Case study

Giving people a space in Brazil's health councils

Brazil's system of health councils and conferences offers inspiring lessons. Thousands of Brazilian citizens, representing churches, women's associations, unions and community groups, meet every month with people who provide health care.

Individuals and groups come together with health worker delegates in municipal health conferences every two or four years. Chosen delegates from civil society then attend a national level conference. Good ideas can find a place and take form in policy proposals that are debated, contested and refined as they move up from municipal to national level.

Is participation in health councils monopolised by groups having political ties with public health managers? Could the participation of particular groups be linked to the way that meetings are designed, how the participatory process is managed and how civil society groups act?

Research carried out in 31 local health councils in S‹o Paulo looks at whether people from all sections of civil society are fairly represented.

Findings show that:

• Fifty percent of the seats in the health councils are reserved for civil society. The rest are divided equally between service providers and public officials: this distribution gives a better opportunity for citizens and civil society organisations to voice their views.
• The selection process of the councillors varies from council to council, but the more open and transparent the selection process, the more inclusive the council.
• Inclusive measures include making information on the election process available, listing all the associations and movements in the region, using radio or newspapers to publicise elections, granting candidatures to individuals as well as organisations.
• Discussion techniques are used to help groups to communicate and express themselves better. Some civil society groups have less information and communication material, and find participatory techniques help them articulate their demands better.

While the system is not perfect, it does show that if the conditions are right, participation can be effective and democracy can be strengthened.

Vera Schattan P. Coelho
Centro Brasileiro de Análise e Planejamento — CEBRAP, R. Morgado de Mateus, 615, 04015-902 S‹o Paulo, Brazil
veraspc@uol.com.br

See also

'Brazilian Health Councils: Including the Excluded?' by Vera Schattan-Coelho, in Spaces for Change? The Politics of Citizen Participation in New Democratic Arenas, Zed Books: London, edited by Andrea Cornwall and Vera Schattan Coelho, 2007

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