The present work addresses the reality of Brazilian fiscal federalism based on the analysis of public health financing in the Rio Grande Basin Region. Understood as a fundamental factor in the realization of the dignity of the human person, the quality of health care, and its respective public financing, the study focuses more precisely on verifying the structure of the transfer funds between political entities that make up the Brazilian federation. From a historical perspective, this article analyzes the transposition of Federalism to Brazil and identifies the anti-democratic roots in political-administrative model, which leaves historical legacies, reflected in an imbalance in the financing of federative entities, in which the municipality received many responsibilities, as, logically, it is the regional power, and has few resources to be able to carry out the responsibilities given to it. In this sense, the municipalization of health services, as established by the health laws, was not accompanied by the distribution of resources in proportion to the attributions. In this way, information relating to the socioeconomic panorama of the sub-region of the Rio Grande Basin in Bahia and its public health context is analyzed based on data from official platforms.