Brazil's Health Councils: The Challenge of Building Participatory Political Institutions

Coelho, Vera Schattan P.

doi:10.1111/j.1759-5436.2004.tb00119.x

Cited by 33 publications

(21 citation statements)

References 7 publications

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“…Those with greater individual and collective social capital are more engaged (Jenkins 1983;Verba, Schlozman, Brady, and Nie 1993;Bekkers 2005). Thus, a central concern of the participation literature is how to level the field to provide fairer access to participation (Forester 1989;Coelho 2004).…”

Section: Resources and Participationmentioning

confidence: 99%

Generating Resources and Energizing Frameworks Through Inclusive Public Management

Feldman

Quick

2009

International Public Management Journal

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Section: Resources and Participationmentioning

confidence: 99%

Generating Resources and Energizing Frameworks Through Inclusive Public Management

Feldman

Quick

2009

International Public Management Journal

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“…As a result, civil society membership often reflects a pre-existing network of relationships between organized civil society groups and the government, excluding groups that lack such government ties and organization, which may also be the most marginalized, from decision-making (Table 1) [1].

Most of the studies about PHCs say that the health councils are important because they represent society.

…”

Section: Resultsmentioning

confidence: 99%

Participatory health councils and good governance: healthy democracy in Brazil?

Köhler

Martinez

2015

Int J Equity Health

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IntroductionThe Brazilian Government created Participatory Health Councils (PHCs) to allow citizen participation in the public health policy process. PHCs are advisory bodies that operate at all levels of government and that bring together different societal groups to monitor Brazil’s health system. Today they are present in 98% of Brazilian cities, demonstrating their popularity and thus their potential to help ensure that health policies are in line with citizen preferences. Despite their expansive reach, their real impact on health policies and health outcomes for citizens is uncertain. We thus ask the following question: Do PHCs offer meaningful opportunities for open participation and influence in the public health policy process?MethodsThirty-eight semi-structured interviews with health council members were conducted. Data from these interviews were analyzed using a qualitative interpretive content analysis approach. A quantitative analysis of PHC data from the Sistema de Acompanhamento dos Conselhos de Saude (SIACS) database was also conducted to corroborate findings from the interviews.ResultsWe learned that PHCs fall short in many of the categories of good governance.Government manipulation of the agenda and leadership of the PHCs, delays in the implementation of PHC decision making, a lack of training of council members on relevant technical issues, the largely narrow interests of council members, the lack of transparency and monitoring guidelines, a lack of government support, and a lack of inclusiveness are a few examples that highlight why PHCs are not as effective as they could be.ConclusionsAlthough PHCs are intended to be inclusive and participatory, in practice they seem to have little impact on the health policymaking process in Brazil. PHCs will only be able to fulfil their mandate when we see good governance largely present. This will require a rethinking of their governance structures, processes, membership, and oversight. If change is resisted, the PHCs will remain largely limited to a good idea in theory that is disappointing in practice.

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“…The membership guidelines effectively create a restrictive level of civil society inclusion, whereby only those who are willing to participate and have the means to form an organized civil society group can qualify for membership. A prior study on the State Health Council of São Paulo also concluded that membership guidelines create “a pre-existing network of relationships among representatives of government and social movements” and exclude those that lack the means to form such ties [13]. …”

Section: Discussionmentioning

confidence: 99%

“…This focus on civil society participation grew out of the Sanitarista movement, which advanced the decentralization of Brazil’s health system and universal health coverage for the population. This same social movement promoted the establishment of Health Councils in 1990 to provide a forum for civil society participation in the implementation and monitoring of health policies for social accountability ( control social in Portuguese) at the municipal, state and federal levels [13–15]. Today, these councils serve as advisory bodies with an ambitious mandate that includes monitoring the health system and the allocation of resources, bringing together civil society groups, heath professionals, and government officials.…”

Section: Introductionmentioning

confidence: 99%

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Civil society participation in the health system: the case of Brazil’s Health Councils

Martinez

Köhler

2016

Global Health

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BackgroundBrazil created Health Councils to bring together civil society groups, heath professionals, and government officials in the discussion of health policies and health system resource allocation. However, several studies have concluded that Health Councils are not very influential on healthcare policy. This study probes this issue further by providing a descriptive account of some of the challenges civil society face within Brazil’s Health Councils.MethodsForty semi-structured interviews with Health Council Members at the municipal, state and national levels were conducted in June and July of 2013 and May of 2014. The geographical location of the interviewees covered all five regions of Brazil (North, Northeast, Midwest, Southeast, South) for a total of 5 different municipal Health Councils, 8 different state Health Councils, and the national Health Council in Brasilia. Interview data was analyzed using a thematic approach.ResultsHealth Councils are limited by a lack of legal authority, which limits their ability to hold the government accountable for its health service performance, and thus hinders their ability to fulfill their mandate. Equally important, their membership guidelines create a limited level of inclusivity that seems to benefit only well-organized civil society groups. There is a reported lack of support and recognition from the relevant government that negatively affects the degree to which Health Council deliberations are implemented. Other deficiencies include an insufficient amount of resources for Health Council operations, and a lack of training for Health Council members. Lastly, strong individual interests among Health Council members tend to influence how members participate in Health Council discussions.ConclusionsBrazil’s Health Councils fall short in providing an effective forum through which civil society can actively participate in health policy and resource allocation decision-making processes. Restrictive membership guidelines, a lack of autonomy from the government, vulnerability to government manipulation, a lack of support and recognition from the government and insufficient training and operational budgets have made Health Council largely a forum for consultation. Our conclusions highlight, that among other issues, Health Councils need to have the legal authority to act independently to promote government accountability, membership guidelines need to be revised in order include members of marginalized groups, and better training of civil society representatives is required to help them make more informed decisions.

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Brazil's Health Councils: The Challenge of Building Participatory Political Institutions

Cited by 33 publications

References 7 publications

Generating Resources and Energizing Frameworks Through Inclusive Public Management

Generating Resources and Energizing Frameworks Through Inclusive Public Management

Participatory health councils and good governance: healthy democracy in Brazil?

Civil society participation in the health system: the case of Brazil’s Health Councils

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