[Modeling of the Brazilian National Health Promotion Policy and its implementation sinuosities]

This study sought to analyze a theoretical-logical model of the implementation of the Brazilian National Policy of Health Promotion (PNPS, acronym in Portuguese) via an Evaluability Assessment (EA). Data were collected from 2022 to 2023. The scenario involved nine states, the Federal District, and 48 municipalities. In total, 291 documents and 276 key informants were searched. A Theoretical-Logical Model (TLM, an EA product) was elaborated and validated in five regional workshops with 112 participants. Due to its complexity, the PNPS requires a TLM with an imaging representation unlike that of conventional TLM (which have a unidirectional sequence). The chosen TLM evinced the principles, values, guidelines, components, activities, and resources in the implementation of the PNPS across Brazil. The discussion of the results has four sections: the problem and the confluences that structure the PNPS (problem and context); inspirations and directionalities in implementing the PNPS (principles, values, and guidelines), subsidies and movements that materialized the PNPS (physical, organizational, and symbolic resources), and the PNPS outcomes and strengths: between what is and what comes to be (activities, actions, results, monitoring, and evaluation). The results show the institutionalization of the PNPS by local policies and actions aimed at chronic noncommunicable diseases. Monitoring and Evaluation showed no specific indicators, evincing the need to invest in them within the PNPS. Despite no indicators, the impact of the interactions between the elements that make up the PNPS implementation design may meet the needs of the original problem. The PNPS includes articulation with other policies.