A construção do Sistema Nacional de Vigilância Sanitária: uma análise das relações intergovernamentais na perspectiva do federalismo

Abstract

This study focuses on the construction of the National Sanitary Surveillance System, analyzing it from the viewpoint of inter-government relations, This construction points out that the way taken by the decentralization model, adopted by the federal sphere till 2003, was different from assistance actions, centered on improvement of the state sphere. Also, a different way in relation to the federative sharing which benefited the municipal sphere, and the small municipalities. Of the four basic principles of federalism, co-operation and co-ordination are highlighted. Co-operation is concerned with the autonomy of federative matter and with the decentralization degree in force. Co-ordination is regarded as necessary to obtain co-operation. The background is the heterogeneous structure of Brazilian municipalities. The study examines: the evolution of federative regimen in republican constitutions and intergovernment relations thus established; the historical trajectory of sanitary surveillance in Brazil; the building strategies of epidemiological and sanitary surveillance national systems; the sanitary surveillance decentralization process in municipalization of health actions, after having provided profits in healthcare coverage and fragmentation of services, deserves more attention when shifting to sanitary surveillance. The State responsibility, the potentially high degree of negative externality, and the heterogeneous municipal structure require: the need for effective federal co-ordination; the need to reinforce the state s role in the context of a necessary regional and local co-operation; the urgency to reformulate decentralization and financing criteria for sanitary surveillance actions. This study does not intend to exhaust the federative issue of sanitary surveillance, but it brings some proposals to overcome some of the detected problems.