Decentralisation process of STD/HIV/AIDS actions: incentives policy in the sphere of the Brazilian AIDS programme
M.A. Tironi1, K.B. Freitas2, S. D'Avila1, R. Burgos Filho3
1Brazilian Aids Program, Planning, Brasilia, Brazil, 2Brazilian Aids Program, Monitoring and Evaluation, Brasilia, Brazil, 3Brazilian Aids Program, Strategic Management, Brasilia, Brazil
Issues: Since the 90s the AIDS epidemic in Brazil has been advancing in state capitals and in towns and medium sized cities in the interior giving rise to the phrase 'interiorisation of the epidemic”.
Description: To address that tendency the National AIDS Programme instituted an “Incentives Policy” in 2002 designed to transfer financial resources to state and municipal authorities. Receipt of such resources is conditioned to the presentation of a Goals and Actions Plan whose priorities are established on the basis of a local analysis of the profile and tendencies of the HIV/AIDS epidemic. To that end, 26 Brazilian states, the federal district and 497 municipalities were selected using the criteria of: number of notified AIDS cases, services structure, management capacity, and incidence figures. Goals must be aligned with the priorities established in the federal sphere. The total amount invested is R$ 100 million reals a year. Monitoring is achieved by a system that makes half-yearly demonstrations of the stage of execution of goals and the respective financial performance, making it feasible to revise and adjust planning to ensure the expected results.
Lessons learned: The decentralisation policy has guaranteed the outreach of prevention and assistance actions to cover vulnerable populations in a country with continental dimensions and notable variations in culture, as is the case with Brazil. However, the process has also revealed the poor capacity of local spheres of government to analyse situations and conduct adequate planning.
Next steps: Expand the decentralisation process to encompass all Brazilian municipalities that have a record of at least one notified case of AIDS. Consolidate Planning, Monitoring and Evaluation by means of negotiated agreements among all levels of government, defining targets, indicators and results.
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