Challenges of inter-sector collaboration in public policies: the dilemma between nutritional supplementation and the promotion of healthy eating in schools

Abstract: The study aimed to identify and analyze the development of inter-sector arrangements between the health and education sectors in the framework of the implementation of the NutriSUS strategy in a municipality (county) in the state of Rio de Janeiro, Brazil. The study was conducted from March 2015 to March 2017 and used policy analysis as the analytical reference, with the following analytical dimensions: operational design; ideas on the nutritional supplementation; institutional context; and inter-sector collaboration. Semi-structured interviews were held with health professionals and administrators and schoolteachers and school system administrators at the three levels of government, in addition to document analysis. The NutriSUS strategy was implemented in five preschool units and required establishing agreements between health professionals and teachers that were affected by the following: the design based on the preventive approach to diseases with emphasis on action by the health sector; mechanisms of induction and convergence of interests between the federal and local governments; management mechanisms and institutional spaces including different stages in the implementation process, that is, the NutriSUS management centered in the health sector but operationalized in the school system; and the intersection between NutriSUS and the National School Food Program which increased the visibility of competing concepts concerning supplementation as a preventive strategy and different approaches to promote healthy eating. Thus, the factors identified by the study challenge the development of inter-sector collaboration oriented by shared processes in the entire chain of implementation of inter-sector programs for schools.

摘要：本研究旨在识别并分析巴西里约热内卢州某市县落实NutriSUS策略（NutriSUS）框架下，卫生与教育部门间跨部门协作安排的发展态势。研究于2015年3月至2017年3月开展，以政策分析为分析范式，确立四大分析维度：运作设计、营养补充相关理念、制度背景，以及跨部门协作。研究采用半结构化访谈法，访谈对象涵盖三级政府体系中的卫生专业人员、行政管理人员、学校教师及学校系统管理者，并辅以文档分析法。NutriSUS策略在5所学前教育机构落地实施，要求卫生专业人员与教师建立协作共识，该共识受以下多重因素影响：其一为以疾病预防为核心导向、侧重卫生部门主导行动的策略设计；其二为联邦与地方政府间的利益诱导与利益趋同机制；其三为覆盖实施全周期的管理机制与制度空间——具体而言，NutriSUS策略的管理权责集中于卫生部门，但实际运作依托学校系统推进；其四为NutriSUS与全国学校供餐计划（National School Food Program）的交叉联动，这一联动凸显了围绕“营养补充作为预防策略”的竞争性认知，以及健康饮食推广的不同路径。综上，本研究识别出的各类因素，对面向学校的跨部门项目全实施链条、以共享流程为导向的跨部门协作发展构成挑战。