Construction of the food and nutrition security policy in Brazil: strategies and challenges in the promotion of intersectorality at the federal government level

Abstracts

Este artigo analisa estratégias institucionais do governo federal brasileiro destinadas à promover a intersetorialidade no campo da Segurança Alimentar e Nutricional (SAN), com base em revisão bibliográfica e análise documental. Pressupõe que, embora a institucionalidade formal neste nível de governo não seja suficiente para promover a intersetorialidade, ela é importante para induzir o processo. Conclui-se que a conjugação de diferentes mecanismos institucionais favorece a intersetorialidade, tais como: a existência e localização de conselhos integrados por setores de governo e sociedade civil na presidência da república; o apoio político da presidência e inclusão do tema como estratégico na agenda governamental; conjugação de espaços institucionais que articulem os primeiros escalões de governo e que aproximem os níveis técnicos; programas que integrem produção, comercialização e consumo de alimentos. Os desafios referem-se à articulação com a política econômica e construção de um orçamento pactuado entre os setores, que seja integrado à gestão e ao monitoramento da política.

Segurança alimentar e nutricional; Intersetorialidade

ARTICLE

Construction of the food and nutrition security policy in Brazil: strategies and challenges in the promotion of intersectorality at the federal government level

Luciene Burlandy

Centro de Ciências Médicas, Faculdade de Nutrição, Universidade Federal Fluminense. Rua São Paulo 30/4º andar, Centro. 24015-110 Niterói Rio de Janeiro RJ. [e-mail]

ABSTRACT

This article analyzes institutional strategies of the Brazilian federal government that aim at promoting intersectorality in the field of Food and Nutrition Security (FNS), based on bibliographic review and document analysis. It is assumed that, although formal institutionality in this government level is not enough to promote intersectorality, it is important in process induction. It follows that the combination of different institutional mechanisms favors intersectorality, such as: the existence and location of councils integrated by government sectors and civil society in the presidency; political support by the presidency and inclusion of the issue as being strategic in the governmental agenda; assembly of institutional spaces that articulate the highest government spheres and that integrate technical levels; programs that integrate food production, commercialization, and consumption. Challenges concern interrelation with economic policy and the construction of budget agreed among sectors, integrated to policy management and monitoring.

Key words: Food and nutrition security, Intersectorality

Introduction

Social protection structures in Brazil, especially until the mid 1990s, were marked by institutional fragmentation and by the predominance of sectoral goals concerning strategies that could change the distribution of power resources, both horizontally (across sectors) and vertically (across government levels)¹. They consequently generate an inefficient resource allocation, overlapping of actions and customers, in addition to limiting the construction of more comprehensive national agreements to deal with complex problems, such as health and Food and Nutrition Security (FNS). In an attempt to overcome this scenario, the country has been formalizing cross-disciplinary ideas and institutional initiatives based on intersectorality.

In the Constitution of 1988, health was instituted as a right granted by social and economic policies. Being understood as resulting from the conditions related to diet, housing, education, income, environment, work and transportation, employment and leisure, freedom, land ownership and access to health services, it entailed the integration of a group of public policies implemented by different government sectors². Similarly, the Organic Law institutes FNS as the achievement of the human right to a healthy, accessible, high-quality diet, in sufficient amounts and in a permanent way, irrespective of the fulfillment of other essential needs, based on healthy dietary habits, respecting cultural diversity and being sustainable from a social and economic, as well as agricultural and ecological point of view³.This right is also only accomplished by means of integration among sectors.

Construction of these fields resulted from a participative social dynamism, shared between the government and social organizations, which achieved institutional status through the Unified Health System (SUS) in 1988, and through the National Food and Nutrition Security System (SISAN) in 2006. Implementation of these systems has been promoting a revision of the current models of health and diet care, aiming at achieving and integrated operation methodology. SUS aims at integrating actions for the promotion, protection, and recovery, and interrelations between the bio psycho social dimensions of the health-disease process. SISAN aims at integrating the production, supply, commercialization and consumption of foods, also considering their interrelations.

