ABSTRACT

With the aim of analyzing the implementation, in Brazil, of some components of the National Policy on Science, Technology and Innovation in Health, in the period between 2004 and 2010, a case study was carried out within the scope of the Department of Science and Technology. In addition to the strategies, the following components were analyzed: the selection of priorities, the formulations of calls for proposals, the monitoring and the evaluation of the policy. It was implemented in relation to most of the strategies proposed, particularly, with regard to the induction, expansion and decentralization of the fostering. It is discussed the historical conditions of possibility besides the problems, obstacles and limits of the policy, as well as the actuality of this historical case, that can be considered as exemplary.

KEYWORDS
Evaluation; National Science, Technology and Innovation Policy; Public policy

Introduction

The complex social construction process that resulted in the formulation of the National Policy on Science, Technology and Innovation in Health (PNCTIS) was only started in 1994, with the holding of the I National Conference on Science and Technology in Health (CNCTS), whose resolutions, however, were not implemented. With the creation of the Department of Science and Technology (Decit), in 2000, and the Secretariat of Science, Technology and Innovation (SCTI), in 2003, it was possible to hold a II CNCTS, in which the National Agenda for Health Research Priorities (ANPPS) and PNCTIS guidelines were approved.

The policy, thus formulated, had as its general objective to induce and finance relevant health research, not only for attending to the 'health needs of the population', but also to produce new knowledge. To achieve these objectives, it contained principles, conducting axis, strategies and actions (BRASIL, 2008B ______. Ministério da Saúde. Secretaria Executiva. Política Nacional de Ciência, Tecnologia e Inovação em Saúde. Brasília, DF: MS, 2008b.). Among these objectives, the induction and decentralized promotion of research were prioritized (BRASIL, 2010A______. Ministério da Saúde. Departamento de Ciência e Tecnologia. Fomento às pesquisas em terapia celular e células-tronco no Brasil. Revista de Saúde Pública, São Paulo, v. 44. n. 4, p. 763-764. 2010a.).

Several essays and investigations have analyzed, since then, the PNCTIS, mainly in terms of its formulation and the main strategies for implementing the policy in its early years (ANDRADE; CARVALHO, 2014ANDRADE, P. A.; CARVALHO, D. B. B. D. Formulação da Política Nacional de Ciência, Tecnologia e Inovação em Saúde: retrospectiva do movimento dos grupos de interesse. Revista de Políticas Públicas, São Luís, v. 18, n. 2, p. 573-585, 2014.; GUIMARÃES , 2006GUIMARÃES, R. et al. Defining and implementing a National Policy for Science, Technology and Innovation in Health: lessons from the Brazilian experience. Cadernos de Saúde Pública. Rio de Janeiro, v. 22, n. 9, p. 1775-85, 2006.), in addition to analyzing the results of some national thematic calls for proposals, such as those in the biotechnology in health area (ALMEIDA-ANDRADE, 2015ALMEIDA-ANDRADE, P. Avaliação da Política Nacional de Ciência, Tecnologia e Inovação em Saúde: contribuições para a pesquisa & desenvolvimento em biotecnologia em saúde (2004-2014). 2015. 269 f. Tese (Doutorado em Política Social) - Universidade de Brasília, Brasília, DF, 2015.), the promotion of studies in the field of cell therapy and stem cells, in Brazil (BRASIL, 2010A______. Ministério da Saúde. Departamento de Ciência e Tecnologia. Fomento às pesquisas em terapia celular e células-tronco no Brasil. Revista de Saúde Pública, São Paulo, v. 44. n. 4, p. 763-764. 2010a.), and some degree of institutionalization of the evaluation of health technologies and its incorporation into the Unified Health System (SUS) (SILVA; PETRAMALE , 2012SILVA, H. P.; PETRAMALE, C. A.; ELIAS, F. T. S.Avanços e desafios da Política Nacional de Gestão de Tecnologias em Saúde. Revista de Saúde Pública. São Paulo, v. 46, n. supl., p. 83-90, 2012.). These works reveal positive impacts of the PNCTIS on stimulating and financing research, in strategic areas of the Country, particularly regarding the fact that all the sub-agendas that made up the ANPPS, approved in 2004, received some funding, in the period between 2003 and 2005 (SILVA, CAETANO, 2011SILVA, R. M.; CAETANO, R. Um exame dos fluxos financeiros do Ministério da Saúde em pesquisa e desenvolvimento (2003-2005), segundo a Agenda Nacional de Prioridades de Pesquisa em Saúde. Cadernos de Saúde Pública. Rio de Janeiro, v. 27, n. 4, p. 687-700, 2011.).

