Discussions on sustainable development were included on the agenda of the United Nations (UN) in 1972, at the United Nations Conference on the Human Environment held in Stockholm, Sweden.¹1. Lavall TP, Olsson G. Governança global e o desenvolvimento na sua pluridimensionalidade: um olhar sobre a Agenda 2030 das Nações Unidas. Direito e Desenvolv [Internet]. 2019; 10(1): 51-64. Disponível em: https://periodicos.unipe.br/index.php/direitoedesenvolvimento/article/view/990 doi: 10.26843/direitoedesenvolvimento.v10i1.990
https://periodicos.unipe.br/index.php/di... Since then, several initiatives related to the theme, from the perspective of the construction of global agreements and agendas, marked the course of the debate between nations. Among these, Rio+20 and the Millennium Development Goals (MDGs) Agenda, which was launched in 2000 and ended in 2015, stand out.²2. Buss PM, Ferreira JR, Hoirisch C, Matida ÁH. Desenvolvimento sustentável e governança global em saúde - Da Rio+20 aos Objetivos de Desenvolvimento Sustentável (ODS) pós-2015. RECIIS - R Eletr Com Inf Inov Saúde [Internet]. 2012; 6(3). Disponível em: https://www.reciis.icict.fiocruz.br/index.php/reciis/article/view/759/1401 doi: ciis.v6i3.759
https://www.reciis.icict.fiocruz.br/inde...

Also in 2015, a new global agenda was initiated, this time called the 2030 Agenda for Sustainable Development, adopted by 193 UN Member States. It is a global action plan, which covers the environmental, economic and social dimensions of sustainable development, in a comprehensive and interconnected manner.³3. Brasil. Instituto Brasileiro de Geografia e Estatística (IBGE). Objetivos de Desenvolvimento Sustentável [Internet]. 2018. Disponível em: https://ods.ibge.gov.br/
https://ods.ibge.gov.br...

4. Malta DC. Crianças e Adolescentes, políticas de austeridade e os compromissos da Agenda 2030. Cien Saude Colet [Internet]. 2019 Feb [acesso em 27 jul 2020]; 24(2): 348-348. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232019000200348&tlng=pt
http://www.scielo.br/scielo.php?script=s...

5. Fundo Internacional de Emergência para a Infância das Nações Unidas (Unicef). Objetivos de Desenvolvimento Sustentável. Ainda é possível mudar 2030 [Internet]. [acesso em 27 jul 2020]. Disponível em: https://www.unicef.org/brazil/objetivos-de-desenvolvimento-sustentavel
https://www.unicef.org/brazil/objetivos-... ^-66. Grupo de Trabalho da Sociedade Civil para a Agenda 2030. III Relatório Luz da Sociedade Civil sobre a implementação nacional da Agenda 2030 [Internet]. Disponível em: https://brasilnaagenda2030.files.wordpress.com/2019/09/relatorio_luz_portugues_19_final_v2_download.pdf
https://brasilnaagenda2030.files.wordpre... This Agenda, includes the Sustainable Development Goals (SDGs), composed of 17 goals (Figure 1) and 169 global action targets to be achieved by 2030. Guided by the global targets, the expectation is that, in addition to reaching the agreed goals, countries define their national goals and incorporate them into their policies, programs and government plans.³3. Brasil. Instituto Brasileiro de Geografia e Estatística (IBGE). Objetivos de Desenvolvimento Sustentável [Internet]. 2018. Disponível em: https://ods.ibge.gov.br/
https://ods.ibge.gov.br...

In this context, this paper presents some reflections on the potential of the data sources available for monitoring the goals of the SDGs in Brazil, especially the indicators used by the Health Surveillance Secretariat of the Ministry of Health (SVS/MS).

