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Municipalities employ cooperation strategies to build instruments for economic and administrative rationalization and overcome difficulties in public service execution. One of these instruments is inter-municipal public consortia, which simultaneously cover multiple areas of activity. The health sector has the most consortia and participation from municipalities. The Intermunicipal Health Consortium of the Northwest of Rio Grande do Sul (CISA) is one of these consortia; it was established in 1997 and covers 47 municipalities in the northwestern region of the state. CISA establishes agreements with doctors and clinics for consultations and specialized tests and procures medicines for associated and partnered municipalities. Given this context, this article analyzes the relevance of Public Health Consortia for municipalities, particularly small ones. The study uses quantitative methods, such as analyzing reports from CISA and municipalities (Augusto Pestana, Bozano, and Panambi in Rio Grande do Sul), and qualitative methods based on interviews with Municipal Health Secretaries and Consortium managers. The data obtained, both from CISA and the Municipal Health Departments, show the importance of the consortium for the municipalities and the significant values involved in the eight years of training, as well as the fact that it constitutes the alternative with the greatest feasibility in overcoming demands and difficulties, especially in small municipalities. [ABSTRACT FROM AUTHOR]

There are 5,570 municipalities in Brazil, of which 1,253 have less than 5,000 inhabitants. The Proposed Amendment to the Constitution no. 188/2019 proposes incorporating part of these municipalities into neighboring municipalities with more significant financial capacity; the municipality's revenue is the second criterion provided for in this legislative instrument. Given this context, this study sought to show that municipalities with fewer than 5,000 inhabitants collect more than the municipalities of the group with a larger population per inhabitant. Even the administrative expenses of these small municipalities are not significantly higher. The social rights of citizens, which are provided for in the Federal Constitution, are more efficiently served in smaller municipalities if the per capita values are considered. For instance, in some of the budgetary functions (e.g., health), the differences in investment volumes are quite high. Additionally, small municipalities act as promoters of development by encouraging economic activities and do so with larger investments, once again using the citizen as a unit. Therefore, it is not appropriate to prejudge and condemn municipalities solely based on the number of inhabitants and the amounts they collect. The municipalities, first and foremost, are proponents and executors of public policies where financial profit cannot be constituted as an evaluation measure. [ABSTRACT FROM AUTHOR]

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