The overall evaluation of the PNCTIS, however, had not been made systematically until 2009. In december of that year, Decit asked the Oswaldo Cruz Foundation (Fiocruz) to carry out an external evaluation of its policy (NATAL; HARTZ; SANTOS, 2010NATAL, S.; HARTZ, Z.; SANTOS, S. M. C. Avaliação da Política de Ciência Tecnologia e Inovação em Saúde Implementada pelo Departamento de Ciência e Tecnologia do Ministério da Saúde, no período de 2003 a 2010. Rio de Janeiro: Fiocruz, 2010.), which would seek to answer the following questions: 'To what extent were the agenda priorities included in the calls for proposals and the projects selected therein?'; 'To what extent have the resources allocated been sufficient for the development of the proposed investigations?'; 'To what extent was the management of the development process adequate?'; 'To what extent do the results of the investigations answered to the problems proposed?' Regarding the first of these questions, Barata (2008)BARATA, R. B. Análise da implementação da Agenda de Prioridade de Pesquisa em Saúde - produto II. Brasília, DF: Ministério da Saúde - DECIT (47º Termo de Cooperação da OPAS e o Ministério da Saúde), 2008. observed that the selection of the majority of the projects financed (90%) was done by Public Calls for Proposals, in cooperation with the National Council for Scientific and Technological Development (CNPq), Funding Authority for Studies and Projects (Finep) or the State Foundations for Research Support (FAPs), covering all sub-agendas.

This paper presents the results of the subproject that analyzed the implementation of some components of PNCTIS between 2004 and 2010.

Methodology

An analysis of the implementation of the PNCTIS was carried out, in the period between 2004 and 2010, through a case study. The components selected for the evaluation were: a) The eight strategies contained in the policy document (BRASIL, 2008B ______. Ministério da Saúde. Secretaria Executiva. Política Nacional de Ciência, Tecnologia e Inovação em Saúde. Brasília, DF: MS, 2008b.); b) The actions related to the management of the promotion, namely: the selection of priorities, the formulation of calls for proposals, the monitoring and evaluation of the policy. The evaluation of the implantation was considered as the judgment about the adequate operationalization of the intervention, having as parameters the policy documents, as well as the goals framework drawn based on the theoretical references of the study.

Initially, an evaluation was undertaken of the degree of implementation of the eight strategies proposed in the base document, 'National Policy on Science, Technology and Innovation in Health' (BRASIL, 2008B ______. Ministério da Saúde. Secretaria Executiva. Política Nacional de Ciência, Tecnologia e Inovação em Saúde. Brasília, DF: MS, 2008b.). The 11 actions related to the strategy "Sustaining and strengthening of the national effort in science, technology and innovation in health" (BRASIL, 2008B ______. Ministério da Saúde. Secretaria Executiva. Política Nacional de Ciência, Tecnologia e Inovação em Saúde. Brasília, DF: MS, 2008b., P. 21) were, also, evaluated. For this purpose, a preliminary logical model was elaborated (figure 1), which corresponded to a macro model derived from the objectives, strategies and expected results (BRASIL, 2008B ______. Ministério da Saúde. Secretaria Executiva. Política Nacional de Ciência, Tecnologia e Inovação em Saúde. Brasília, DF: MS, 2008b.). It was considered as implemented, the component of the PNCTIS for which there was complete information on the execution of the action in documents. In other words, documentary information was considered sufficient as evidence of implantation. For those strategies or actions in which information was incomplete or insufficient, the assigned classification was 'partially' implemented. The information was considered insufficient when it could not be considered as conclusive evidence of implantation.