Public policies with integrating purposes, such as the ones mentioned, are strategic for the country development policies, and therefore cannot be limited to sectoral decision-making environments. As a result, both systems have intersectorality as an underlying principle, and institutional strategies are being implemented in order to enable its operation.

Acknowledging that the FNS policy is being built by governmental and civil society actors at the local, state and national levels, this article focuses on mechanisms implemented by the federal government to promote interrelation among sectors. Although the formal institutionality at this government level is not enough to put intersectorality into effect, it is important to induce it. In an attempt to highlight potentialities and challenges involved in this process, the study was based on history review and on the analysis of technical governmental documents, of reports generated by FNS National Conferences that had taken place until then, and of federal legislation.

Challenges and potentialities concerning the coordination of public policies

Coordination among different government sectors is related to the degree of integration and segmentation of the decision-making process, and to the ways interests are organized and interact at the institutional level. Highly integrated processes, with strong interdependence on the set of policies and a global and intersectoral implementation of actions characterize the modalities of state societal planning. At the other extreme, segmentation is at its highest point when there are numerous decision-making agencies specialized in sectoral items of the agenda, and negotiations revolve around players that are significant for each policy sector in specific fields of interest⁴.

The implementation of coordination mechanisms by means of state societal planning is hardly made operational, due to growing processes of functional differentiation in progress in different countries. Fields such as economics, law, sciences, education, and even politics, have developed their own rationale and dynamics, being relatively closed and self-referenced in functional subsystems. Such dynamics increases the sectoralization of policies and the autonomy of each subsystem, which hinders the establishment of a single coordinating center, a role traditionally played by the State⁵.

In distinct national contexts, from the 1980s onwards, centralized power and decision-making structures - which had remained, until then, limited to the boundaries of governmental institutions - were replaced by hybrid management methods, which join different governmental and societal sectors. "Policy networks" were thus established around political issues or programs, characterized by multiple non-hierarchical decision-making centers, and by a more or less stable pattern of relations among players. Interdependence is the main reason behind their establishment and sustainability, and it varies according to the goals at stake and how much they imply the mobilization of resources by the group of players involved^6-8.

Since the main problems are not limited to a single area, the tension created concerns how to balance differences and integration. If cooperation among organizations is closely related to interdependence, how does it coexist with the ongoing process of greater subsystem autonomy?

To provide an answer to this question it is important to understand that if, on the one hand, sectoralization created greater autonomy and fragmentation of social life, on the other hand it resulted in a growth in the number of players involved in the political process, and increased demands for State intervention. As a consequence, not only did it increase the internal differentiation of the state apparatus, but it also resulted in delegation of roles and co-responsibilities, as well as in the need to share resources, which paved the way for new management mechanisms⁵.

Some factors must be taken into consideration in this scenario: the growing complexity of decision-making processes; the increasing number of players involved and the importance of cooperation; the combination of different organizational structures; the broad spectrum of coordination tasks (from data collection to the achievement of political consensus); the differentiation among state roles and tools used (decrees, laws, financial incentives, formal and informal agreements, etc.)⁵.

Analytically, distinct levels of interrelation and coordination among sectors can be identified: multisectorality - when a cross-sectoral public policy goal enables the identification of highly important programs that are intensified by means of a convergent action. Such process may result in specific achievements in the sectoral programs and in sectors coming closer to a macro-sectoral approach; intersectorality - when sectors share an integrated project, identifying the key determinants of the problem at issue, formulating strategic interventions that transcend sectoral programs, and allocating resources based upon these priorities⁹.

Integrated planning allows the identification of key interventions that have high impact on a problem, or those with a simultaneous effect in different determinant dimensions. As an example, support to the production of foods by small-size farming and to the commercialization of such products increases societal and nutritional well-being of both producers and consumers by facilitating access to fresh foods at lower costs¹⁰.

