{"id":82,"date":"2026-07-06T15:54:04","date_gmt":"2026-07-06T19:54:04","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/agencyforfoodsecurityinbrazil\/chapter\/__unknown__-5\/"},"modified":"2026-08-30T19:41:55","modified_gmt":"2026-08-30T23:41:55","slug":"__unknown__-5","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/agencyforfoodsecurityinbrazil\/chapter\/__unknown__-5\/","title":{"raw":"Chapter 5 - Challenges Implementing the School Food Program in Rio Grande do Norte: Local Micronutrient Supplementation and Full-Time Schooling Expansion","rendered":"Chapter 5 – Challenges Implementing the School Food Program in Rio Grande do Norte: Local Micronutrient Supplementation and Full-Time Schooling Expansion"},"content":{"raw":"
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Wendjilla Fortunato de Medeiros, Ricardo Andrade Bezerra, Joana Yasmin Melo de Ara\u00fajo, Laura Brito Porciuncula, Antonio Teofilo Pinheiro Neto, Dinara Leslye Macedo Silva Calazans & F\u00e1bio Resende de Ara\u00fajo*<\/p>\r\n

*Corresponding author: fabio.resende@ufrn.br<\/a><\/p>\r\n\r\n

1. Introduction <\/strong><\/h2>\r\n

The human right to adequate food, guaranteed in the Brazilian Constitution, is granted when Food and Nutritional Security (FNS) is ensured. Since the early 2000s, Brazil has made significant progress in reducing Food and Nutrition Insecurity (FNI), although not without periods of major setbacks (see Fagundes et al., 2026, and Rocha et al., 2026a, in this volume; Neves et al., 2021). In 2014, the country was declared out of the Hunger Map by the Food and Agriculture Organization (FAO). However, a few years later, a survey conducted in 2021\/2022 showed that more than half of Brazilians (58.7%) experienced some degree of Food and Nutrition Insecurity. In Brazil\u2019s Northeast region, the survey showed even more alarming results, with FNI affecting 68.1% of the population (PENSSAN, 2022). Fortunately, after a change in government in 2023 that restored a number of previously neglected social programs, the country was out of the Hunger Map again in 2025, with less than 2.5% of its population experiencing hunger (FAO\/IFAD\/UNICEF, 2025).<\/p>\r\n

Brazil\u2019s School Food Program (PNAE) has played a central role in combating FNI in the country (Rocha et al., 2026b; Vasconcelos, 2013). Launched in 1955, through the years the program has been substantially modified and expanded, both in terms of budget and population coverage. PNAE is a nationwide and universal program, implemented in all public schools and childcare centres in the 5,570 municipalities in Brazil\u2019s 26 states and the Federal District (Nogueira et al. 2016). It covered more than 40 million students in 2023, spread out over the three levels of publicly funded schools that compose the educational system: federal, state, and municipal.<\/p>\r\n

Under PNAE, the federal government transfers funds to cover most of the cost of food on a student per-capita basis, while state and municipal governments are responsible for covering all other costs associated with providing school meals according to specifications detailed in the legislation of 2009 and modifications thereafter. Table 1 indicates the funds transferred in 2023 by the federal government to cover the number of meals and nutritional requirements in different modalities.<\/p>\r\n

Table 1. Funds transferred by the Brazilian federal government per student<\/em><\/p>\r\n\r\n<\/div>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
Level\/Modality<\/strong><\/th>\r\nValue per Student (R$)<\/strong><\/th>\r\nMeals<\/strong><\/th>\r\nNutritional Needs<\/strong><\/th>\r\n<\/tr>\r\n
Nursery School (Creches)<\/td>\r\n1.37<\/td>\r\n2 small meals<\/td>\r\n30%<\/td>\r\n<\/tr>\r\n
Elementary and High School<\/td>\r\n0.5<\/td>\r\n1 small meal<\/td>\r\n30%<\/td>\r\n<\/tr>\r\n
Youth and Adult Education (EJA)<\/td>\r\n0.41<\/td>\r\n1 small meal<\/td>\r\n30%<\/td>\r\n<\/tr>\r\n
Elementary School (Indigenous and Quilombola*)<\/td>\r\n0.86<\/td>\r\n1 small meal<\/td>\r\n30%<\/td>\r\n<\/tr>\r\n
Elementary Education (Full-Time)<\/td>\r\n1.37<\/td>\r\n2 small meals and 1 lunch<\/td>\r\n70%<\/td>\r\n<\/tr>\r\n
High School (Full-Time)<\/td>\r\n2.56<\/td>\r\n2 small meals and 1 lunch<\/td>\r\n70%<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n
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Source: Prepared by the authors based on PNAE\/FNDE Resolution No. 02\/2023 (FNDE, 2023).<\/p>\r\n

(*) According to Art. 2 of Brazil (2003), the remaining quilombo communities are considered ethnic-racial groups that refer to themselves as having their own historical trajectory, with specific territorial relations, a presumption of black ancestry, and a history of resistance to oppression.<\/p>\r\n