The data were obtained by analyzing the following documentary and bibliographic sources: management reports of the Decit, from 2004 to 2008 (BRASIL, 2005______. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Relatório de Gestão 2004: Departamento de Ciência e Tecnologia em Saúde. Brasília, DF: MS, 2005. (Série C Projetos, Programas e Relatórios). Disponível em: <http://bvsms.saude.gov.br/bvs/publicacoes/relatorio_gestao_decit_2004.pdf>. Acesso em: 5 set. 2017.
http://bvsms.saude.gov.br/bvs/publicacoe... , ^2007A______. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Relatório de Gestão 2005. Brasília, DF: MS, 2007a. (Série C. Projetos, Programas e Relatórios). Disponível em: <http://bvsms.saude.gov.br/bvs/publicacoes/relatorio_gestao_decit_2005.pdf>. Acesso em: 5 set. 2017.
http://bvsms.saude.gov.br/bvs/publicacoe... , ^2007B______. Ministério da Saúde, Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Relatório de Gestão 2006. Brasília, DF: MS 2007b. (Série C. Projetos, Programas e Relatórios). Disponível em: <http://bvsms.saude.gov.br/bvs/publicacoes/relatorio_gestao_decit_2006.pdf>. Acesso em: 5 set. 2017.
http://bvsms.saude.gov.br/bvs/publicacoe... , ^2008A______. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Relatórios de Gestão 2007. Brasília, DF: MS, 2008a. (Série C. Projetos, Programas e Relatórios). Disponível em: <http://bvsms.saude.gov.br/bvs/publicacoes/relatorio_gestao_decit_2007.pdf>. Acesso em: 5 set. 2017.
http://bvsms.saude.gov.br/bvs/publicacoe... , ²⁰⁰⁹______. Ministério da Saúde. Secretaria de Atenção à Saúde. Relatório de Gestão 2008. Brasília, DF: MS, 2009. Disponível em: <http://bvsms.saude.gov.br/bvs/publicacoes/relatorio_gestao_2008_cgsh.pdf>. Acesso em: 5 set. 2017.
http://bvsms.saude.gov.br/bvs/publicacoe... ); National Calls for Proposals; reports from the Science and Technology Conferences; ten-year evaluation report of the Decit (BRASIL, 2010B______. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Decit 10 anos. Brasília, DF, 2010b. (Série B. Textos Básicos de Saúde).); and the Lattes curricula of the members of the judging committees. Technical notes produced by the department were also consulted (BRASIL, 2006A______. Ministério da Saúde. Departamento de Ciência e Tecnologia. Avaliação de Tecnologias em Saúde: institucionalização das ações no Ministério da Saúde. Revista de Saúde Pública, Rio de Janeiro, v. 40, n. 4, p. 743-747, 2006a., ^2006B______. Ministério da Saúde. Departamento de Ciência e Tecnologia. Da política à ação institucional: prioridades de pesquisa no Ministério da Saúde. Revista de Saúde Pública. Rio de Janeiro, v. 40, n. 3, p. 548-552. 2006b., ^2010C______. Ministério da Saúde. Departamento de Ciência e Tecnologia. Rede Nacional de Pesquisa Clínica do Brasil: respostas e redução da dependência estrangeira. Revista de Saúde Pública, Rio de Janeiro, v. 44, n. 3, p. 575-578, 2010c., ^2010A______. Ministério da Saúde. Departamento de Ciência e Tecnologia. Fomento às pesquisas em terapia celular e células-tronco no Brasil. Revista de Saúde Pública, São Paulo, v. 44. n. 4, p. 763-764. 2010a.), as well as the project sites and the networks of researchers created because of the implementation of the policy.

Then, the analysis of implementation of the fomentation management was carried out, in the scope of Decit. The analysis of implantation, besides the measurement of its adequate operationalization, tries to relate it to the context of the implantation. With this aim, a second logical model was developed (figure 2). This model corresponded to a goal framework of the actions considered necessary and pertinent for the achievement of the purposes related to the induction, selection and judgment of the calls for proposals, research financing and the use of results. There was a preference for the analysis of the management process related to the selection of priorities, the formulation of the calls for proposals, the monitoring and evaluation of the policy.

