The Brazilian national sanitary surveillance system: An analysis of intergovernmental relations in the perspective of federalism

In the Federal Brazilian System the municipalities, heterogeneous structures, are a federative component. Brazilian health system is an arrangement in which decentralization was implemented to the municipalities that have, according to the law, the main responsibility for implementation of health actions.  Sanitary surveillance system (SSS) is responsible for the sanitary control (drugs; services; health control of ports, airports and borders). The decentralized construction of this system only starts at the end of the 1990s and the incorporation of municipalities is still precarious. The study focuses on the construction of this system and his constraints, analyzing it from the viewpoint of inter-government relations, utilizing co-operation and co-ordination as central categories of analysis and considering the politics, fiscal and historical aspects. The study examines also the building strategies – including financing – of epidemiological and sanitary surveillance national systems; the sanitary surveillance decentralization process in one provincial government. Because of absence of prior national policies which contributes to the construction of the system (SSS), the descentralization model until 2003 was centered in strengthening the provincial sphere. Provincial services structured are the result of this decentralization process. After 2003, the municipalities were incorporated into the process in a context of advancement in the federal sphere for the Epidemiological Surveillance Federal Body. 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 brings some proposals to overcome detected problems and constraints and to make possible to understand the peculiar model of sanitary surveillance in Brazil and its relation to others health regulatory systems.