Challenges are multiple, considering political conflicts surrounding the allocation of public assets. They demand, therefore, negotiations within various government spheres and levels (competing for existing resources) so that mid and long-term investments can be agreed upon, even if this means postponing the more immediate investments of some segments. In order for this to happen, it requires: commitment and adherence to integrating projects by players beyond their specific goals; the State to be able to promote agreements and coordinate actions so that short-term goals are replaced with future benefits; "strategic consensus" to happen, only made possible by means of the establishment of new political solidarities and agreements achieved through comprehensive negotiation processes¹¹.

Possible institutional mechanisms for articulation among sectors

In this complex context, new planning and management strategies are essential. Management of these relations by the State (which acts as a "multilateral dealer") requires the traditional decision-making structures to become more decentralized and flexible, and information systems to allow players to have a shared understanding of the problems^10,12. This implies the identification of potential points of coordination (areas of common interest and practices among them), and the dissemination of strategic information that point towards a way for cooperation to simultaneously meet broader interests and individual demands^13,14.

Councils integrated by different sectoral leaderships may comprise an important institutional coordination mechanism by allowing, among other factors: the establishment of agreements concerning key decisions on resource allocation; a global planning that provides common guidelines for the various sectors, and that highlights intersection areas and allows the identification of strategic interventions. Additionally, it is also necessary to establish spaces for more frequent interaction among sectors¹⁰.

Monitoring systems that subsidize an integrated planning must consider information on the decision-making process itself, in that they should identify how decisions made by a sector can dim or intensify the impact of others. Measures taken in the field of economy, for instance, can increase societal well being or void the impact of strategies developed by other sectors.

Intersectoral interrelation initiatives in the sphere of FNS policies

Governmental initiatives in the field of food and nutrition date back to the beginning of last century (such as the Public Nutrition Comissariat - 1918 - which controlled inventories and defined prices for basic food items). However, initiatives for the construction of a national scope policy integrated by different institutions and ministries occurred at a later stage, such as the first National Food and Nutrition Plan (1952). Intersectorality had already become a strategic issue since policies involved actions concerning the production, commercialization, supply, access, and consumption of foods. Its operationalization, however, has always been complex, since ministries intensified the sectoral utilization of resources ^15-18.

Historically speaking, several institutional mechanisms of coordination were created, such as: the National Food Committee - CNA (1945), an agency of the Federal Council for Foreign Trade, regulated by and transferred to the Ministry of Health in 1951, and the National Food and Nutrition Institute (INAN) in 1972, which coordinated diet and nutrition activities in the country, and which created and coordinated the National Food and Nutrition Program (1^st PRONAN [1973-1974] 2^nd PRONAN [1976-1989] ^16-18.

Some programs of the 2^nd PRONAN (the first did not take place) had a strong intersectoral characteristic as they simultaneously influenced food production, commercialization and consumption conditions, such as: (a) the Basic Foods Supply Program (PROAB) - INAM / MS - which commercialized a number of subsidized basic foods to populations living in urban outskirts through a network of small retailers; (b) the Project for Basic Foods Procurement in Low Income Rural Areas (PROCAB) - INAM / MS - which ensured the outlet of produce from small farmers at prices based on quotations of the wholesale market, and channeled them to PRONAN programs; (c) the Popular Nutrition Program - Ministry of Agriculture - which commercialized foods at reduced prices to the low income urban population, acquired from local producers by the government. (d) Somar Network - COBAL (an agency that later became the current National Company for Food Supply - CONAB), which consisted of a trade network that supplied small retailers with approximately 600 items at prices lower than or comparable to those charged by supermarkets, and provided technical support. These were isolated strategies were due to INAN's own management difficulties^19,20.