The implementation of a nationwide public policy such as PNAE may have some different local characteristics depending on how subnational partners choose to participate. In federalism, there is a particular relationship between the central government and subnational governments, which affects the design of public policies such as PNAE.<\/p>\r\n

Monteiro Neto (2014) points out that in the theory of federalism, the concept of decentralization of government is a fundamental idea. One of the main aspects is the so-called vertical decentralization, that is, one in which a central government shares power with subnational governments. According to Bonduki and Palotti (2021), in federative countries, nationalized social policies may face the challenge of striking a balance between vertical coordination seeking to promote some level of unity of actions and their compatibility with a wide range of state capabilities at the local\/regional level. Traditional mechanisms, such as policy standardization, can ensure consistent provision of services in programs, but they must be combined with efficient arrangements of inter-sectoral and intergovernmental coordination.<\/p>\r\n

In Brazil, after the Federal Constitution of 1988, state governments have taken on important roles in the provision (and, hence, co-funding) of services (Licio et al., 2021). For decentralization to be feasible, subnational governments must be endowed with not only economic and financial resources, but also with institutional capacities (Gomides and Pires, 2014; Monteiro Neto, 2014). It is this challenge that may sometimes lead to failures of implementation, because subnational governments have fewer financial and human resources to keep up with the proposals of a central government.<\/p>\r\n

The National Fund for the Development of Education (FNDE) under the Ministry of Education (MEC) is responsible for PNAE\u2019s legislation and monitoring, while states and municipalities oversee its local execution (Bonduki and Palotti, 2021). There is the centralization of the main financial resource for the program, provided by the federal government, but variations in its implementation depend on the local capacity of states and municipalities.<\/p>\r\n

In this chapter, we report on two studies looking at local attempts to complement the basic services provided by the National School Food Program in the Northeastern state of Rio Grande do Norte (RN). In section 2, we report on a research project concerned with identifying barriers to the successful implementation of NutriSUS (a micronutrient supplementation strategy) through the School Food Program in a small town. The study proposed to highlight key behavioural problems during the implementation of the program, which could compromise its effectiveness.<\/p>\r\n

In section 3, we look at how the state of Rio Grande do Norte attempted to address the challenge of keeping up PNAE\u2019s national standards with the increase of full-time education in the state through the creation of a new program, the Pague Mais <\/em>Alimenta\u00e7\u00e3o<\/em> (Pay More Food) in 2022. Under the State Department of Education, Culture, Sport, and Leisure (SEEC\/RN), the new program proposed an increase in state funding for PNAE in the public schools implementing full-time periods. The study identifies the main local groups which lobbied the state government in developing this new program.<\/p>\r\n\r\n

2. <\/strong>Behavioural<\/strong> Barriers for the Implementation of a School-based Micronutrient Supplementation Program in Brazil<\/strong><\/h2>\r\n

Malnutrition, including micronutrient deficiencies, is driven by inequality and poverty, and there is not necessarily a technical solution capable of solving these problems in isolation. In this context, nutritional supplements and micronutrient fortification are emergency strategies that aim to mitigate the effects of nutritional deficiencies (Coutsoudis et al. 2019). According to the World Health Organization (WHO) (2016), there should be coordination of actions aimed at the prevention and control of micronutrient malnutrition. There is a variety of interventions in this area: fortification at the point of use with Multiple Micronutrient Powder (MNP), fortified foods, supplementation with isolated nutrients (Iron, Vitamin A, Vitamin D...), and lipid-based nutritional supplements (LNS). In choosing an intervention, issues such as cost, effectiveness, feasibility, and acceptability must be considered in the implementation of actions.<\/p>\r\n

MNP supplementation is usually carried out through a strategy of home fortification, but it can also be done through fortification at the point of use, where the supplement is added to meals in service networks such as schools, for example. This type of fortification differs from industrial fortification, where the addition is done by the industry, and processed foods are used as vehicles for fortification. WHO's recommendation (WHO, 2016) indicates the use of MNP as a preventive measure against micronutrient deficiencies, targeting early childhood populations. The program is recommended where anemia has been identified as a public health problem, prioritizing children aged 6 to 23 months with the aim of improving iron levels and reducing iron-deficiency anemia, though the age group of 2 to 12 years can also be included as a target audience.<\/p>\r\n

The use of MNP globally is high. Data from the United Nations International Children's Emergency Fund\u2019s (UNICEF) NutriDash report (UNICEF, 2024a) show that in 2020, around 10 million children received supplementation. While significant, this number reflected a decrease in MNP supplementation during the COVID pandemic. In 2022, for instance, over 14 million children received MNP supplementation across 36 countries. (UNICEF, 2024b)<\/p>\r\n