It was considered the 'context' of the implantation as the historical conditions of possibility of the implantation of the policy. This analysis was made to identify historical events related to the genesis of policy, which not only created the structural conditions for its formulation and operationalization, but also influenced the conceptions and practices of the agents involved. These, in turn, structured and socially constructed these conditions.

Eleven in-depth interviews were conducted, in 2010, with the Secretary of Science and Technology of the Ministry of Health (MH), directors, sub-coordinators (substitute coordinators) and professionals working in the various sectors of the Decit, identified through the snow ball technique. Two interviews were, also, conducted with former managers, and obtained information by e-mail from a third party, which totaled 14 interviews. The script that guided the questions was personalized for each coordinator/technician. Informed Consent Forms were signed by the interviewees. Although all of them agreed to be identified, it was chosen to maintain the anonymity of the respondents, who will be identified as E1...E14. The informations were complemented with the analysis of the documentary and bibliographic sources already mentioned.

The interviews provided information about the implementation process, social, professional and political trajectories of respondents and conceptions about science and technology, as well as the view of the managers on obstacles to implementation. The professional trajectories, analyzed through the academic training and the positions held in the university and in health institutions, allowed to classify the predominant insertion of the interviewees in the scientific and/or bureaucratic fields. Data collection was done in September and October 2010.

Results and discussion

The implementation situation and the funding management

The PNCTIS was found implemented with reasonable consistency, during the period investigated (2004 to 2010), with respect to most of its objectives, particularly those related to induction, expansion, decentralization and the search for reduction of regional inequalities in the research funding (chart 1).

Considering the breadth of the policy objectives, for the elaboration of the implantation matrix the strategies and several proposed actions were considered, through which appear, implicitly, more specific objectives (BRASIL, 2008A______. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Relatórios de Gestão 2007. Brasília, DF: MS, 2008a. (Série C. Projetos, Programas e Relatórios). Disponível em: <http://bvsms.saude.gov.br/bvs/publicacoes/relatorio_gestao_decit_2007.pdf>. Acesso em: 5 set. 2017.
http://bvsms.saude.gov.br/bvs/publicacoe... ). The analysis of this chart reveals that, for most of the proposed strategies and actions, documentary records were found indicative of their complete or partial operationalization (chart 1).

The main component implemented was the induction of funding, guided by the ANPPS, through various strategies of approximation between the scientific community and the governmental managers of health institutions. The priority given by the MH to PNCTIS was expressed both in its progressive institutionalization, materialized by the creation of the Secretariat of Science and Technology, in 2003, as well as in the volume of budgetary resources allocated to the sector, which rose from R$ 23.177.321,00, in 2003, to R$ 125.209.209,00 in 2004, reaching R$ 387.345.796,00, in 2010, obtaining, therefore, an increase of 1.571%, in the analyzed period (SILVA; CAETANO, 2011SILVA, R. M.; CAETANO, R. Um exame dos fluxos financeiros do Ministério da Saúde em pesquisa e desenvolvimento (2003-2005), segundo a Agenda Nacional de Prioridades de Pesquisa em Saúde. Cadernos de Saúde Pública. Rio de Janeiro, v. 27, n. 4, p. 687-700, 2011.).

