Data Sharing in a Decentralized Public Health System: Lessons From COVID-19 Syndromic Surveillance.

The COVID-19 pandemic revealed that data sharing challenges persist across public health information systems. We examine the specific challenges in sharing syndromic surveillance data between state, local, and federal partners. These challenges are complicated by US federalism, which decentralizes public health response and creates friction between different government units. The current policies restrict federal access to state and local syndromic surveillance data without each jurisdiction's consent. These policies frustrate legitimate federal governmental interests and are contrary to ethical guidelines for public health data sharing. Nevertheless, state and local public health agencies must continue to play a central role as there are important risks in interpreting syndromic surveillance data without understanding local contexts. Policies establishing a collaborative framework will be needed to support data sharing between federal, state, and local partners. A collaborative framework would be enhanced by a governance group with robust state and local involvement and policy guardrails to ensure the use of data is appropriate. These policy and relational challenges must be addressed to actualize a truly national public health information system.

Whose experts? How federalism shaped psychiatry in the late Habsburg monarchy.

The late Habsburg period (1867-1918) created a constitutional dual monarchy of Austria-Hungary. This paper discusses the role of psychiatry in Cisleithania, both as a developing profession and as a distinct 'policy field'. Tension between psychiatry's academic professionalisation and the creation of public institutions as signature projects by individual crownlands created complex relationships between psychiatry and politics. In federalist Cisleithania, psychiatrists became very 'political': whether employed by the state or a crownland influenced their position on policy, despite claiming that their expert knowledge was 'scientific' and 'objective'. The conflicts between asylum-based and academic psychiatrists mirrored those between the central state and the crownlands. This led to intractable delays in mental health law reform, eventually resolved by Imperial decree in 1916.

Implementing health system and the new federalism in Somalia: challenges and opportunities.

In the 21st century, healthcare stands out as a formidable, contentious social responsibility for governments due to its high costs. This study delves into Somalia's healthcare system under Federal Government leadership, scrutinizing the complexities of health governance and financing. The Federal Government (FGS), along with governmental states (FMS) and regional authorities, collectively shoulder leadership and governance roles within Somalia's healthcare framework. Vital to resilient and inclusive development, the health sector holds a pivotal role. A strategic investment in healthcare not only drives substantial demographic dividends through enhanced life expectancy and reduced fertility rates, but also paves Somalia's trajectory toward progress. The Federal Government of Somalia confronts a multitude of challenges in its pursuit of effective healthcare implementation. A prominent obstacle lies in health financing. Somalia relies heavily on international and private sources for health support, primarily due to limited government revenue generation. This financial shortfall restrains the government's capacity to allocate ample funds for public services and critical investments, including healthcare. This paper sheds light on the present healthcare landscape in Somalia and expounds on the hurdles confronted by healthcare systems under federal governance. Moreover, it delves into the historical evolution of Somalia's healthcare system and the advent of new federalist principles. In doing so, this study comprehensively examines the dynamics of healthcare governance, financing, and historical progression in Somalia.

Nepal's experience in implementing the federal government system: Assessment of law-making by the local governments of Kaski district, Nepal.

The Constitution of the Federal Republic of Nepal 2015 institutionalizes the sovereign right of the people and the right to autonomy, shared rule and self-rule via the three levels of government: federal, provincial, and local. Accordingly, to deliver service to the local residents and to assure the residents of the practice of self-rule, the constitution has given state powers to the local levels with 22 exclusive mandates and 15 concurrent competencies and mandates. However, being the new practice in the Nepalese context, for implementing the delegated authority, related laws are to be formulated by the concerned local level. In this study, I assessed if the five local levels of Kaski district: Pokhara Metropolitan, Annapurna Rural Municipality, Machhapuchhre Rural Municipality, Madi Rural Municipality, and Rupa Rural Municipality in the first five years of their establishment formulated the requisite laws concerning the 22 local-level powers. I conducted a questionnaire survey and in-person interviews with the elected members of the local levels. The result revealed that during the first five years of operation (2017-2022), Pokhara Metropolitan formulated 98 laws, Annapurna Rural Municipality made 34 laws, Machhapuchhre Rural Municipality made 54 laws, Madi Rural Municipality made 88 laws, and Rupa Rural Municipality made 56 laws. The laws formed by the five local levels were of mainly two categories. The laws of the first category were related to the legal set-up of the local governments for the smooth functioning of administrative affairs which were almost identical across the five local levels. The laws of the second category were specific to the local level and thus apparently distinctive from each other, however, those laws were aimed towards providing service to the local residents, meeting the distinctive development aspirations of the local people and fulfilling the needs of local self-governance. Despite the deficiency of expertise in law-making and the limitation of resources, the local levels have laid a foundation for the functioning of local-level government. Although the local units of the Kaski district have put their best effort into formulating laws, they are yet insufficient to ensure the delivery of all the 22 constitution-delegated rights of the local residents. Therefore, the newly elected government should keep priority in formulating the remaining laws not only for the smooth functioning of the local government but also to assure the residents of the aspiration of self-governance and the constitution-granted rights.

