No abstract

Users' and leaders' perceptions of the current barriers and opportunities seemed to show that they are critical of their own reality and constitute important potential actors for becoming key interlocutors with institutions and the state. A similar attitude would be necessary on the part of institutional actors to build a real and permanent participatory culture.

Los sistemas de salud en Colombia y Brasil incluyen políticas que promueven la participación de la población en el control de la calidad de los servicios de salud. El objetivo del artículo es analizar la percepción de usuarios y líderes de ambos países sobre su capacidad para lograr cambios en los servicios de salud. Se realizó un estudio cualitativo, exploratorio y descriptivo mediante grupos focales y entrevistas individuales a usuarios y líderes en Colombia y Brasil. La gran mayoría de usuarios y líderes se perciben con capacidad de inducir cambios que mejoren la calidad de los servicios de salud. Capacidad que atribuyen fundamentalmente a factores internos, relacionados con su comportamiento participativo y únicamente a un factor externo, la existencia de espacios de participación en las instituciones. La ausencia de capacidad se relacionaba con actitudes conformistas y temor a las represalias - sólo en Colombia. La existencia de una población con alta capacidad de logro percibida se revela como potencial a fortalecer, al tiempo que se mejora la apertura democrática de las instituciones, para aumentar la efectividad de las políticas de participación en salud.

The results indicated scarce knowledge and little use of social participation in health mechanisms (market-based ones predominating). Much greater investment in information and training the population and health system personnel is required as a first step towards promoting real social participation for social control of the health system.

This article seeks to analyze changes in awareness and utilization of social participation mechanisms of the Colombian health care system in the last 10 years by comparing two cross-sectional studies based on surveys among health care users in 2000 and 2010. The results show that while in 2000, the level of awareness and utilization of the mechanisms were low, in 2010 researchers identified a significant tendency toward further diminishing of awareness and utilization. In both surveys, the best-known and most-used participation mechanisms were the market mechanisms. Also in both surveys, individuals from the rural zone were aware of and used the mechanisms. In the first survey, men were more aware of the mechanisms and used them more frequently, but it was women in the second survey who presented higher rates of awareness and use; these differences, however, were not statistically significant. The results herein indicate that effective social participation in the General Social Security System in Health is far from being achieved. The policy has failed to materialize, as evidenced by the lack of balance in the participation of one of the main actors of the General Social Security System in Health: the users.