On the other hand, there was an increase of the research funding for several states, through the Research for SUS Program (PPSUS). Even the creation of several thematic networks, such as the Brazilian Network for Health Technology Assessment (Rebrats), the Multicentric Network for the Evaluation of Orthopedic Implants (Remato), the National Clinical Research Network (RNPC) and the Northeast Network for Biotechnology (Renorbio), were initiatives with potential to contribute to the development of research in the various regions of the Country. This decentralization of financial resources, however, did not mean the expected reduction of the regional inequalities predicted, as shown by Danda, Queiroz and Hoffmann (2016)DANDA, G. N.; QUEIROZ, L. F. N.; HOFFMANN, V. E. A hélice do poder público: padrões de distribuição de recursos federais para as Fundações de Amparo à Pesquisa Estaduais. Rev. Adm. Pública, Rio de Janeiro, v. 50, n. 5, p. 843-865, 2016.. According to these authors, transfers of federal resources to the FAPs in the period between 2004 and 2012, were higher in the states that had the highest Human Development Index (HDI) and higher concentration of doctors (DANDA; QUEIROZ; HOFFMANN, 2016DANDA, G. N.; QUEIROZ, L. F. N.; HOFFMANN, V. E. A hélice do poder público: padrões de distribuição de recursos federais para as Fundações de Amparo à Pesquisa Estaduais. Rev. Adm. Pública, Rio de Janeiro, v. 50, n. 5, p. 843-865, 2016.). These results reinforce the thesis that research funding cannot be dissociated from investments in the training of researchers.

To evaluate the projects to be financed, besides the evaluation of scientific merit, usually by ad hoc consultants, the criterion of social and economic merit or applicability was incorporated. However, what would be the social and economic merit was not very clear in the speech of the interviewees. It appeared as evident, common sense. Also in the analysis of the reports of the Judging Committees of the Calls for Proposals was not made explicit how the social relevance had been incorporated.

The information system, denominated Health Research (SILVA; CAETANO, 2011SILVA, R. M.; CAETANO, R. Um exame dos fluxos financeiros do Ministério da Saúde em pesquisa e desenvolvimento (2003-2005), segundo a Agenda Nacional de Prioridades de Pesquisa em Saúde. Cadernos de Saúde Pública. Rio de Janeiro, v. 27, n. 4, p. 687-700, 2011.), created to monitor the projects approved in the various calls for proposals, had many gaps, including low percentages of completion of some variables. In addition to this initiative, there were several ways of incorporating both the scientific community and the MH technical areas in the evaluation, such as seminars and workshops (E8).

Despite the existence of these tools, the process of monitoring the projects was not systematic and not even the end products were not easily accessible. The available informations were produced, mostly, by means of academic studies of technicians of the department (ELIAS; SOUSA, 2006ELIAS, F. S.; SOUSA, L. E. P. Indicadores para monitoramento de pesquisa em saúde no Brasil. Ciência da Informação. Brasília, DF, v. 35, n. 6, p. 218-226, 2006.).

Relations with CNPq/Finep/FAPs

The establishment of partnerships between Decit and the government's research funding agencies, at their various levels, not only resulted in a greater contribution of resources but also in the qualification of funding management. The partnership with the Ministry of Science, Technology and Innovation (MCTI) took place through a technical cooperation agreement with the MH. Decit made budget transfers to MCTI, which allocated them to CNPq and Finep to finance combined calls for proposals. In 2005, the partners CNPq, Finep and the United Nations Educational, Scientific and Cultural Organization (Unesco) invested R$ 127.8 million, and in 2006 CNPq and Finep invested R$ 125 million (BRASIL, 2006B______. Ministério da Saúde. Departamento de Ciência e Tecnologia. Da política à ação institucional: prioridades de pesquisa no Ministério da Saúde. Revista de Saúde Pública. Rio de Janeiro, v. 40, n. 3, p. 548-552. 2006b.), amounts higher than the budget of the Decit for those years, which was of the order of R$ 66 million, in 2005, and of 73 million, in 2006 (BRASIL, 2010B______. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Decit 10 anos. Brasília, DF, 2010b. (Série B. Textos Básicos de Saúde).).

The CNPq was considered important for the management of the research selection process because it is an institution with the expertise and adequate infrastructure for this activity. There was, however, another point of view, according to which the ideal situation would be the autonomy of the Decit in relation to funding, which would imply the creation of it's own agency for research funding, so that they would not be dependent on the bureaucratic structure of the MH (E6).

On the other hand, from the point of view of the interviewees of CNPq, the partnership with the Decit was mentioned as very important for the institution, not only with regard to the definition of priorities, but, also, in the scientific dissemination that the Decit did through its portal (E12).