Since these programs were linked to different ministries INAN had the responsibility of coordinating them, consolidating a policy for the sector. However, having been created as a federal autarchy linked to the Ministry of Health, that agency was not given the institutional importance required by its attributions. Additionally, its Managing Board, comprised by the ministries involved, was unable to promote the necessary intersectoral relation. Up to its dissolution in 1997, INAN was unable to establish itself as a coordinating instance, also because it practically did not interfere with programs developed by other Ministries, such as the Workers' Food Program (PAT) - Ministry of Labor - and the National School Food Program (PNAE) - Ministry of Education^9,19. Internal documents and surveys reiterate the weaknesses of the agency's management, such as: lack of clarity by the government in stating what would be the best institutional framework to support food and nutrition activities; staff with reduced personnel and frail quality (due to high turnover rates and impossibility to hire in a more stable manner); budgetary limitations and small political importance of the agency within the government.

During the 1980s, societal budget and population coverage of the programs were increased. However, the confused nature of that process increased client overlapping and incited competition among ministries for resources, hindering even further intersectoral interrelation²⁰. Therefore, the challenge of defining where and how food and nutrition policy would be established from an institutional point of view still existed. Would a super-ministerial level be necessary?

The intense societal mobilization seen since the middle of the 1980s, after twenty years of military dictatorship, characterized the construction of proposals to deal with social issues, including food and nutrition. It is within this context, guided by the action of civil society organizations, that Food Security acquires growing relevance in the governmental agenda ^21,22.

It should be highlighted that this concept appeared as a strategic issue within the international plan during the First World War, when the productive self sufficiency of national states became central. The issue became stronger with the advent of the international supply crisis, and the World Food Conference (1974) defined it as "a safe and suitable food supply, based on physically defined necessity criteria". Thus, the concept initially focused on food availability²³.

During the mid 1980s the Brazilian governmental policies showed the first records of the term "food security" when, in 1985, a proposal was formulated in the Ministry of Agriculture for a "national safe food policy". A possible distinction when compared with the international approach of the 1970s concerned a definition of goals beyond national production self-sufficiency, including the fulfillment of food needs. In that occasion one could already identify the creation of a National Food Security Council, administered by the President of the Republic, comprised of government ministers and employers' and workers' unions representatives, and that had little repercussion at the time^23,24.

In 1986, with the 1^st National Conference on Food and Nutrition (an evolution of the 8^th National Conference on Health), food became a citizenship right and Brazil progressively inserted the rules of human rights into its legal system, especially the human right to food, provided for by the 1996 National Plan for Human Rights. The concept was then resized, since the conference introduced the idea of incorporating the nutritional aspect as well. There were also proposals for the creation of a National FNS System integrated by Councils and systems at the state and municipal levels (the proposal was reassessed in 2004), and of a National Council for Food and Nutrition, aiming at conceiving a National Food and Nutrition Policy ((PNAN), established by the Ministry of Health in 1999)^24-27.

In 1992, an internal document of INAN already pointed towards the need to establish a FNS Committee comprised of ministries of the economic and social areas, where INAN would play the role of executive secretariat, aiming at achieving intergovernmental collaboration¹⁷.

In the 1990s, after a strong technical and political stripping in social policy institutions (1990 - 1993) a confluence of processes that occurred both at the societal and governmental levels intensified federal initiatives. The government established in 1993 defined the fight against hunger as a priority, in a context of intense social mobilization, where MEP - Movement for Ethics in Politics is to be highlighted, giving origin to the creation of the Citizenship Initiative against Poverty and for Life. In such an environment the "Fight Plan Against Hunger and Poverty" was devised, in an agreement between the government (including INAN) and the society, based on the National FNS Policy Proposal by the "Parallel Government" of the Workers' Party. The plan provided for the "joint, interdependent and coordinated" implementation of several sectoral programs, associated to managerial improvements in their execution and aiming at intensifying resources. The ultimate agency in the administration of the organizational structure was the National Food Security Council (CONSEA), which would be administered by the President of the Republic, and comprised of nine government ministers and 21 civil society representatives (Decree no. 807 04/24/1993)^28,29.

