The role of partnerships in promoting physical activity: the experience of Agita São Paulo.

Strategic partnership is a logical approach to face some of the public health problems. However, its application is somewhat more complex. In this paper our experience with three networks (Agita São Paulo, Physical Activity Network of Americas, and Agita Mundo Network) was described. In the case of Agita São Paulo even the name was a consequence of a partnership with a marketing company, and is an idiomatic expression that means much more than just to move your body. It also means to move psychologically and socially, with the concept of "active citizenship". Among the important features of that intervention, we highlighted: (a) national and international intellectual partnership; (b) strong institutional partnerships, including government in one hand, and non-governmental and private sector in the other hand, in a so called: "two-hats approach"; (c) minimal formalization/maximal flexibility; (d) a signed letter of agreement: an active symbol of institutional commitment; (e) use the "mobile management" adaptation of the ecological model, in which attention was given to intrapersonal, social, and physical environmental factors, in a dynamic way; (f) attention to inter-sectoral as well as to intra-sectoral partners, in which creates incentives for participation of more than one representative from each sector; (g) the inclusion principle, that was not restricted to the institution, but affected the program actions, materials, and particularly the messages; (h) a high level of legitimacy of the coordination institution in the leadership; (i) special attention to improve environment supports for physical activity, such as: strategic partnerships established with the Metro System, that serves over 1 million persons/day; the Truck Drivers Radio Station; the State Secretariat of Environment, that built a walking path around its main building; the city of São Caetano do Sul, with the healthy sidewalk program; the city of Santana do Parnaiba building a walking path around the outpatients clinic, as well as the establishment of a fitness room in the basic unit of health; and Sorocaba, a city of 600,000 inhabitants, that after 4 years of the program of building walk and bike pathways, and parks, found a decrease in hospitalization of 50% by stroke, and 57% of diabetes type 2. A recent paper has shown that sedendarism has declined relatively about 70% from 2002 to 2008 in the State of Sao Paulo, and World Bank has reported that Agita represents a saving of 310 million US dollars per year in the health sector of Sao Paulo. All this scenario strongly suggests that the social issue in the developing countries facilitates the success of strategic partnerships.