The partnership developed between Decit and the FAPs would also have resulted in an increase in the resources allocated to research at the local level, resulting in the strengthening of the National Science and Technology System throughout the Country, and reducting regional inequalities in the research funding, from the perspective of the interviewees (E4, E12).

From the point of view of the managers interviewed, the obstacles to the implementation of the policy were related to the precariousness of the employment relationship of the majority of Decit's technical staff and the absence of a personnel policy (E4, E6). As in other departments of the MH, the board consisted of professionals with technical training and competence, but with temporary contracts, leading to high staff turnover (E2, E4, E5, E12). Few professionals were tenured, and most of the group was selected through public calls (E10). The absence of a stable bureaucracy caused the discontinuity of processes and affected the accumulation of technical capacity, during the studied period.

The implementation of most of the objectives of the PNCTIS, verified in the period (2004 to 2010), is consistent with other studies that investigated the same theme (ALMEIDA-ANDRADE, 2015ALMEIDA-ANDRADE, P. Avaliação da Política Nacional de Ciência, Tecnologia e Inovação em Saúde: contribuições para a pesquisa & desenvolvimento em biotecnologia em saúde (2004-2014). 2015. 269 f. Tese (Doutorado em Política Social) - Universidade de Brasília, Brasília, DF, 2015.; GUIMARÃES 2006GUIMARÃES, R. et al. Defining and implementing a National Policy for Science, Technology and Innovation in Health: lessons from the Brazilian experience. Cadernos de Saúde Pública. Rio de Janeiro, v. 22, n. 9, p. 1775-85, 2006.; NATAL; HARTZ; SANTOS, 2010NATAL, S.; HARTZ, Z.; SANTOS, S. M. C. Avaliação da Política de Ciência Tecnologia e Inovação em Saúde Implementada pelo Departamento de Ciência e Tecnologia do Ministério da Saúde, no período de 2003 a 2010. Rio de Janeiro: Fiocruz, 2010.; SILVA; PETRAMALE; ELIAS; 2012SILVA, H. P.; PETRAMALE, C. A.; ELIAS, F. T. S.Avanços e desafios da Política Nacional de Gestão de Tecnologias em Saúde. Revista de Saúde Pública. São Paulo, v. 46, n. supl., p. 83-90, 2012.; TENÓRIO; MELLO; VIANA, 2017TENÓRIO, M.; MELLO, G. A.; VIANA, A. L. D'Á. Políticas de fomento à ciência, tecnologia e inovação em saúde no Brasil e o lugar da pesquisa clínica. Ciência & Saúde Coletiva, Rio de Janeiro, v. 22, n. 5, p. 1441-1454, 2017.). In addition, the aforementioned policy has broadened support for the infrastructure of health research in clinical research and the constitution of several thematic networks, through the calls for proposals (TENÓRIO; MELLO; VIANA, 2017TENÓRIO, M.; MELLO, G. A.; VIANA, A. L. D'Á. Políticas de fomento à ciência, tecnologia e inovação em saúde no Brasil e o lugar da pesquisa clínica. Ciência & Saúde Coletiva, Rio de Janeiro, v. 22, n. 5, p. 1441-1454, 2017.). The priority given by the MH to PNCTIS was expressed in its progressive institutionalization, as well as in the volume of budgetary resources allocated to the sector.

The definition of an ANPPS, in the II CNCTS, fulfilled the role of enabling the meeting and the dialogue between researchers and managers, which was adopted in later events. These spaces created, along with the technical cooperation agreements signed with the MCTI (CNPq and Finep), brought to the MH some elements of the logic of the scientific field, through peer judgement, based mainly on merit. On the other hand, the CNPq began to participate in the definition of calls for proposals along with managers and technicians of health institutions - MH and State Health Secretariat (SHS). Because of this fact, its advisory committees sought to incorporate 'social relevance' and regional equity in the criteria of judgment, thus, approaching the world of work.

Despite the importance of the ANPPS, the selection of priorities was concretely influenced by several orders, from personal and/or collective initiatives of Decit's directors and technical staff to the result of the pressure of researchers and the technical areas of the MH.

