Role of policy makers in the implementation of successful physical activity in the Brazilian public health system

Abstract

Introduction: Understanding the role of local policymakers is an important pathway for analyzing physical activity as a public policy. Objective: To analyze the role of health managers in implementing successful physical activity interventions linked to the Brazilian Unified Health System (Sistema Único de Saúde - SUS). Method: Ten health secretaries, or representatives designated by them, from municipalities with interventions deemed successful across all regions of the country were interviewed. The interviews were guided by the question: how does local health management operate in the implementation of physical activity interventions within the SUS? The interview guide was based on the stages of the public policy cycle, and responses were analyzed qualitatively through deductive content analysis. Results: Managers’ responses were superficial in the phases of problem identification, agenda setting, alternative formulation, and decision-making. However, in the implementation phase, managers reported supporting physical activity initiatives through partnerships, funding, professional incentives, and personal engagement. For evaluation, participant and professional reports were used to assess the success of the interventions. Conclusion: Key aspects of planning public policies for physical activity were not addressed in depth by managers. Nevertheless, the efforts of managers, health professionals, and other stakeholders have created a successful track record in promoting physical activities within the SUS, despite the absence of overarching, structured public policies from the federal government.