In Brazil, the high prevalence of anemia and other nutritional deficiencies among children aged 6 to 23 months led to the creation of a Multiple Micronutrient Powder program (NutriSUS) in 2015 (Freitas et al. 2023). NutriSUS was originally developed as a point-of-use fortification program to be implemented in the school environment. That seemed to be a good strategy given PNAE\u2019s reach throughout the country. While a mandated and funded federal program, NutriSUS was to be implemented at the municipal level, through the collaboration between primary health care units and local public schools and daycare centers.<\/p>\r\n\r\n

2.1 Study location, research subjects, and methodology<\/em><\/h3>\r\n

Our study was carried out in the city of Currais Novos, a small municipality in the state of Rio Grande do Norte. The city of Currais Novos was chosen because it experienced a decline in the number of children reached by NutriSUS between 2018 and 2019. According to data from the Currais Novos Health Department, in 2018, 81.9% of the 628 children eligible to participate in the program actually received the MNP supplements. The coverage dropped to only 70.2% in 2019, prompting calls for an evaluation of the program. We worked with eight daycare centres, out of the 10 in the city. The data generated were collected during the development of a strategic plan to improve the implementation of NutriSUS from July to November 2019.<\/p>\r\n

The research subjects were participants in the preparation of the strategic planning to improve the implementation of NutriSUS in Currais Novos. They included school principals and teachers, cafeteria workers, managers from the education department and education professionals, and children\u2019s caregivers (parents, grandparents, and others). All participants gave consent through the Free and Informed Consent Form and signed the Voice Recording Authorization Form. The research project received ethical approval from the Research Ethics Committee at the Federal University of Rio Grande do Norte.<\/p>\r\n

In the methodology of our study, we followed four phases of an action research process (Nascimento et al. 2020): 1. Planning; 2. Focus groups with the school community; 3. Presentation of the partial plan, and 4. Public consultation of the plan with the community. The main product of this project was a strategic plan to improve the implementation of NutriSUS in Currais Novos.<\/p>\r\n

Conversations in the focus group meetings at the daycare centres and conversations with managers at the secretariat level were recorded and transcribed. In the data analysis, a decision map was constructed following the Practitioner\u2019s Guide to Getting Started with <\/em>Behavioural<\/em> Science Applications to United Nations Policies, Programs and Administration<\/em> (United Nations Innovation Network , 2022) and the BASIC behavioural insights tool of the Organization for Economic Co-operation and Development (OECD, 2019). The main behavioural problems at the tactical-operational level were identified according to the decision stage in which they were analyzed using the ABCD framework for analyzing behavioural problems from the BASIC tool<\/p>\r\n

This map focused on designing choices that occurred in the daycare centres. The analysis of this study concentrated on behavioural problems, and the diagnosis was comprehensive, examining both structural and behavioural issues. At the management level, the emphasis was on the tactical-operational level of implementation, since strategic planning for NutriSUS is carried out at the federal level.<\/p>\r\n

The theory that anchored our analysis is found in Behavioural Science. Behavioural Science can contribute to public planning, through analyses leading to better choices in the design of public policies, making them more effective. The behavioural approach in public policies allows for the analysis of unintentional attitudes of those involved, which impact public programs. Through this understanding, it is possible to arrive at Behaviour Insights (BI) and propose changes that can lead to better results (United Nations Network, 2022). The application of BI requires an understanding of the context in which the public policy is applied, as behavioural traps may occur if the same solution is applied to different realities. Moreover, the use of BI must undergo a robust democratic debate regarding public permissions and ethics (TOPS, 2017).<\/p>\r\n

Social policies and programs, which prioritize individuals in social vulnerability, must take particular care. The cognitive load of poorer individuals tends to be higher due to the large number of decisions they need to make due to scarcity (Lichand et al. 2022). As theorized by Banerjee and Duflo (2012), there are a series of decisions that most individuals in more developed countries do not need to make because their environment already takes care of them (such as access to clean piped water and reliable health services). These decisions are barely noticed as they are deeply embedded in the system, allowing people to take better care of themselves and be free from such concerns.<\/p>\r\n

Understanding how the contexts of social and economic vulnerability affect individuals' behaviours in the implementation of public policies is an expanding agenda. Complex problems, like widespread nutritional deficiencies, demand public policies formulated with attention to structural issues (financial, human, technological, logistical and scarcity of resources), and behavioural attitudes of users and implementing bureaucrats.<\/p>\r\n\r\n

2.2 Results <\/em><\/h3>\r\n

In total, 97 members of the school community and program management in the health sector participated in the various stages of the project, with some members attending more than one meeting. Preschool teachers (43.3%) and caregivers (19.6%) were the most prevalent participants throughout the stages of the project. It is noteworthy that daycare centre directors had low participation throughout the research, revealing a low level of engagement from the tactical management level in the development of the planning.<\/p>\r\n

In data analysis, we built a decision map (Figure 1). This map focused on the choices that took place in daycare centres. Rectangles represent the flow of action and diamonds represent the decision behaviours. The map revealed five main behavioural problems, further discussed below:<\/p>\r\n\r\n