Sustainable Development Goals in the Ministry of Health

Brazil, as a Member State of the UN, adhered to the SDGs from the moment it came into effect. In 2016, the National Commission for the SDGs (CNODS)⁷7. Brasil. Presidência da República. Decreto No 8.892, de 27 de outubro de 2016. Cria a Comissão Nacional para os Objetivos de Desenvolvimento Sustentável. [Internet]. 2016. Disponível em: http://www.planalto.gov.br/ccivil_03/_ato2015-2018/2016/decreto/d8892.htm
http://www.planalto.gov.br/ccivil_03/_at... was created with the aim of integrating, disseminating and providing transparency to the process of implementation of the UN 2030 Agenda for Sustainable Development.⁷7. Brasil. Presidência da República. Decreto No 8.892, de 27 de outubro de 2016. Cria a Comissão Nacional para os Objetivos de Desenvolvimento Sustentável. [Internet]. 2016. Disponível em: http://www.planalto.gov.br/ccivil_03/_ato2015-2018/2016/decreto/d8892.htm
http://www.planalto.gov.br/ccivil_03/_at... ^,88. Brasil. Secretaria de Governo da Presidência da República. Relatório Nacional Voluntário sobre os Objetivos de Desenvolvimento Sustentável: Brasil 2017 [Internet]. 2017. Disponível em: http://www4.planalto.gov.br/ods/publicacoes/relatoriovoluntario_brasil2017port.pdf/view
http://www4.planalto.gov.br/ods/publicac... Since the revocation of that Commission in 2019,⁹9. Brasil. Presidência da República. Decreto No 10.179, de 18 de dezembro e 2019. Declara a revogação, para os fins do disposto no art. 16 da Lei Complementar no 95, de 26 de fevereiro de 1998, de decretos normativos. [Internet]. 2019. Disponível em: http://www.planalto.gov.br/ccivil_03/_Ato2019-2022/2019/Decreto/D10179.htm#art1
http://www.planalto.gov.br/ccivil_03/_At... the implementation of the 2030 Agenda has been under the coordination of the Special Secretariat for Social Articulation of the Government Secretariat of the Presidency of the Republic. In the Ministry of Health, the Department of Monitoring and Evaluation of the Brazilian National Health System (DEMAS), an instance of the Ministry of Health Executive Secretariat, coordinates and articulates the monitoring and evaluation of the 2030 Agenda, and is the focal point of articulation with external institutions, with the execution of actions distributed among the departments that have goals to be monitored, due to their scope of action.

In the context of the SDGs, in addition to the political component, it is necessary to articulate initiatives in terms of monitoring and shared governance, which encourage the active participation of the entities of the federation, the civil society and the private sector in monitoring the goals, including technical support, and the implementation of local, regional and national initiatives.

In this sense, a structure was created in the Ministry of Health to organize the process of monitoring the SDGs. In 2020, a working group (WG) was created at the SVS, called GT ODS SVS, composed of representatives from all departments of the Secretariat, to work specifically on the indicators under its direct responsibility (SDG 3 - Health and Well-being), as well as those related to the themes of that secretariat (SDGs 5, 6, 8, and 16). This WG contributed so that the SDGs monitoring activities, already in place in the Ministry of Health, could be better organized and qualified. Since its implementation, the WG develops permanent activities in the following areas:

Faced with the need to expand the monitoring of the SDGs, in order to encompass goals and indicators related to the SDGs throughout the Ministry of Health, in 2021, through the Advisory Committee for Monitoring and Evaluation of the Brazilian National Health System (SUS), coordinated by DEMAS, the WG for the 2030 Agenda in the Ministry of Health (GT ODS MS) was created, composed of the its secretariats - the Specialized Health Care Secretariat, Primary Health Care Secretariat, the Secretariat of Science, Technology, Innovation and Strategic Health Inputs, the Special Secretariat of Indigenous Health, the Work and Education Management in Health Secretariat, and the Health Surveillance Secretariat -, the National Health Surveillance Agency, the National Health Foundation, and the National Cancer Institute.

Monitoring the Sustainable Development Goals and the data sources from the Ministry of Health

The availability of quality, accessible, updated, reliable and disaggregated data, based on official national sources, is essential condition for the periodic production of indicators.³3. Brasil. Instituto Brasileiro de Geografia e Estatística (IBGE). Objetivos de Desenvolvimento Sustentável [Internet]. 2018. Disponível em: https://ods.ibge.gov.br/
https://ods.ibge.gov.br...

In the Brazilian context, the following are pointed out as important data sources for monitoring the SDGs, in particular SDG 3: the Mortality Information System (SIM), the Live Birth Information System (SINASC), the Information System for Notifiable Diseases (SINAN), and the national health epidemiological surveys, such as the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL), the National School-based Health Survey (PeNSE) and the National Health Survey (PNS).

