Supplementing a traditional focus on economic dimensions of development, sociologists now frequently examine the origins of macro-level growth in human capabilities. One emergent theoretical framework for doing so emphasizes the promise of “twenty-first-century developmental states” for broadening delivery of capability-enhancing public services like health and education. Nevertheless, the configurations of state-society actors that are consistently willing and able to construct such institutions are far from obvious, highlighting a missing-agent problem at the core of the framework. The article addresses this gap by tracing Brazil's historic improvements in social development to what I call “programmatic configurations,” or broad-based alliances of civil and political society actors that ameliorate vexing public problems by building democratic institutions and state capacities needed to enact rights-based social policies. It argues that frequent local office-holding by “sanitarista” activists from the country's most important health movement, the Sanitarist Movement, has been essential for constituting the programmatic configurations that maximized social development across urban Brazil in recent decades. More specifically, a brief historical account of the movement and fuzzy-set analysis show that programmatic configurations assembled by sanitaristas in Brazil's largest capitals have generally been a sufficient condition for maximizing improvement over time in three outcomes: infant-mortality reduction, municipal spending on health and sanitation, and municipal delivery of primary public health care. I correspondingly argue for broadening the twenty-first-century developmental state framework to accommodate how programmatic configurations—and the pragmatically inclined civil society activists at their core—can contribute to democratic state-building for social development.

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