Federalism for Bioethics?

In the wake of the Dobbs decision withdrawing federal constitutional protection for reproductive rights, the United States is in the throes of federalist conflicts. Some states are enacting draconian prohibitions of abortion or gender-affirming care, whereas other states are attempting to shield providers and their patients seeking care. This article explores standard arguments supporting federalism, including that it allows for cultural differences to remain along with a structure that provides for the advantages of common security and commerce, that it provides a laboratory for confined experiments, that it is government closer to the people and thus more informed about local needs and preferences, and that it creates layers of government that can constrain one another and thus doubly protect rights. We contend that these arguments do not justify significant differences among states with respect to the recognition of important aspects of well-being; significant injustices among subnational units cannot be justified by federalism. However, as nonideal theorists, we also observe that federalism presents the possibility of some states protecting rights that others do not. Assuming that movement among subnational units is protected, those who are fortunate enough to be able to travel will be able to access rights they cannot access at home. Nonetheless, movement may not be readily available to minors, people without documentation, people with disabilities, people who lack economic resources, or people who have responsibilities that preclude travel. Only rights protection at the federal level will suffice in such cases.

Medicaid Home and Community-Based Services in the Wake of the COVID-19 Pandemic.

The need to bolster Medicaid home and community-based services (HCBS) became more evident during the COVID-19 pandemic. This recognition stemmed from the challenges of keeping people safe in nursing homes and the acute workforce shortages in the HCBS sector. This article examines two major federal developments and state responses in HCBS options as a result of the pandemic. The first initiative entails a one-year increase of the federal Medicaid matching rate for HCBS included in the American Rescue Plan Act championed by the Biden administration. The second initiative encompasses administrative flexibilities that permitted states to temporarily expand and modify their existing Medicaid HCBS programs. The article concludes that the effects of the pandemic flexibilities and enhanced federal funding on most state HCBS programs will be limited without continued investment and leadership on the part of the federal government, which is a Biden administration priority. States that make the American Rescue Act and COVID-19 flexibilities initiatives permanent are states that have the fiscal resources and political commitment to expanding HCBS benefits that other states lack. States' different approaches to bolstering Medicaid HCBS during the pandemic may contribute to widening disparities in access and quality of HCBS across states and populations who depend on Medicaid HCBS.

Continuous Reproductive Surveillance.

The Dobbs opinion emphasizes that the state's interest in the fetus extends to "all stages of development." This essay briefly explores whether state legislators, agencies, and courts could use the "all stages of development" language to expand reproductive surveillance by using novel developments in consumer health technologies to augment those efforts.

Overcoming the challenges facing Nepal's health system during federalisation: an analysis of health system building blocks.

