Desafios da gestão intersetorial na Política Nacional de Segurança Alimentar e Nutricional / Challenges of intersectoral management in the National Policy for Food and Nutrition Security

Diante da necessidade do equacionamento do problema da fome, a questão da segurança alimentar e nutricional no Brasil e no mundo tem ocupado o centro das discussões nas últimas décadas. A Lei nº 11.346, de 15 de setembro de 2006, Lei Orgânica da Segurança Alimentar e Nutricional (LOSAN) veio expressar o amplo conceito de Segurança Alimentar e Nutricional (SAN) do governo brasileiro e estabelecer as diretrizes para a construção da política e do plano nacional, colocando a SAN como objetivo permanente a demandar ações contínuas e intersetoriais do governo e da sociedade. Entretanto, observa-se que os arranjos institucionais da estrutura governamental geram obstáculos que dificultam a execução de ações intersetoriais que levem em consideração uma concepção mais ampliada da SAN. Este estudo procura entender como se dá a gestão intersetorial da política de SAN e como, dentro do aparato administrativo do Estado brasileiro, é possível desenvolver ações intersetoriais que consigam incluir toda a multidimensionalidade da temática da SAN no Brasil. Ademais, tenta responder a estas perguntas trazendo para o debate o orçamento e planejamento do governo federal. Buscou-se identificar os limites e desafios para a gestão intersetorial das políticas públicas com um foco mais específico na PNSAN. Constatou-se que, apesar da fragmentada estrutura administrativa estatal do país, o processo de implementação de uma gestão intersetorial tem avançado, mesmo verificando-se que há um longo caminho a ser percorrido em direção a um planejamento governamental que integre a lógica orçamentária à gestão da PNSAN. Há o desafio de construção de um orçamento pactuado entre os setores, que seja integrado gestão e ao monitoramento da política...

As the problem of hunger continues to plague society, food and nutrition security subject keeps heading discussions worldwide. In Brazil, the Organic Law on Food and Nutrition Security (LOSAN) - Law No. 11.346, September 15th, 2006 - embraced the wide concept of Food Security and Nutrition (SAN), as well as established guidelines for the construction of the Brazilian Policy and the National Plan. It also has placed the SAN as a permanent government goal, and as result, the need of a continuous and intersectoral actions has become a hard task, which must involve both government and civil society. The actual institutional arrangement do not make it any easier, and demands a lot of effort to cope with the wide concept of the SAN and the means available to achieve its objectives.This study tries to map how is the intersectoral management for the national policy on food and nutrition security and how, within the administrative structure of the Brazilian State, it is possible to develop intersectoral actions that can include all the multidimensionality of this subject. Moreover, it attempts to answer those questions by bringing to the debate the Brazilian’s budget structure and the major planning of the federal government.Some limits and challenges of the intersectoral public policies management are identified, with a close look on the PNSAN. Then it is shown that despite the fragmented state structure in found in the country, the process of implementing an intersectoral management has somehow succeeded, even though there still have some gaps to be fulfilled towards a government planning that integrates its budget structure to the PNSAN management. There is also the challenge of constructing a budget that is agreed among many different sectors, and which is well integrated into the management and monitoring policy...

Nevirapine-induced side effects in pregnant women: experience of a brazilian university hospital

Nevirapine-based therapy is associated with increased frequency of adverse events among HIV-infected pregnant women. The aim of this article was to evaluate the incidence of adverse effects in HIV-infected women who started nevirapine during pregnancy. A retrospective study was performed in our center between January 2003 and December 2006 analyzing all women prescribed nevirapine during pregnancy. Women presenting any risk factor for hepatotoxicity were excluded from the analysis. Patients were divided into two groups according to the presence or absence of adverse effects, and a correlation to CD4 counts was performed. Liver function abnormality was graded according to the Division of AIDS toxicity guidelines. A total of 170 women initiated nevirapine during pregnancy, but only 133 were included in the study. Twenty-seven women (20.3 percent) presented adverse effects, skin rash accounting for 77.8 percent (21/27 women) and liver function abnormalities for 22.2 percent (6/27) of the cases. Baseline CD4 counts, viral loads and transaminases were similar in both groups. All nevirapine side effects were developed in less than seven weeks. Four of 31 women with CD4 counts <250 cells/µL (12.9 percent) and 23 of 102 women with CD4 counts ≥250 cells/µL (22.5 percent) developed adverse events. All patients who experienced hepatotoxicity had pretreatment CD4 counts >250cells/µL. The incidence of adverse events with nevirapine in our study was high, but most of them were cutaneous. There was no correlation between high CD4 counts and adverse events when analyzing both cutaneous and hepatic reactions; nevertheless, hepatotoxicity occurred only in pregnant women with CD4 counts ≥250cells/µL.