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Abstract The management of water involves complex issues related to just allocation and sustainability. While integrated approaches incorporating diverse stakeholders have emerged as the dominant global framework for 21st-century challenges, policymakers face difficulties in assessing stakeholder participation and integration. This study generated primary data from a survey and interviews and used social network analysis to reveal and map the dynamics of interaction among ten groups holding stakes in the water resources of the Açu Lake State Park, a Brazilian coastal estuary. The results indicate that stakeholder group interaction was concentrated within two distinct clusters, such that high interaction correlated positively with political power, while those most dependent on the resources were characterized by limited decision-making influence and low interaction with other groups. These results offer insight for the equitable and sustainable governance of water resources and the assessment of participation and interaction among stakeholder groups.

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Objective. To identify how countries have positioned themselves to fight against all forms of malnutrition. Methods. Qualitative, exploratory, and descriptive study of the statements of 91 out of the 127 (71.7%) countries that issued declarations in the Second International Conference on Nutrition. Results. According to the analysis of the official statements from the Conference, countries still responded to nutrition issues in a traditional way. Food systems were part of the narrative and mentioned as part of the problem and solution, but little thought was given to their determinants. Conclusions. The Decade of Action on Nutrition is spurred on by the urgent need to coordinate global endeavors in the fight against malnutrition and could aggregate efforts in prioritizing actions to address the determinants rather than the biological outcomes of malnutrition–which requires commitments–; and strengthening the countries’ ability to implement robust regulatory measures. These measures could be empowered through efforts across different levels, making use of multilateral spaces, and through strengthening civil society participation, including developing better mechanisms for the recognition and control of conflicts of interest across different political spaces.

Abstract: Multi-stakeholder processes - as a necessary part in the development of public policies - can provide diverse perspectives to inform and to improve food security policy-making. Iran’s National Food Assistance Program (NFAP) is one of the major welfare programs in Iran that reduces food insecutiry to low-income households. This study aimed to identify and to categorize actual and potential stakeholders in NFAP using the stakeholder salience model. According to Mitchell’s theory, stakeholders’ attributes (power, legitimacy, and urgency) were assessed based on the nature of their interactions, roles, and level of engagement. Results revealed a number of significant but marginalized stakeholders, including Iranian Ministry of Health (office of community nutrition improvement), academia, center for food and nutrition research, target group, charities, and international organizations, who have not received any targeted organizational attention and priority to their claims. The unbalanced attention provided to some stakeholder groups characterized as “definitive” and “dominant” and ignoring some important ones will jeopardize long-term viability and undermine support for the program with inevitable declines in legitimacy. Understanding the change in the stakeholders’ characteristics is the main variable to determine the allocation of organizational resources in response to different and rising stakeholders’ demands and possibly the projects outcomes. This will facilitate and enhance the possibility of knowledge exchange and learning, and greater trust among stakeholders during the food and nutrition policy-making process.

RESUMO A incorporação dos diferentes interessados ao processo avaliativo é estratégica para facilitar a compreensão da avaliação e a apropriação de seus resultados. Este artigo se propõe a descrever e analisar criticamente a participação dos atores (stakeholders) no processo de avaliação, utilizando a pesquisa avaliativa do Projeto de Formação e Melhoria da Qualidade de Rede de Atenção à Saúde (Projeto QualiSUS-Rede). Para isto, foram tomadas como base as memórias das reuniões de trabalho, das oficinas de alinhamento conceitual e de validação dos Modelos Lógicos dos seminários realizados, assim como dos relatórios elaborados no período de agosto de 2012 a dezembro de 2015. A abordagem colaborativa envolveu inúmeros desafios, englobando 15 projetos, com distintos níveis de abrangência e complexidade, e com diversos stakeholders, com diferentes tipos e níveis de colaboração, o que condicionou os limites e as possibilidades de participação. Esta experiência gerou a adaptação do Modelo de Avaliação Colaborativa de Rodriguez-Campos e Rincones-Gomez (2013). A abordagem colaborativa exige por parte dos avaliadores um exercício de flexibilização e de ajuste às distintas particularidades e aos contextos locais, sem perder de vista o alinhamento às teorias da intervenção e ao modelo teórico da avaliação.