INTRODUCTION: Nepal's move to a federal system was a major constitutional and political change, with significant devolution of power and resources from the central government to seven newly created provinces and 753 local governments. Nepal's health system is in the process of adapting to federalism, which is a challenging, yet potentially rewarding, task. This research is a part of broader study that aims to explore the opportunities and challenges facing Nepal's health system as it adapts to federalisation. METHODS: This exploratory qualitative study was conducted across the three tiers of government (federal, provincial, and local) in Nepal. We employed two methods: key informant interviews and participatory policy analysis workshops, to offer an in-depth understanding of stakeholders' practical learnings, experiences, and opinions. Participants included policymakers, health service providers, local elected members, and other local stakeholders. All interviews were audio-recorded, transcribed, translated into English, and analysed thematically using the six WHO (World Health Organization) health system building blocks as a theoretical framework. RESULTS: Participants noted both opportunities and challenges around each building block. Identified opportunities were: (a) tailored local health policies and plans, (b) improved health governance at the municipality level, (c) improved health infrastructure and service capacity, (d) improved outreach services, (e) increased resources (health budgets, staffing, and supplies), and (f) improved real-time data reporting from health facilities. At the same time, several challenges were identified including: (a) poor coordination between the tiers of government, (b) delayed release of funds, (c) maldistribution of staff, (d) problems over procurement, and (e) limited monitoring and supervision of the quality of service delivery and data reporting. CONCLUSION: Our findings suggest that since federalisation, Nepal's health system performance is improving, although much remains to be accomplished. For Nepal to succeed in its federalisation process, understanding the challenges and opportunities is vital to improving each level of the health system in terms of (a) leadership and governance, (b) service delivery, (c) health financing, (d) health workforce, (e) access to essential medicines and technologies and (f) health information system.

The Wrong Place at the Wrong Time? Territorial Autonomy and Conflict During Regime Transitions.

This article evaluates how territorial autonomy affects ethnic mobilization and conflict during regime transitions. Previous research has highlighted its conflict-inducing role during prominent transition contexts. Alternatively, it has shown its pacifying role in the "average" case, without distinguishing transition periods from stable contexts. Addressing these gaps, we argue that the de-escalatory consequences of autonomy depend on critical stabilizing factors which are themselves "muted" during transitions. We test our expectations in a cross-national analysis, covering all regime transitions between 1946 and 2017. We also revisit the 1989 transition from Communism, focusing on the role of "inherited" autonomy in the post-communist successor states. This enables us to address concerns whereby autonomy is offered to ward off transitions or whereby transitions are themselves induced by mobilization. Our findings indicate that during transitions, territorial autonomy increases the likelihood of ethnic mobilization, government concessions in response, and violent escalation where these are not forthcoming.

Fiscal decentralization in Poland: 2004-2019 municipal and city dataset.

This dataset covers 2476-2479 Polish municipalities and cities (dependent on the year) over a period from 2004 when Poland joined the EU to the pre-COVID-19-pandemic 2019. The created 113 yearly panel variables include budgetary, electoral competitiveness, and European Union funded investment drive data. While the dataset has been created out of publicly available sources, their use requires advanced knowledge of budgetary data and their classification, as well as data gathering, merging, and clearing, which required many hours of work over a year. Fiscal variables were created out of raw data of over 25 million subcentral governments records. They were sourced from Rb27s (revenue), Rb28s (expenditure), RbNDS (balance), and RbZtd (debt) forms, which are reported quarterly by all subcentral governments to the Ministry of Finance. These data were aggregated according to the governmental budgetary classification keys into ready-to-use variables. Furthermore, these data were used to create original EU-financed local investment drives proxy variables based on large investments in general and in sports objects in particular. Moreover, subcentral electoral data from 2002, 2006, 2010, 2014, and 2018 were sourced from the National Electoral Commission, mapped, cleared, merged, and used to create original electoral competitiveness variables. This dataset can be used to model different aspects of fiscal decentralization, political budget cycles, and EU-funded investment in a large sample of local government units.

Politics and the Public Health Workforce: Lessons Suggested from a Five-State Study.