The SIM is the official death registration system in Brazil¹⁰10. Brasil. Ministério da Saúde. Portaria no 116, de 11 de fevereiro de 2009. Regulamenta a coleta de dados, fluxo e periodicidade de envio das informações sobre óbitos e nascidos vivos para os Sistemas de Informações em Saúde sob gestão da Secretaria de Vigilância em Saúde. 2009. and, since its creation in 1975, it has progressively improved data quality in terms of coverage, regularity and proportion of ill-defined causes.¹¹11. Oliveira CM de, Ciríaco DL, Silva CF da, Barros HCS, Cunha CC da, França EB, et al. The impact of the investigation on deaths classified as garbage codes on the quality of the cause-of-death information in the Northeast region, Brazil. Rev Bras Epidemiol [Internet]. 2019 [acesso em 7 jul 2020]; 22(suppl 3). Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-790X2019000400405&tlng=pt
http://www.scielo.br/scielo.php?script=s... ^,1212. Malta DC, Minayo MCS, Soares Filho AM, Silva MMA, Montenegro MMS, Ladeira RM, et al. Mortality and years of life lost by interpersonal violence and self-harm: in Brazil and Brazilian states: analysis of the estimates of the Global Burden of Disease Study, 1990 and 2015. Rev Bras Epidemiol [Internet]. 2017 May [acesso em 25 jun 2020]; 20(suppl 1): 142-56. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-790X2017000500142&tlng=pt
http://www.scielo.br/scielo.php?script=s... In 2019, a 96.2%, coverage was achieved, ranging from 89.2% to 100% among the Units of the Federation.¹³13. Brasil. Ministério da Saúde. Indicadores de cobertura que utilizam a metodologia do Busca Ativa [Internet]. 2021. Disponível em: http://svs.aids.gov.br/dantps/acesso-a-informacao/acoes-e-programas/busca-ativa/indicadores-de-saude/cobertura/
http://svs.aids.gov.br/dantps/acesso-a-i... The SINASC was created in 1990 and, in 2019, its coverage was 97.8%, ranging from 91.4% to 100% depending on the Unit of the Federation.¹³13. Brasil. Ministério da Saúde. Indicadores de cobertura que utilizam a metodologia do Busca Ativa [Internet]. 2021. Disponível em: http://svs.aids.gov.br/dantps/acesso-a-informacao/acoes-e-programas/busca-ativa/indicadores-de-saude/cobertura/
http://svs.aids.gov.br/dantps/acesso-a-i... The high coverage presented by SIM and SINASC turn these systems into robust sources of data for the calculation of indicators. SINAN, which is fed through the notification and investigation of cases of diseases and conditions from the national list of notifiable diseases,¹⁴14. Brasil. Ministério da Saúde. Sistema de Informação de Agravos de Notificação [Internet]. 2020 [acesso em 16 jul 2020]. Disponível em: http://portalsinan.saude.gov.br/o-sinan
http://portalsinan.saude.gov.br/o-sinan... ^,1515. Pinto LF, Freitas MPS de, Figueiredo AWS de. Sistemas Nacionais de Informação e levantamentos populacionais: algumas contribuições do Ministério da Saúde e do IBGE para a análise das capitais brasileiras nos últimos 30 anos. Cien Saude Colet [Internet]. 2018 Jun 1 [acesso em 16 jul 2020]; 23(6): 1859-70. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232018000601859&lng=pt&tlng=pt
http://www.scielo.br/scielo.php?script=s... assists in the health sector planning and definition of intervention priorities, also enabling evaluations of the impact of such interventions, ¹⁴14. Brasil. Ministério da Saúde. Sistema de Informação de Agravos de Notificação [Internet]. 2020 [acesso em 16 jul 2020]. Disponível em: http://portalsinan.saude.gov.br/o-sinan
http://portalsinan.saude.gov.br/o-sinan... thus demonstrating its important role in the production of indicators.

As they are official data recording systems and due to their scope, SIM, SINASC and SINAN make up the basis for calculating at least 15 of the indicators referring to SDG 3, consisting of 13 targets and 28 indicators, in addition to their use for the indicator 16.1.1, pertaining to SDG 16 (Box 1).

In terms of national surveys as sources of data for the SDG indicators, it is important to highlight that in the 2019 edition of the PNS there was an important change in relation to the previous version, conducted in 2013. In this latest edition, the minimum age of the selected resident to answer the survey questions was reduced from 18 to 15. This change occurred due to the monitoring of internationally agreed indicators, especially those related to the SDGs. To demonstrate the importance of such compliance, the SDG 3.a.1 indicator assesses the prevalence of smokers in the population aged 15 years and over.¹⁶16. Instituto Brasileiro de Geografia e Estatística(IBGE). Panorama IBGE, Brasil/ Minas Gerais [Internet]. 2018 [acesso em 31 may 2018]. Disponível em: https://cidades.ibge.gov.br/brasil/mg/panorama
https://cidades.ibge.gov.br/brasil/mg/pa... ^,1717. WHO. SDG Indicators - Metadata repository. 2021. Disponível em: https://unstats.un.org/sdgs/metadata/
https://unstats.un.org/sdgs/metadata... Thus, with the instituted change, the PNS became the data source for the calculation of this indicator. In addition to this, indicators 3.3.5 and 3.5.2 are also calculated using data from national surveys (Box 1).

