STRATEGIC PLANNING IN HEALTH IN BRAZIL

rise and decline

Abstract

This study adopts a reflective approach, revisiting the conceptual foundations and historical milestones of health planning in Brazil, with particular attention to its emergence, prominence, and subsequent decline. Health planning in Latin America initially drew upon economic rationality, taking inspiration from the CENDES/PAHO methodology to enhance system performance and efficiency. In Brazil, during the 1960s, normative planning—characterized by centralized programming—was employed to address priority health issues. In response to the political authoritarianism of the military dictatorship and a deepening economic crisis, Strategic Planning (SP) emerged as a critical alternative to normative approaches. It aimed to foster democratic and participatory institutional planning processes. Notably, Mario Testa conceptualized SP as a transformative tool, integral to the historical construction of a more equitable society. Carlos Matus contributed to this framework by emphasizing situational analysis as a key mechanism for enhancing governability and strengthening governmental responsiveness and capacity. Institutional analysis further enriched the planning landscape by advocating for innovative institutional arrangements that expanded dialogue and fostered shared responsibility among stakeholders in efforts to democratize organizational structures. Between the 1980s and early 2000s, SP methodologies were widely integrated into undergraduate and postgraduate education, as well as professional training programs. These approaches played a significant role in the implementation of Brazil’s Unified Health System (SUS), contributing to the development of more participatory and democratic governance in health. Over time, however, SP tools and methodologies were increasingly supplanted by managerialist practices focused on performance metrics, leading to a gradual disengagement from contextual and policy-based analysis. This shift marks the decline of Strategic Planning in Brazil, a trend observable in the academic sphere through a notable decrease in related publications, research, and teaching activities.