ABSTRACT

Introduction:

The public policy diffusion approach is utilized to chart the influencing factors that shape the consolidation of government policies through interactions between federated states, organizations, and nations. In Brazil, public policy diffusion studies have a great deal of potential due to the country's federative system, as established in the 1988 Constitution, the policies developed from this institutional structure, and the constant intergovernmental interaction. Within this scenario, our focus on the Family Health Strategy (FHS) allows us to analyze the diffusion patterns based on a variety of factors (political, regional, economic, and demographic) following the decision to implement this public policy.

Materials and methods:

We employed three discrete-time models inscribed in the survival-analysis paradigm to evaluate the role and impact of external and internal factors on the adoption of the FHS policy in the Brazilian state of São Paulo between 1998 and 2018.

Results:

Our findings showed that adherence to the FHS within the state of São Paulo was impacted by its prior adoption in neighboring municipalities. Furthermore, party alignment between mayor and president and being an electoral year were also influential factors for adopting this public policy.

Discussion:

The impact of neighboring municipalities on the diffusion of the FHS within the state of São Paulo stands in stark contrast with the insignificance of this variable in other regions in the country. This highlights the uniqueness of the state of São Paulo in the diffusion process of this public policy. I compared this process to an emulation mechanism and drew attention to the heterogenous consolidation factors for the FHS throughout the national territory. We detected electoral and political incentives and confirmed their positive influence, as expected.

Keywords
public policy diffusion; Family Health Strategy; survival analysis; municipal governments; federal programs