These results are the product of a process of social construction that began at the time of the democratic transition, when the I National Conference on Science and Technology was held, in 1985, convened by Minister Renato Archer to subsidize the actions of the newly created MCTI (BRASIL, 2002BBRASIL. Ministério da Ciência e Tecnologia. Centro de Estudos e Gestão Estratégica. Memórias da Conferência Nacional de Ciência e Tecnologia. Brasília, DF: MCTI, 2002. Disponível em: <http://www.cgee.org.br/arquivos/plenarias.pdf>. Acesso em: 30 out. 2017.
http://www.cgee.org.br/arquivos/plenaria... ). On the other hand, its development in concrete actions, especially about the expansion and induction of funding, only consolidated later, with the advent of the legislation that created the sectoral funds, as well as the horizontal fund destined to the infrastructure for the research, in 1999 (PACHECO, 2007PACHECO, C. A. Manual de Políticas Públicas: As reformas da política nacional de ciência, tecnologia e inovação no Brasil (1999-2002). Santiago: Cepal, 2007.). This legislation also dictated induction, emphasis on technological production and decentralization. The creation of Decit, in 2000, still as Department of the Secretariat of Health Policies, was influenced by this process. However, it was only in 2003, with the creation of the SCTI, that the volume of the own resources of the Decit increased considerably and the implementation of the policy was expanded.

Among the main obstacles identified by the Decit team were the small institutionalization of the department itself, in which most technicians had temporary contracts, which generated discontinuity, loss of institutional memory and instability. Consequently, the organization of work processes varied widely, with reports of overload, centralization and lack of document archiving routines.

Although the amount of resources earmarked for health research increased considerably, during the period analyzed, the identified needs demanded even greater expansion, considering, in several published notices, references to projects approved on merit, but not financed due to lack of resources.

Regarding monitoring and evaluation, although there were several initiatives for this purpose, the identification of the main results of the funded research was difficult, given that the network sites created and the 'Health Survey' were not up to date.

The limitations of this evaluation are related, foremost, to its scope due to the necessary delimitation of the analysis of the implantation to the component funding management. The other components of the process, which complement the research funding, explained in the second logical model (figure 2), include: selection and judgment of projects with merit, their execution, production of relevant knowledge, until the incorporation of this knowledge in the practice of health services. All of these moments require additional specific research, in various scopes. Secondly, the incipience of the 'Health Research' system, as well as the difficulty of obtaining the set of documents and information necessary for the analysis.

Conclusions

The findings of the present evaluation provided evidences on the implementation of most of the objectives of PNCTIS, in the period between 2004 and 2010. The conditions of possibility that influenced this result were related to several articulated phenomena, such as the diversity of the trajectories of Decit leaders and the influence of CNCTS. They also made possible the coexistence between support for basic research, and the induction of funding in line with health policy priorities. On the other hand, the process of redemocratization of the Country started the incorporation of the scientific community to the debate on the issue. But the creation of sectoral funds, with the contribution of a greater volume of resources for research, together with the increase in Decit's own budget, created the material conditions for funding.

At that historic moment, the creation of Decit and SCTI in the MH allowed the formulation and institutionalization of PNCTIS. The occupation of the leading positions of these instances by managers with mixed trajectory, both in the scientific field and in the bureaucratic field, with insertion in the sanitary movement, institutionalized not only the consultation to the researchers, through the elaboration of the ANPPS, as they decentralized and reduced the inequalities, through PPSUS. In this way, the funding management of the PNCTIS can be characterized as successful and innovative, because it achieved to articulate the induction of funding, aiming at the improvement of the SUS, with structural support to consolidated research groups. Despite these results, their improvement and expansion require the increase of the volume of resources destined to the financing of the research in health, mainly directed to the strategic and long-term projects.

Finish writing this article occurred at a time of fiscal adjustment and budget cuts in 2016, which could impact on the overall financing of science, technology and innovation in the Country. The analysis of the historical period here, however, remains actual as an exemplary case of the historical possibilities of formulating and implementing a PNCTIS capable of influencing national development.

References

Publication Dates

History