Policy Points The United States public health system relies on an inadequate and inefficient mix of federal, state, and local funding. Various state-based initiatives suggest that a promising path to bipartisan support for increased public health funding is to gain the support of local elected officials by providing state (and federal) funding directly to local health departments, albeit with performance strings attached. Even with more funding, we will not solve the nation's public health workforce crisis until we make public health a more attractive career path with fewer bureaucratic barriers to entry. CONTEXT: The COVID-19 pandemic exposed the shortcomings of the United States public health system. High on the list is a public health workforce that is understaffed, underpaid, and undervalued. To rebuild that workforce, the American Rescue Plan (ARP) appropriated $7.66 billion to help create 100,000 new public health jobs. As part of this initiative, the Centers for Disease Control and Prevention (CDC) distributed roughly $2 billion to state, local, tribal, and territorial health agencies for use between July 1, 2021, and June 30, 2023. At the same time, several states have enacted (or are considering enacting) initiatives to increase state funding for their local health departments with the goal of ensuring that these departments can deliver a core set of services to all residents. The differences in approach between this first round of ARP funding and theseparate state initiatives offer an opportunity to compare, contrast, and suggest lessons learned. METHODS: After interviewing leaders at the CDC and other experts on the nation's public health workforce, we visited five states (Kentucky, Indiana, Mississippi, New York, and Washington) to examine, by means of interviews and documents, the implementation and impact of both the ARP workforce funds as well as the state-based initiatives. FINDINGS: Three themes emerged. First, states are not spending the CDC workforce funding in a timely fashion; although the specifics vary, there are several organizational, political, and bureaucratic obstacles. Second, the state-based initiatives follow different political paths but rely on the same overarching strategy: gain the support of local elected officials by providing funding directly to local health departments, albeit with performance strings attached. These state initiatives offer their federal counterparts a political roadmap toward a more robust model of public health funding. Third, even with increased funding, we will not meet the nation's public health workforce challenges until we make public health a more attractive career path (with higher pay, improved working conditions, and more training and promotion opportunities) with fewer bureaucratic barriers to entry (most importantly, with less reliance on outdated civil service rules). CONCLUSION: The politics of public health requires a closer look at the role played by county commissioners, mayors, and other local elected officials. We need a political strategy to persuade these officials that their constituents will benefit from a better public health system.

Gestão estadual da atenção primária à saúde em resposta à COVID-19 na Bahia, Brasil / State management of primary health care in response to COVID-19 in Bahia, Brazil

Resumo Análise da gestão estadual da atenção primária à saúde (APS) em resposta à pandemia de COVID-19 na Bahia. Estudo de caso de natureza qualitativa mediante entrevistas com gestores e documentos normativos analisados segundo as categorias de projeto e capacidade de governo. Proposições estaduais de APS foram debatidas na Comissão Intergestores Bipartite e no Comitê Operacional de Emergência em Saúde Pública. O conteúdo propositivo do projeto da APS concentrou-se na definição de ações específicas de gestão da crise sanitária junto aos municípios. O apoio institucional do estado aos municípios modulou as relações interfederativas e foi determinante na elaboração dos planos municipais de contingência, da capacitação das equipes, produção e difusão de normas técnicas. A capacidade do governo estadual foi condicionada pelo grau de autonomia municipal e disponibilidade de referências técnicas estaduais nas regiões. O estado fortaleceu parcerias institucionais para interlocução com gestores municipais, mas não foram identificados mecanismos de articulação com o nível federal e o controle social. Este estudo contribui para a análise do papel dos estados na formulação e implementação de ações de APS mediadas por relações interfederativas em contextos de emergência em saúde pública.

Abstract This is an analysis of state management of Primary Health Care in response to the COVID-19 pandemic in Bahia. It is a qualitative case study with interviews with managers and regulatory documents analyzed according to the categories of government project and government capacity. State PHC proposals were debated in the Bipartite Intermanagerial Commission and in the Public Health Operational Emergency Committee. The scope of the PHC project focused on the definition of specific actions to manage the health crisis with the municipalities. The institutional support of the state to the municipalities modulated inter-federative relations and was decisive in the elaboration of municipal contingency plans, training of teams and production and dissemination of technical standards. The capacity of the state government was dependent upon the degree of municipal autonomy and the availability of state technical references in the regions. The state strengthened institutional partnerships for dialogue with municipal managers, but mechanisms for articulation with the federal level and social control were not identified. This study contributes to the analysis of the role of states in the formulation and implementation of PHC actions mediated by inter-federative relationships in emergency public health contexts.

Vaccine hesitancy and respect for public health measures: Citizens' trust in politicians and public servants across national, subnational and municipal levels of government.

