This paper analyzes the Brazilian Sanitary Surveillance System as an arrangement aimed at regulating and reducing health risks associated with consumption of products, use of health services and the environment. Historical, political and tax aspects were considered and their development compared with the National Health Surveillance System, which has received strong international cooperation. The comparison was based on the trajectory of their national systems and related federal agencies, as well as on criteria adopted for decentralization. The central category of analysis is federative coordination and was based on the framework of federalism and intergovernmental relations. The institutional context of health and sanitary surveillance presents strong political competition, instability in the project and probable reduction of the ability of federal coordination after the Pact for Health. The National Sanitary Surveillance System due to its nature of public good and high externality in its field of action requires federal coordination for increasing the regional and local cooperation, also because of the structural heterogeneity of Brazilian municipalities.