Participative Typologies: A Comparative Study Among Health Councils in Montevideo, Uruguay and Porto Alegre, Brazil

Research Problem And Objective

The participative movement path, searching for an identity that could assure larger legitimacy in the social politic context of Public Health in Latin America, has been permeated by evolutions and retreats. The demanding process for the quality improvement of health public services became a historical mark for its delineation, starting from what it was extolled by the international agencies for the developing countries, settling down the promotion of the economical self-support and community participation. In countries like Brazil and Uruguay, where the population has had an active role through local councils, there is recognition of public claiming necessity, making the social dimension of the participative process a part of the national agenda.

In Brazil, since the Constitution of 1988, health services and actions have become a universal right of all citizens and a State obligation. The Constitution determines that those services should be decentralized, having a municipal administration in partnership with the civil society by a participative municipal health council, a deliberative and paritary instance, where there is a cooperative relationship among users, representatives, governmental staff, employees and health professionals. By doing so, the councils become a political and public space where the population’s interests are formally and openly acted out (Cortes, 1996), exercising the social control on the production and consumption of the health services (Final Report of the 8^th Health National Council/ CNS).

In Uruguay, the councils act as the population’s spokesman, presenting their needs, demands and proposals to the national and municipal authorities. These councils are recognized by the municipal legislation and are also integrated by social, cultural and sports organizations that contribute to their neighborhood development. The ascension of the left and center-left political parties in the 90’s, constituted an inflectional point of the political articulation modalities experienced in the country until then (Schelotto, 2002). Considering that:

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  The participation is a constant dynamically evolving process, where groups share needs, adopt decisions and establish mechanisms for assistance, seeking for collective interest heading for the social emancipation (Silva, 1999, p. 32).

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  The population, in general, ignores the importance of the municipalization of health actions and services. People need to be well-informed in order not to be manipulated concerning their decisions (Cardoso, 1985).

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  The welfare State is in crisis, consequently, there aren’t enough resources available in order to assist the population health needs.

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  In most cases, the health councils are controlled by the administrators and become vehicles for legitimating health policies other than the needed ones (Neder, 1996).