Vargas Cortes SM. Conselhos Municipais de Saúde: a possibilidade dos usuários participarem e os determinantes da participação. [Municipal Health Councils: the possibility of user participation and the determinants of such participation.] Ciência e Saúde Coletiva [Science and Collective Health] 1998; III(1):5-17.

Objectives: Critical review of the international literature, which notes the difficulty of creating channels of participation in Latin American countries. Analyze participation on the Municipal Health Councils in Brazil , which contradicts the findings of prior literature.

Methodology: Bibliographic review. Analytical and interpretive.

Results: The international literature concludes it is very difficult to create channels of popular participation in the developing countries, particularly in Latin America . This difficulty is due to the weaknesses of political institutions and of civil society. In the area of health, initiatives undertaken to promote participation have resulted in failure.

T his general assertion, however, is not confirmed by the Brazilian experience with Municipal Health Councils. The article analyzes the historical context in Brazil out of which these participatory processes emerged and developed, together with the appearance of the new trade union and social movements in the country.

The article also analyzes the determinants of success within this participatory process. Several determinants are analyzed: 1) changes in the institutional structure of the Brazilian healthcare system; 2) the organization of social and trade union movements in the cities; 3) the links between healthcare workers employed in local healthcare offices and among union and popular leaders; 4) the support given to popular participation by federal, state, and municipal health authorities; 5) the manner in which the Councils functioned. These determinants are all closely interrelated and mutually reinforcing, although the first two are considered the most influential. Participation has been hindered when it confronts entrenched elitist attitudes and paternalistic practices.

Conclusions: The reform of the Brazilian health system created a participatory forum that contributed on the level of municipal government to democratizing the decision-making process in the healthcare sector. By means of these participatory forums, the representatives of social and trade union movements could influence the deployment of resources in the public sector, obtain information, oversee the quality of services offered, and influence the formulation of policies that favored the social sectors which they represent.

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