As an initiative of CONSEA and of the Citizenship Action movement, the first National FNS Conference was held in Brasilia in 1994, defined as a strategic governmental component that encompassed a set of principles, policies, measures and tools that permanently ensure access of all inhabitants within the Brazilian territory to foods at reasonable prices, in quantity and quality enough to meet the nutritional demands of a respectable and healthy lifestyle like the other rights of citizenship³⁰.

The Conference gave FNS the status of a project that integrated sectoral actions, capable of establishing itself as the strategic core of a new national development model^25,26,30. However, according to its assessment CONSEA was unable to avoid the fragmentation and the contradiction of governmental policies, but promoted greater proximity among governmental and societal sectors, combining political agreement and societal control. Furthermore, it acted as an instance of partnership in defining priorities and in a space of political pressure for resource allocation based on shared resources^30-32. Its interventions in economic policy were, however, limited, expressing the difficulty of social and economic areas of the government in adopting integrated priorities³³.

In the following conjuncture, CONSEA was dissolved and the Solidary Community strategy was established (SC), operationalized in the presidencies of the Federal Government (1995-1998; 1999-2002), comprised of an Executive Secretariat (ES) and a Council, also comprised of different Ministries and societal organizations. Its main goal was the fight against hunger by means of the convergence of sectoral programs to municipalities and impoverished families, aiming at their integration and synergy in the territory. The core theme of FNS was based on the agenda of the Council by means of 'rounds of dialogue' with the civil society administrated by an FNS Committee, comprised of government technicians, albeit informally established^34,35.

Studies about the SC pointed towards an improvement in the focalization of specific programs by means of negotiations carried out on a case-by-case basis with each Ministry, especially during the first presidency of the Federal Government (until 1998). The ES of the SC administered that process, and the Council invested in non-governmental programs considered to be innovative by means of partnerships with local social organizations. Thus, there were two coexisting movements; one that aimed at intensifying governmental programs through coordination, and another at intensifying the societarian resources of local communities. The second administration of SC focused on the latter objective, and consolidation of the governmental framework of SC at the local level was feeble, thus hindering the integrated territorial planning ^9,37.

Internal INAM / MS documents of that period reiterate the need for interrelation between the agency and several government sectors present within the SC Council that had closer interfaces with actions carried out by the Ministry of Health³⁸.

Also, within the sphere of this Ministry it is important to mention the Intersectoral Committee for Food and Nutrition (CIAN) of the National Health Council (CNS), provided for by Law 8080 of September 19, 1990, which assumes the role of a potential space for the dialogue between health and other sectors to occur. Comprised by representatives from different Ministries, from the civil society and for-profit private sector (which includes an SC representative in the context at issue), CIAN assists CNS in the supervision of PNAN, which has intersectorality as one of its guidelines^24,27.

In 2003 (Lula Government) CONSEA was reestablished as an agency that provides consultancy to the President of the Republic, 1/3 of which is comprised of government sectors, and 2/3 by the civil society^39,40. Evaluative documents ascribe some merits to CONSEA, such as: having conceived the Family Agriculture Crop Plan, which integrated ministries and social organizations in a negotiated proposal; execution of the 2^nd and 3^rd National Conferences on FNS; modifications made to the National Program for Nutrition at School, including the increase of the per capita allocated to municipalities and expansion of the number of clients assisted by the program. In terms of challenges, one can mention the low interference in resource allocation, especially concerning the Pluriannual Plan and the 2004 budget; limitations in fostering intersectorality, given the low participation of the highest Ministry levels in the construction of an integrated monitoring system^41,42.