Research shows that citizens' trust in government is associated with lower vaccine hesitancy and an increased willingness to follow public health measures. Thus far, however, the population health literature has largely conceptualized "government" as a unitary actor. This article furthers our understanding of this relationship by examining two important features of modern governance that have largely gone unexamined: (1) that governing involves popularly elected politicians and appointed bureaucrats; and (2), that governing often comprises many levels of government within the same country. Analyzing survey data from Canada with various multivariate regression models, this article finds that the relationship political trust has with vaccine hesitancy and intention to follow for public health measures is more complex than presently recognized. Specifically, a larger change in citizens' public health behaviors is associated with trust in public health officials than with trust in government, and of particular importance is trust in national public health authorities, despite the fact that public health measures in Canada are largely the jurisdiction of subnational governments. The implications of these findings for population health research and policymakers are discussed.

Institutional quality and COVID-19 vaccination: does decentralization matter?

Vaccination campaigns are one of the factors that can help mitigate the adverse effects of viral pandemics. The aim of this paper is to understand the institutional factors that are associated with a higher success rate, measured by the percentage of vaccinated population against COVID-19 across countries. Along with supply side determinants, institutional factors, related, at the national level, to the organization of the healthcare sector, governance and organization of the State and social capital, and, at the subnational level related to the authority and autonomy of lower tiers of government, are important correlates of successful vaccination campaigns, suggesting potential areas of public policy interventions.

Desigualdades territoriais no financiamento das políticas de educação e de saúde na Espanha e no Brasil / Desigualdades territoriales en la financiación de las políticas de educación y sanidad en España y Brasil / Territorial inequalities in the funding of education and health policies in Spain and Brazil

Resumo O presente artigo compara os modelos e as desigualdades territoriais no financiamento de duas políticas sociais pilares do estado de bem-estar social e com alto grau de descentralização territorial na Espanha e no Brasil: educação e saúde. A análise utiliza bibliografia especializada, legislação nacional e documentos governamentais para descrever as políticas e seus mecanismos de financiamento. Dados fiscais são usados para apresentar os gastos e analisar as desigualdades dos governos subnacionais no financiamento da educação e da saúde nos dois países. A conclusão é que a experiência espanhola apresenta elevado nivelamento de gastos em saúde e educação nas comunidades autônomas do regime comum, com patamares menores de desigualdade que o observado nos estados e municípios brasileiros. O resultado espanhol é decorrente de um processo incremental de aperfeiçoamento do federalismo fiscal, que culminou em um modelo marcado pela priorização e solidariedade territorial no financiamento das políticas sociais. Esse modelo é uma referência para a análise e discussão do caso brasileiro, que configurou seu federalismo fiscal com pouca preocupação em conciliar eficiência e equidade na distribuição dos recursos entre os entes governamentais, mas apresentou avanços importantes em reformas no financiamento da educação e da saúde.

Resumen El artículo compara los modelos y las desigualdades territoriales en la financiación de dos políticas sociales que son pilares del estado de bienestar y con un alto grado de descentralización territorial en España y Brasil: la educación y la sanidad. El análisis utiliza literatura especializada, legislación nacional y documentos gubernamentales para describir las políticas y sus mecanismos de financiación. Los datos fiscales se utilizan para analizar las desigualdades de los gobiernos subnacionales en la financiación de la educación y la sanidad en ambos países. La conclusión es que la experiencia española muestra una alta nivelación del gasto en salud y educación en las comunidades autónomas de régimen común, con niveles de desigualdad inferiores a los observados en los estados y municipios brasileños. El resultado español es fruto de un proceso de mejora y perfeccionamiento del federalismo fiscal que culminó en un modelo marcado por la priorización y la solidaridad territorial en la financiación de las políticas sociales. Este modelo es una referencia para el análisis y la discusión del caso brasileño, que ha configurado su federalismo fiscal con poca preocupación por conciliar la eficiencia y la equidad en la distribución de los recursos entre las entidades gubernamentales, pero que ha presentado importantes avances en las reformas de la financiación de la educación y la sanidad.

