level actors recognized power to propose modifications in the regulatory framework; nodes: federal policies were adapted at the state level in a differential manner.

Conclusions:

Centralized governance, differential levels of convocation of actors, decision-making power, level of agreements, as well as responsibility and leadership, all defined the reach of governance and, in turn, the level of response to the Covid-19 pandemic.

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