Responses to COVID-19 have included top-down, command-and-control measures, laissez-faire approaches, and bottom-up, community-driven solidarity and support, reflecting long-standing contradictions around how people and populations are imagined in public health-as a 'problem' to be managed, as 'free agents' who make their own choices, or as a potential 'solution' to be engaged and empowered for comprehensive public health. In this rapid review, we examine community-engaged responses that move beyond risk communication and instead meaningfully integrate communities into decision-making and multi-sectoral action on various dimensions of the response to COVID-19. Based on a rapid, global review of 42 case studies of diverse forms of substantive community engagement in response to COVID-19, this paper identifies promising models of effective community-engaged responses and highlights the factors enabling or disabling these responses. The paper reflects on the ways in which these communityengaged responses contribute to comprehensive approaches and address social determinants and rights, within dynamics of relational power and inequality, and how they are sometimes able to take advantage of the ruptures and uncertainties of a new pandemic to refashion some of these dynamics.

Aim This article offers a brief description and analysis of public participation in health in Brazil and England in order to highlight different motivators and tensions within an acceptance of participation as official policy.Sources ⁄ methods The article draws on a range of research in both countries and an analysis of official documents relating to participation. It is based on collaboration between researchers deriving from broad programmes of work on public participation in which the authors are involved.Argument There is a tension between different principles underpinning collective public involvement in health both within and between countries. Different aspirations or claims have been made about what such participation will achieve and there are trade-offs between design principles that have consequences for issues such as who takes part and thus also for what can be achieved. The democratic origins of public participation are more evident in the Brazilian situation than in England, but there are still questions about the inclusivity of the practices through which this is achieved. The English picture is both more diverse and dynamic, but formal decision-making power of participatory forums is less than in Brazil. Whilst social justice claims for participation have been made in both countries, there is as yet limited evidence that these have been realized. Social participation in health in Brazil and EnglandGreater public participation in policy-making is evident in countries of the global North and South. Health services and policy-making are the focus of such participation in many countries where political systems and cultures, demography and the balance between state, private and NGO action on health is hugely varied. This paper draws on collaboration between researchers in England and Brazil to offer a comparative analysis of the way in which collective participation in health policy-making has developed and the different principles and purposes on which this is built. We identify four purposes that are evident to different degrees at different times and in each country: (i) deepening

Abstract

The need to respond to the COVID-19 pandemic has created challenges for services delivered by frontline workers (FLW). This paper analyzes how the Brazilian government regulated the reorganization of Primary Health Care (PHC) and how FLW responded to these initiatives, comparing the roles played by nurses and community health workers. Given the multilevel health system, it was expected that the high level of ambiguity would stimulate innovations. However, data show that the ambiguity created different situations for each profession. While nurses were able to adapt their work and act with more autonomy, CHW lost their role in the policy.

Este artigo discute a experiência brasileira dos Conselhos de Saúde. De início, faz uma revisão da literatura que analisa os fatores que contribuem para a "legitimidade democrática" dessas experiências. Em seguida, são apresentados os resultados de um estudo realizado com os Conselhos Locais de Saúde das 31 subprefeituras da cidade de São Paulo.Na conclusão,discute-se,à luz desses resultados,a importância relativa dos diferentes fatores identificados pela literatura como centrais para o estabelecimento da legitimidade democrática desses "novos espaços democráticos".PALAVRAS-CHAVE: Conselhos de Saúde; São Paulo; legitimidade democrática; espaços democráticos. SUMMARYThis article discusses the Brazilian experience of the Health Councils.At first,it reviews the literature concerning factors that contribute to the "democratic legitimacy" of these experiences. Next,it presents results of a study made with Local Health Councils of the 31 subdistricts of the city of São Paulo. In the conclusion, it discusses the relative importance of different factors identified by this literature as keys to establish the democratic legitimacy of these "new democratic spaces".KEYWORDS A idéia de tornar a democracia mais inclusiva não é nova: ela está presente, por exemplo, na defesa da representação proporcional como um sistema que cria mais oportunidades do que a regra da maioria para a representação de minorias. E também está presente no esforço de multiplicar e fortalecer espaços para deliberação no interior do Congresso.Mas foi sobretudo a partir de meados dos anos 1970 que a participação e a deliberação nos "novos espaços democráticos", criados na esfera estatal ou na esfera pública,nos níveis local,nacional ou internacional, começaram a ser defendidos como fundamentais para tornar o sistema democrático mais inclusivo 2 .Esses "novos espaços" têm como fundamento a idéia de que boa parte da atual incapacidade das políticas públicas em promover mudanças substantivas no O paradoxo de atrair não aliados 1

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As a means of dealing with shortcomings in the coverage, quality and efficiency of the public health care sector, several municipalities in the state of São Paulo, Brazil, have started to contract pre-certified non-profit or non-governmental organizations to take part in the delivery of health care services.This paper explores the impact of introducing these contracts in the primary health care sector. Using data on the 645 municipalities in the state of São Paulo and difference-in-differences methods, we estimate the effect of contracting out in the primary health care sector on various dimensions of mortality and health care use. The results show that implementation of the contracting out strategy significantly increases the number of primary health care appointments by approximately one appointment per user of the national health care system per year. Point estimates indicate a reducing effect on hospitalization for preventable diseases.

This paper discusses the causal nexuses between participatory governance and development through theoretical debate and research that empirically investigates this relationship. It starts by discussing literature on participation and then goes on to deal with the most relevant contributions to international debates about development. Next, departing from two of the principal explanations presented in studies about participatory democracy -institutional design and social mobilization -it analyzes empirical evidence that supports the relationship between participation and development. Finally, in light of this discussion, some conclusions are presented concerning the causal nexus capable of supporting the belief in the potentially virtuous relationship between participation and development.Early literature on participation was broadly optimistic about what participatory governance could achieve in terms of public policies and democracy, often assuming that participation could contribute to more viable and just policies, and have a positive impact on poverty, inequality and development processes. More recently, studies have become more focused on the real conditions under which forms of participatory governance have evolved.These studies have focused on: the dilemmas of emphasizing either efficiency or the inclusion of the poorest in institutional design (Abramovay et al. 2010;Bebbington et al. 2008); the difficulties of checking the distributive impacts of participatory experiences (Avritzer 2007); the disjunction between the motives and resources mobilized by the agents responsible for organizing participatory spaces; the technical and economic dimensions involved in processing the problems dealt with in these spaces (Coelho 2006;Coelho and Favareto 2007;Dagnino and Tatagiba 2007); and the fragility of the connections between deliberative experiences and governance (Favareto and Demarco 2004;Melo and Baiochi 2007). There is a lack of evidence about the causal nexuses capable of supporting the link between participation and development.The belief in participatory governance associates the inclusion of a broad spectrum of citizens in public life with an increased circulation of information, greater transparency in political processes, and participation in public debate. The democratization of debate and decision-making, together with decentralization, are key elements in an intricate process of improving systems of governance which should contribute toward giving impetus to development.This belief is based upon the combination of two analytical perspectives. The first suggests that changes in the design of the institutions can contribute to promoting changes in policy. The second draws attention to the role of social actors and their capacity to push for change in processes of development. In both approaches, participation can promote access to public policies, and their quality and responsiveness.