Abstract The article compares the patterns and territorial inequalities in the funding of two social policies that are pillars of the welfare state and present a high degree of territorial decentralization in Spain and Brazil: education and health. The analysis uses specialist literature, national legislation and government documents to describe the policies and their financing mechanisms. Fiscal data are used to analyze subnational government inequalities in the funding of education and health in both countries. The conclusion is that the Spanish experience has significantly leveled spending on health and education between the autonomous communities of common regime, with lower levels of inequality than those observed in Brazilian states and municipalities. The Spanish result derives from an incremental process of improvement of the country's fiscal federalism, which culminated in a model marked by prioritization and territorial solidarity in the funding of social policies. This model is reference for the analysis and discussion of the Brazilian case, which has configured its fiscal federalism with little concern for reconciling efficiency and equity in the distribution of resources between subnational governments, but which has presented important advances in the reforms of education and health funding.

Impacts of language barriers on healthcare access and quality among Afaan Oromoo-speaking patients in Addis Ababa, Ethiopia.

BACKGROUND: Ethiopia is a multilingual and multinational federation with Addis Ababa serving as both the capital city of Oromia regional state and the seat of the Ethiopian federal government. Nevertheless, only Amharic is considered as the working language of the city and federal offices, including hospitals. As a result, Afaan Oromoo-speaking patients may be facing language barriers in the healthcare settings in Addis Ababa. Language barriers have the capacity to affect patients' experience of care and treatment outcomes. This study, hence, examined the impacts of language barriers on the healthcare access and quality for the Afaan Oromoo-speaking patients in public hospitals in Addis Ababa. METHODS: In-depth interviews with patients (N = 27) and key informant interviews with healthcare providers (N = 9) were conducted in six public hospitals found in Addis Ababa. All the interviews were audio-taped and transcribed verbatim. A thematic analysis technique was employed to address the study objectives. RESULTS: The study participants indicated the widely existing problem of language discordance between patients and healthcare providers. The impacts of language barriers on the patients include preventable medical errors, low treatment adherence, low health-seeking behavior, additional treatment cost, increased length of hospital stays, weak therapeutic relation, social desirability bias, less confidence, and dissatisfaction with the healthcare. For the healthcare providers, language barriers are affecting their ability to take patient history, perform diagnoses and provide treatment, and have also increased their work burden. The use of ad hoc interpreters sourced from bilingual/multilingual patients, patient attendants, volunteer healthcare providers, and other casual people has been reported to deal with the problem of language barriers. CONCLUSION: A significant number of Afaan Oromoo-speaking patients are facing language barriers in accessing quality healthcare in public hospitals in Addis Ababa, and this constitutes structural violence. As a way out, making Afaan Oromoo an additional working language of the public hospitals in Addis Ababa, the assignment of professional interpreters, and a hiring system that promotes the recruitment of qualified multi-lingual healthcare providers are suggested.

Enhancing Federal Revenue under the American Rescue Plan Act: An Opportunity to Bolster State Medicaid Home and Community-Based Services Programs.

The American Rescue Plan Act (ARPA) includes a one-year 10 percentage point increase in the Federal Medical Assistance Percentage for Medicaid-funded home and community-based services (HCBS). The goal is to strengthen state efforts to help older adults and people with disabilities live safely in their homes and communities rather than in institutional settings during the COVID-19 pandemic. This essay provides a detailed description and analysis of this provision, including issues state governments need to consider when expending the additional federal revenue provided. It also draws lessons from the Affordable Care Act's Balancing Incentive Program to suggest insights for the potential of ARPA to promote further growth in Medicaid HCBS programs. It argues that key to success will be consultation with community stakeholders under the auspices of clear and frequent federal guidance and the development of concrete plans with which to expend the additional revenues in the most effective way possible in the limited time frame provided. The essay concludes by highlighting the importance of instituting strategies and processes for maximizing enhanced federal matching funds under ARPA in preparation for subsequent availability of substantial additional federal resources targeting Medicaid HCBS under other proposed initiatives.

Federalism and pandemic policies: variety as the spice of life.

