Advances and difficulties of the National Accident and Violence Reduction Policy: the implementers' point of view

A qualitative study analyzes advances and challenges in implementing the National Policy for Reducing Morbidity and Mortality from Accidents and Violence from the perspective of 63 implementers from the Brazilian regions. Aspects of institutionalizing complex public policies that require inter-organizational coordination are discussed. The results show that Primary Care is the level that most developed the Policy guidelines, and the Rehabilitation sector is the least engaged. From national coordination, the following stand out: training processes, formalization of commitments at all levels, decision, and negotiation mechanisms, permanent consultancy, creation of prevention centers, strengthening information systems, and financial subsidies. Of the local coordinations, the following stand out: actors from the prevention and health surveillance centers; leadership capacity to promote training and integration with other areas to carry out local diagnoses and choose priorities; networking; creating mechanisms for routinizing procedures. Obstacles to the implementation of PNRMAV are also addressed, which today can be seen as a glass half full and half empty. However, the country has sufficient capacity for it to be institutionalized.