Abstract
The research developed in this study is an analysis of the National Health Council and the Subnational Councils, formed by the State Councils and Municipal Health Councils. It is a way of understanding the construction process of public policy networks and its role as the main citizen participatory space institutionalized by law in Brazil. This study presents the results obtained from a survey developed between the years 2006 to 2010, at the University of Brasilia. Its objective is to seek a broadening of citizen participation spaces supported by Information and Communication Technologies (ICTs), to form an effective network for constructing sectorial policies in Brazilian healthcare. The current work aims to fill in a gap in studies about improving citizen participation in Brazil, in order to establish new ways for expanding the network formed by the councils and the consequent improvement in the collaborative spaces within the decision making process.
TopIntroduction
Democratic Brazil is known for its participative institutions. During the elaboration of the 1988 Federative Constitution of Brazil1, citizen participation spaces were created in several sector areas, including healthcare, social work and education. They are called Councils of Public Policies.
The research developed and described in this study is an in-depth analysis of one of the oldest Brazilian citizen participation spaces, the National Health Council and the Subnational Councils, formed by the State Councils and Municipal Health Councils. It is a way of understanding the construction process of public policy networks and its role as the main citizen participatory space institutionalized by law in Brazil, in the context of a representative democracy.
This work aimed to fill in a gap in studies about broadening and improving citizen participation in Brazil. The idea is that the study may contribute to establishing new ways for expanding the network formed by the councils and the consequent improvement in the collaborative spaces within the decision making process, stemming from the political network formed by the National Health Council and subnational Councils.
In accordance with the Brazilian Constitution (1988), the councils have legal jurisdiction in which there is an institutionalized space that provides for direct citizen participation, in constructing public policies. In accordance with its statute, the National Health Council was created like a commission, having different social sectors represented. The formation of the councils, in accordance with Federal Law number 8.142/90, paragraph 2° defines that the makeup of such institutions must be composed of different actors, who act in controlling the execution of healthcare policies. Health Councils are to be established by the law’s regulations and under the possibility of effective participation of organized civil society, which represents a pole for qualifying citizens to put into action Social Control in other spheres where the State acts.
The Health Council be it, National, State or Municipal in its constant and deliberative character is a collegial body composed of representatives of the government (managers), service providers (private entities), professionals of the Sistema Único de Saúde or the National Healthcare System (SUS). Its activities take place via the formulation of strategies and in the control of executing healthcare policies in the corresponding institution, including the economic and financial aspects, whose decisions are approved by the head of the legally constituted power in every sphere of government (BRAZIL, 1990).
Based on this, the current study presents the results obtained from a survey developed between the years 2006 to 2010, at the University of Brasilia. Its objective is to seek a broadening of citizen participation spaces supported by Information and Communication Technologies (ICTs), to form an effective network in for constructing sectorial policies in Brazilian healthcare.
The use of ICTs in expanding citizen participation spaces is justified by the continental distance that Brazil is endowed with as well as by the inequality of opportunity, access to information, complex government structure, experienced by the country after the Brazilian State was decentralized. We start with the principle that the structuring of government information and its availability must be in agreement with the necessities of the citizen. So, by using ICTs, access to information could be promoted and also the possibility that citizens with little or no familiarity with government processes and structures may also be able to increase their participation (Takahashi, 2000).
In Brazil, the National Councils, organs connected to the federal government, are institutions that allow the most direct connection between the citizen and power, since it is the institution that provides for institutionalized participation through laws and its internal rules. This fact justified choosing the National Health Council and subnational Councils as an object for studying Brazil’s social reality. Added to this, the Health Councils are a reality in 26 states and in the Federal District and in 5.700 Brazilian municipalities. Without its presence at every point in the Federation, there would be no planning of Brazilian healthcare policies.
Key Terms in this Chapter
The National Department of Health Councils: Created on February 3rd, 1982, with its headquarters in Brasilia, the council has the aim of representing the State and Federal District Departments of Health and it is made up of the State and Federal District Departments of Health – which are effective members – and by formal representatives while they are title holders of the referred to Departments.
Ministry of Health: The Ministry of Health is an organ of executive federal power responsible for the organization and elaboration of plans and public policies geared towards promoting, preventing and assisting Brazilian healthcare.
Municipal Department of Health Councils: Emerged from a social movement on behalf of public healthcare and became legitimate as a political force which assumed the mission of aggregating and representing the group of all municipal departments of health in the country.
Collaborative Spaces: Are spaces of citizen participation responsible to create a dialog channel between government and social spheres, including the straight participation of the citizen. Such spaces act like fields of interaction and information source in the context of the formulation of public policy. The Collaborative Spaces promote the exchange and the discussion of important topics for the formulation of Public Policy.
Brazilian Constitution: The Constitution of the Federative Republic of Brazil of 1988 is the current fundamental and supreme Brazilian law, serving as a measure of validity for all of its normative variants, and is situated at the top of the legal system. It is the seventh constitution to govern Brazil since its Independence.
The State Departments of Health: Organs that act together with the national health councils, discussing and deliberating on national, state and municipal healthcare policy. Its activities along with the federal government are also aimed at serving public healthcare in Brazil. They should carry out with the Municipal Department of Health Councils harmonious activities concerning healthcare policy, being able to support them technically and financially.
National Health Council: The National Health Council (CNS) was created in 1937 by law no. 378, which instituted a consultative body where members were nominated by the minister of state. The structure as it is formed today, is intended for, among other matters, acting in the formulation of strategies and in controlling the execution of the National Healthcare Policy in the Federal Government sphere. This includes financial and economic aspects; establishing guidelines to be observed when developing health plans; due to epidemiological characteristics and of the organization of services, elaborating schedules for transferring financial resources to the States, the Federal District and to Municipalities linked to the National Healthcare System; and in proposing criteria for defining assistance standards and parameters.
Social Network Analysis: All four of these features are found in modern social network analysis, and together they define the field: i) Social network analysis is motivated by a structural intuition based on ties linking social actors; ii) It is grounded in systematic empirical data; iii) It draws heavily on graphic imagery, and iv)It relies on the use of mathematical and/or computational models. (Freeman, 2004).
Public Policy Networks: The Public Policy Network aims to promote communication and collaboration among researchers, policy makers and practitioners across Brazil and beyond. The Public Policy implemented by the Brazilian political contemporary system is a result of a complex and continuous interaction between several actors, inside and outside the government. This interaction does not take place in an organizational vacuum. It has many particular structural characteristics, which create limits and means for these actors acting. The underlying structure to this interaction is called Public Policy Networks.
Critical Systems Heuristics: Methodology based on the Critical Systems Heuristics for development of social planning. The participants of the social planning are the ones who are directly affected and wrapped. The affected ones are considered part of the system and the wrapped ones are the actors responsible for the formulation and execution of the social planning.
Citizen participation: The Citizen Participation is the active participation of the citizens in the society, which includes all forms of participation, political, social, cultural or economical, as well as the combination between them, for example, social economic or social cultural.