Health pact: approaches and collisions in the federal arena

This article analyze the institutional construction process of the Health Pact, consolidated in 2006 and that expresses an incremental evolution of the regulatory framework of federative relationships in Brazilian National Health System. Even considering that such process has developed in a federative parity arena ( CIT) it is assumed the general hypothesis of Brazilian literature about federalism that suggests the Federal Government dominant role in the formulation of social policies. Using an institutionalist approach, focusing on the relationship between Federalism and Public Policy it was done a qualitative study starting from semi-structured interviews with managers and consultants who participated in the process and analyzing the minutes of meetings from CIT between 2004-2012. The results indicate: the federal government held the formulation initiative, but there was reasonable influence of sub national governments; the long discussions period reflected a high degree of dissent between the federated entities; as a result, the question of financing was transferred to a political commitment for expansion of funding sources to be assumed by the three spheres of government; the Health Pact did not change the dynamics federative relations regarding the frame of regional health care networks.