The Local Health Councils (LHC) in Brazil: From non-design to a Poor Policy Design space

Abstract

The Local Health Councils (LHC) in Brazil is one of the most interesting policy innovations of contemporary Brazilian health reform. Formulated at a time of intense social and institutional change, the LHC can be understood as a social policy resulting from the struggles against the military dictatorship (1964 to 1985) and the battles for hegemony in conducting the re-democratization process. Part of the major health reform that created the Unified Health System (UHS) and produced important changes in the institutional design of the Brazilian state, the Local Health Councils originate in a set of laws that promote decentralization and popular participation, allowing Brazilian citizens to oversee and deliberate about health issues on the local level. Considering that not all policymaking processes are logical or rational in an instrumental sense, and considering that the government capacity is very significant for successful formulation and implementation, this paper adopts the "model of policy capacity" (Howlett et al., 2015) to explain the situation of "Poor Policy Design Space" of the Local Health Councils in Brazil.