A significant progress was the enactment of the Organic Law for Food and Nutritional Security (2006), which established the previously mentioned SISAN, comprised of councils and conferences that assemble agencies and entities from different sectors across all government levels. Additionally, the law designated an interministerial chamber comprised of the government ministers and federal secretariats, under the coordination of the Civil Office, whose role is to devise the FNS policy and National Plan. The chamber enhances the participation of the highest government levels, and commits them to the construction of a dedicated agenda for negotiation (considering past difficulties concerning systematic participation of the highest levels in CONSEA). It may, however, face some difficulties to promote intersectorality as it was once linked to the Ministry of Social Development and the Fight Against Hunger and not to the Civil Office of the Presidency of the Republic, as is the case with CONSEA^3,43,44.

The report produced by the 3^rd National FNS Conference⁴⁵ acknowledges that advances made in the incorporation of FNS policies into the public agenda of the country and its contribution to the integration of actions toward intersectorality. Within this scenario some programs stand out, such as the Food Acquisition Program of the Family Agriculture - PAA (2003), acknowledged as being innovative in the sense that it is both a tool for agricultural policy and for access to adequate and healthy foods⁴⁶. PAA is coordinated by a Managing Group comprised of different Ministries, and combines tools for supporting production and trade, using differentiated reference prices for family production, facilitating procedures for governmental acquisition of their products and allocating them to certain population segments^43,47. PAA^'s experience reestablishes initiatives already existing in PRONAN, which exert simultaneous influence on several dimensions of the agricultural-nutritional chain, and which facilitate a closer relationship between food production and consumption, and a more integrated view of public actions.

Likewise, the current legislative bill for School Nutrition (PL 2877/2008), under development in the National Congress, sets forth that out of the total financial resources granted by FNDE within the sphere of PNAE, at least 30% must be used in the acquisition of foods originating from family agriculture. It thus ensures the commercialization of that production and provides quality to meals served at school, making fresh local products available.

CONSEA also give more visibility to conflicts and different opinions of the government itself about certain subjects, such as the trade of transgenic foods, and the distinct demands of the family agriculture and of the agribusiness. The very existence of two ministries that deal in different ways with these issued (The Ministries of Agriculture and Agrarian Development) is proof of the divergence of sectoral dynamics within the government, which becomes more visible through the council^42,45.

Final considerations

Promoting intersectorality is a challenging tasks that requires the convergence of different mechanisms, processes, and institutional tools. Balance between the autonomy of subsystems and their integration is especially complex in the field of FNS Being a supersectoral policy, it encompasses actions of subsystems with distinct and robust institutional frameworks, such as SUS itself, and also of sectoral policies, which as the National Policy for Food and Nutrition of the Ministry of Health, among others.

The analysis of intersectorality promoting strategies implemented by the federal government indicates that factors such as the institutional locus, the political influence of spaces for coordination, and the degree of insertion of the subject itself in the governmental agenda facilitate this process. In a presidentialist system, the integrating objectives are either incorporated by the presidency and the highest government levels as political - and not only technical-administrative (for better program management) priority, or they will hardly be achieved. It should be highlighted that the mobilizing role of civil society organizations has lent significant dynamism to the entire process.

The progressive strengthening and broadening of the FNS concept, up to its consolidation as an Organic Law with a Policy and a National System in progress, has been facilitating the promotion of intersectorality within the sphere of the historical activity of the federal government in the field of food and nutrition. Although this principle was already present in the food and nutrition policy from its origins, it has hardly been accomplished by means of sectoral mechanisms and strategies, and FNS reinforced the supersectoral nature of this institutionality.

INAN's dialogue initiatives were hindered by the political-institutional weakness of the agency and by its sectoral locus, which constrained intersectoral coordination spaces to the boundaries of the dynamics of the health sector itself, limiting its intervention in programs of other Ministries.