Broad dissemination of the produced results is part of this monitoring process. In Brazil, this disclosure is made through the Sustainable Development Goals Digital Platform (ODS Platform),³3. Brasil. Instituto Brasileiro de Geografia e Estatística (IBGE). Objetivos de Desenvolvimento Sustentável [Internet]. 2018. Disponível em: https://ods.ibge.gov.br/
https://ods.ibge.gov.br... developed and managed by the Brazilian Institute of Geography and Statistics (IBGE). IBGE, Brazil's representative at the Inter-agency and Expert Group on SDG Indicators,¹⁸18. WHO. Inter-agency and Expert Group on SDG Indicators - IAEG-SDGs [Internet]. 2021. Disponível em: https://unstats.un.org/sdgs/iaeg-sdgs/
https://unstats.un.org/sdgs/iaeg-sdgs... is a contributor to this process, especially in terms of monitoring and qualifying indicators. Through integrated meetings, the internal debate within the Ministry of Health and with IBGE is strengthened in the process of designing national indicators based on the UN metadata sheets,¹⁷17. WHO. SDG Indicators - Metadata repository. 2021. Disponível em: https://unstats.un.org/sdgs/metadata/
https://unstats.un.org/sdgs/metadata... which also supports IBGE's dialogue with the organization. The product of this articulation can be viewed on the ODS Platform,³3. Brasil. Instituto Brasileiro de Geografia e Estatística (IBGE). Objetivos de Desenvolvimento Sustentável [Internet]. 2018. Disponível em: https://ods.ibge.gov.br/
https://ods.ibge.gov.br... which presents the indicators to Brazil and the world, with the respective methodological sheets and historical data series, in addition to several possibilities for extracting and disaggregating information.

However, in order to monitor and achieve the goals of the SDGs, it is necessary to have intersectoral initiatives for the construction and management of networks that involve the entire Brazilian society and contribute to the formulation of policies, programs and plans. With the end of the period of validity of the 2011-2022 Strategic Action Plan to Tackle Non-Communicable Diseases in Brazil,¹⁹19. Malta DC, Morais Neto OL de, Silva Junior JB da. Apresentação do plano de ações estratégicas para o enfrentamento das doenças crônicas não transmissíveis no Brasil, 2011 a 2022. Epidemiol e Serviços Saude [Internet]. 2011 Dec [acesso em 16 abr 2021]; 20(4): 425-38. Disponível em: http://scielo.iec.pa.gov.br/scielo.php?script=sci_arttext&pid=S1679-49742011000400002&lng=en&nrm=iso&tlng=en
http://scielo.iec.pa.gov.br/scielo.php?s... and in response to the global agreement to reach the goals of the SDGs, the Ministry of Health developed the 2021-2030 Strategic Action Plan to Tackle Non-Communicable Diseases in Brazil, based on the contributions from its secretariats, the Federal District, states and municipalities, the private sector and the civil society. This plan, besides being updated for the goals of tackling Non-Communicable Diseases (NCDs), was expanded to include violence and accidents, health promotion and actions related to the SDGs, in addition to aligning its validity with the period of the 2030 Agenda.²⁰20. Brasil. Ministério da Saúde. Plano de ações estratégicas para o enfrentamento das doenças crônicas e agravos não transmissíveis no Brasil, 2021-2030. 2021. Disponível em: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/publicacoes-svs/doencas-cronicas-nao-transmissiveis-dcnt/09-plano-de-dant-2022_2030.pdf/view
https://www.gov.br/saude/pt-br/centrais-...

Final considerations

The production of the SDG indicators is still a major challenge for the country, both in terms of quantity and diversity. Although Brazil has solid data sources, of good quality and with an adequate level of disaggregation, the 2030 Agenda requires combinations of information beyond this sector, which increases the difficulty of the process. The dispersion and lack of regularity in the production of some type of data can be cited as central issues to be observed for the production of such indicators and, consequently, the monitoring of the goals.

Lastly, it is opportune to develop the objectives and goals of the SDGs in line with the demands of the Brazilian National Health System (SUS). This way, possibilities are created for its reach and the strengthening of intersectorality, universalization and equity in health, requirements to contemplate the diversity and complexity of the themes of the 2030 Agenda in face of the social, political, economic, cultural and environmental health determinants.

References

Publication Dates