The Brazilian public health system was born innovative, anchored by the Trinitarian
cooperative federalism installed in the 1988 Constitution, inaugurating the challenges to
restructure ways of thinking and executing health policies. In this context, this dissertation
sought to analyze the role of inter-federative partnerships in the local continuity of national
public health policies, identifying obstacles and indicating suggestions for their execution,
guided by the new constitutional federalist logic. To achieve this goal, the investigation used
the guiding instruments of content analysis, permeated transversely by participant observation
and based on the documentary analysis of the normative collection and on the referenced
bibliographic research. The analyzed data were provided by consultation with federal, state and
municipal managers from all over the country, experienced in interfederative articulation and
in processes related to the phases of a national policy. The results are presented in analytical
categories that show national weaknesses in intergovernmental collaboration. They point out
procedural and instrumental lapses of federal coordination, of the state's performance as
coordinator and regional supporter and of municipal management to assume the local execution
of the policy. In view of the challenges identified, the study suggests actions to strengthen
commitments between governments, to agree responsibilities and accountabilities, creating an
environment of cooperation and conscientious control in monitoring the implementation of the
policies implemented, according to the needs and conditions of the entity and the executing
environment. The suggestions show paths to effectiveness in the implementation of national
health policies in the territories, overcoming obstacles through co-responsible changes in the
intergovernmental relationship model. It concludes with the confirmation of the driving force
of permanent and autonomous inter-federative partnerships in the structuring of a stable and
active integrated governance. According to the study, this is a path for the quality of execution
and the positive impact of national health policies on the fulfillment of SUS actions, for the
improvement of citizens' lives.
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