In the case of supersectoral Councils, such as CONSEA and the Solidary Community Council, (SC), the possibility of interfering with sectoral dynamics is intensified by its very entailment to the presidency of the republic. Priorities undertaken by each council, the political support provided by the presidency, and strategic insertion of the subject into the governmental agenda (which were frail, in the case of SC, and strong within the sphere of CONSEA) set the conditions for the differentiated performance of those spaces in the promotion of intersectorality. Even though the Executive Secretariat of SC has undertaken efforts to coordinate federal programs, they aimed mainly at increasing effectiveness in specific programs, especially the focalization on impoverished segments (a goal that was achieved, according to evaluations). However, construction of an integrated government policy continued to be a challenge. One should consider the difficulties of an ES in articulating the Ministries by itself, since the Council gave priority to strengthening non-governmental initiatives, and became the focal point of the entire strategy of SC in the second administration of the government⁹.

The first CONSEA (1993), despite being supported by the presidency, was weak in promoting intersectorality, partly due to its being recent. The second (2003) achieved political legitimacy both due to priority given to FNS by the government, and to the fact that the presidency of the republic enacted propositions made by the council (albeit not always obeying all), made evident by the enactment of the FNS Organic Law, and in programs such as PNAE and PAA. Support coalitions between state bureaucracy and the presidency may have contributed in this process, considering alliances and the exchange of several types of resources that occurred among the involved players⁴⁸.

Another fact that facilitates intersectorality within the sphere of the CONSEA is the combination of different institutional mechanisms and tools, such as legislation, the formation of Interministerial Managing Groups linked to programs, which promote a leveling in the technical and political levels (such as in PAA), in addition to the Interministerial Chamber itself, which involves administrators from the highest spheres.

Interrelation with the economical area is still a challenge to be overcome, since ministers of the social area are frequently far from the decision-making arenas that establish policies related to the core subjects of economy (negotiation of the foreign debt, economic adjustments, etc.)¹⁰.

Councils of this type also lend greater visibility to conflicts and disagreements, both within the government itself and with civil society. This action is important for the construction of broader national agreements; it does, however, make the decision-making process more complex. The adherence of governmental sectors may be different, depending on how much each one aims at achieving solid benefits.

In the case of CONSEA, some factors facilitate this adherence: the fact that the government sees FNS as a strategic goal makes CONSEA harmless in the sense that it will not claim possible political laurels resulting from the actions; sectors strengthen their capacity to interfere in the decision-making process, because CONSEA broadens the scope of the discussion regarding decisions that are traditionally made inside the offices of Ministers and Secretaries, with little influence by technicians. By broadening the vocal power of sectoral demands, the council can facilitate the adherence, the dialogue between themselves, and between them and the presidency of the republic, improving sectoral programs. In case of failure to reach an agreement, CONSEA customarily disseminates all existing opinions^42,45.

Some challenges still remain, such as the construction of an integrated monitoring system, and interrelating budget and management, made evident by difficulties in interventions in the budgetary process. Additionally, although intersectorality can advance in the more formal levels, other hindrances appear in the daily work toward integrated actions, such as: differences between principles, ideas, the redistribution of financial, human, and political resources, time, willingness to reorganize the work processes, among others. On the other hand, greater proximity is facilitated when sectors are able to see benefits in exchanging resources.

Beyond the spheres of the federal government, other challenges exist for the promotion of intersectorality in states and municipalities. It is, therefore, essential that mechanisms for the dialogue between government levels exist within the sphere of SISAN, as is the case with the Intermanagement Committees of SUS.

Lastly, given the arid scenario that characterized the fragmented state institutionality of the country, the outlined progress is promising, even though the path that needs to be traversed towards a planning that integrates budget and public management of different government sectors is long.

Acknowledgements

I wish to express my gratitude to Renato Maluf for his valuable contributions to this document.

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Publication Dates

• Publication in this collection
  15 June 2009
• Date of issue
  June 2009

History

• Accepted
  09 Feb 2009
• Reviewed
  09 Jan 2009
• Received
  20 Oct 2008