Abstract
Background
In Brazil, loan agreements and the Incentive Policy were fundamental to decentralize the management of the AIDS policy; however, few studies have evaluated their effects within the scope of the National Health System (NHS).
Objective
To analyze the implementation of programmatic actions related to STD/AIDS in the country and in the state of São Paulo regarding the advances and gaps of the loan agreements with the World Bank and the implementation of the NHS Incentive Policy currently in force.
Method
A retrospective descriptive case study based on documentary analysis and in-depth interviews with six coordinators from three governmental levels and two presidents of the State Forum for NGO/AIDS in São Paulo.
Results
Different degrees and forms of operationalization of the AIDS policy were identified; they are marked by periods of centralization of decisions and funding in the “AIDS Project I”, followed by administrative decentralization at the end of the “AIDS Project II” and, finally, decentralization brought about by the Incentive Policy, which transfers responsibilities and resources in line with NHS’ principles.
Conclusion
Despite the progress of decentralized management, weaknesses along the process of monitoring and evaluation of actions may compromise the technical and financial sustainability of the NHS Incentive Policy.
Keywords:
history; World Bank; decentralization; program development; acquired immunodeficiency syndrome