ABSTRACT OBJECTIVE The study aims to characterize and discuss the processes of patient and public involvement (PPI) in the Brazilian Health Regulatory Agency (Anvisa), the National Committee for Health Technology Incorporation (Conitec), and the National Agency for Supplementary Health (ANS) in Brazil. METHODS This is an exploratory, descriptive, and comparative study, conducted by analyzing the public documents and regulation of the three institutions. RESULTS The mechanisms for PPI included public consultations, public hearings, participation in advisory committees, and health technology evaluation requests. Anvisa conducted 187 public consultations between 1999 and 2018, gathering 10,699 contributions. In total, 76 (41%) public consultations did not present information about the contributions received. Conitec carried out 234 public consultations and received 53,174 contributions between 2011 and 2018. It was identified that 70 (23%) recommendations from Conitec did not go through public consultation, and 26 (8%) recommendations changed after public consultation. Recommendation changes seemed to have occurred especially in cases with a greater number of contributions in the public consultation process. ANS conducted eight public consultations regarding the list of health procedures and events covered by health insurances between 2000 and 2018, and it received 31,498 contributions. For three public consultations, there was no information about the number of contributions received. CONCLUSIONS There are regulatory advances and institutional activity supporting PPI in highly technical decision-making processes in Brazil, although heterogeneously among the analyzed institutions. The power of PPI to influence health technology deliberative processes still requires in-depth studies, including the characterization of stakeholders and the legitimacy of decisions.

Objective: to identify and analyze the concepts of the realist evaluation and the methodologies recommended for its development in the health area. Method: an integrative review, which included theoretical and methodological studies published in the following databases: COCHRANE Library, EVIPNet, Health Systems Evidence, LILACS, PDQ-Evidence, PubMed, Rx for Change, and SciELO, in addition to Teses-CAPES and Google Scholar, for the gray literature. The mediation category underlay the analysis. Results: 19 references were included, published between 1997 and 2018. It is an innovative proposal to direct the process of evaluating health programs, interventions, and/or policies, with the democratic participation of the parties involved, such as users, workers, managers and researchers; it proposes to elaborate theories about what works, for whom, in what context, and how. The mediation category indicated the need for these theories not to be restricted to the micro-context, but to incorporate the elements of the social macro-structure to which they are connected. Conclusion: It is indicated that the realist evaluation is to be conducted in 21 stages. It takes into account qualitative and procedural methods, which makes it powerful for understanding human and social relationships in the context analyzed. Theories that come from evaluating the functioning of the programs analyzed have greater explanatory chances if they are built by reference to the social totality.

Este trabalho discute os desafios que se colocam à sociedade contemporânea no âmbito do combate à vulnerabilidade social, realça a importância da abordagem holística dos problemas socioambientais através da integração transversal e simultânea das dimensões social, ambiental e económica da sustentabilidade e exorta para a necessidade do uso combinado de métodos qualitativos e quantitativos como forma de compreender o fenômenos ambientais e sociais e implementar programas de intervenção sustentáveis.This article discusses challenges concerning contemporary society with respect to social vulnerability. The role of holistic approach to face socio-environmental problems by integration of the sustainability dimensions is also addressed. Finally, an approach that combines qualitative and quantitative methods is recommended as the appropriate way to understand socio-environmental processes, and perform sustainable programmes.

ABSTRACT Objectives: To reflect on the scope of the working process in nurse participation political activities as a possibility for expanding its performance. Methods: this is a reflective study, supported by the discursive elaboration on the nursing participation political activities and work process, structured through concepts, theoretical perspectives and practices based on the experiences described in references. Results: studies on this process demonstrate that nurses need sensitivity to understand the complexity of their social practice. Final Considerations: in their professional actions, nurses must mobilize political resources, making their knowledge, skills and attitudes available to their practices, aiming at power and improvement of conditions for the work of Nursing.