In the ordinary course of life, choices vary with age and other factors because one's opportunities vary with one's circumstances. Thus, investments in and expenditures on healthcare (and most other things) vary with age and a variety of other factors, including whether one lives in a rural area, suburb, or central city, health risks, risk aversion, and beliefs about the nature of a good life. Because assessment of the effects of illnesses vary with the same factors, the conclusions reached about best private and governmental health policies also tend to vary. This implies that conformity to "ideal" pandemic policies is more likely to be generated by a federal or polycentric system of policy making than a unitary system, especially ones that are constrained by a generality principle.

Transferências fundo a fundo: coordenação e cooperação federativa na segurança pública do Brasil / Transferencias fondo a fondo: coordinación y cooperación federativa en seguridad pública en Brasil / Fund-to-fund transfers: federative coordination and cooperation in public security in Brazil

Resumo O objetivo deste artigo é analisar a realização de transferências fundo a fundo e avaliar se ela tem contribuído para a coordenação e cooperação federativa de políticas voltadas à segurança pública no Brasil. Para tanto, o trabalho foi dividido em três etapas: (i) levantamento dos valores do Fundo Nacional de Segurança Pública (FNSP), destinados aos estados e ao Distrito Federal, no período de 2000 a 2022, antes e depois da adoção das transferências fundo a fundo; (ii) realização de entrevistas semiestruturadas para levantar as percepções dos gestores responsáveis pela elaboração e coordenação do processo de descentralização e pelo acompanhamento da execução dos recursos descentralizados; e (iii) análise dos mecanismos de coordenação/cooperação previstos nos planos de aplicação elaborados pelos estados no período supracitado. Os achados da pesquisa confirmam resultados de estudos anteriores sobre o poder de indução das transferências fundo a fundo na cooperação e coordenação de políticas nacionais, também para a área de segurança pública. Verificou-se que a ampliação de recursos e a obrigatoriedade de seu compartilhamento com os estados favoreceram o alinhamento das políticas estaduais às diretrizes estabelecidas pela União, mas que ainda é incipiente a interação entre os órgãos, organizações e membros da sociedade em relação ao tema.

Resumen El objetivo de este artículo es analizar si las transferencias de fondo a fondo han contribuido a la coordinación y cooperación federal de las políticas dirigidas a la seguridad pública en Brasil. Para ello, el trabajo se dividió en tres etapas: (i) Relevamiento de los montos del Fondo Nacional de Seguridad Pública asignados a los estados y al Distrito Federal en el período 2000-2022, antes y después de la adopción de las transferencias fondo a fondo; (ii) Realización de entrevistas semiestructuradas para conocer la percepción de los gerentes responsables de preparar y coordinar el proceso de descentralización y monitorear la ejecución de los recursos descentralizados; y (iii) Análisis de los mecanismos de coordinación/cooperación previstos en los planes de aplicación elaborados por los estados en el período. Los hallazgos de la investigación confirman los resultados de estudios previos sobre el poder de inducción de las transferencias fondo a fondo en la cooperación y coordinación de políticas nacionales también para el área de seguridad pública. Se verificó que la ampliación de los recursos y la obligatoriedad de compartirlos con los estados favorecieron el alineamiento de las políticas estatales con las directrices establecidas por el Gobierno federal, pero que la interacción entre organismos, organizaciones y miembros de la sociedad sobre el tema es aún incipiente.

Abstract This article aims to analyze whether fund-to-fund transfers have contributed to federal coordination and cooperation of policies aimed at public security in Brazil. To this end, the work was divided into three stages: (i) Survey of National Public Security Fund amounts allocated to the states and the Federal District in the period from 2000 to 2022, before and after the adoption of fund-to-fund transfers; (ii) Conducting semi-structured interviews to raise the perceptions of managers responsible for preparing and coordinating the decentralization process and monitoring the execution of decentralized resources; and (iii) Analysis of the Coordination/Cooperation mechanisms foreseen in the Application Plans prepared by the states in the period. The research findings confirm the results of previous studies on the induction power of fund-to-fund transfers in the cooperation and coordination of national policies for public security. It was verified that the expansion of resources and the obligatoriness of their sharing with the states favored the alignment of state policies with the guidelines established by the Union but that the interaction between bodies, organizations, and members of society on the subject is still incipient.