Lucas, Simone D.; Campomizzi, Jader B. A participação cidadã no controle do Sistema Único de Saúde em Belo Horizonte. [Citizen participation in the control of the single health system in Belo Horizonte.] In: Campos, Cezar R.; Malta, Deborah C.; Teixeira dos Reis, Afonso; Dos Santos, Alaneir; Merhy, Emerson E. Sistema Único de Saúde em Belo Horizonte. Reescrevendo o público. [The Single Health System in Belo Horizonte. Rewriting the public.] São Paul Xamá Editora, 1998. p. 51-80
Objectives: To analyze: a) the origins of citizen participation in the Brazilian health system, b) the process by which local health councils and commissionswere created in Belo Horizonte, in particular the role of municipal councils, c) the principal issues addressed by the councils during the government of the Popular Front in Belo Horizonte, and d) the process by which ordinary citizens consolidated and exercised control over the health system on the municipal level.
Methodology: Qualitative, analytical, and interpretive.
Results: The authors begin their analysis by placing the origins of community participation in historical context. They analyze its beginnings in the United States. In contrast to the U.S., where the movement declined in strength, it gained strength in Brazil, following its inception in 1970. Thus in Brazil, one moves from the concept of community participation (generally subordinated to government interests), to that of social control exercised by citizens themselves (active and independent participation). Such control is exercised over both the fulfillment of policies committed to by governments and the initiatives undertaken by healthcare institutions.
The authors trace two intertwined processes carried out in Brazil: democratization affecting society in general and democratization affecting healthcare in particular. The development of the National Conferences on Healthare described, as is the impact of the 1988 VIII Conference on Constitutional Reform, which led to the creation of the Single Health System.
These reforms gave legal impetus to the creation of the National, State, and Municipal Health Councils. The following groups comprised Council membership: 50% assigned to users of the system, 25% to government officials and providers, and 25% to healthcare workers.
The authors analyze an eight-year period (1990-98) during which this system operated in Belo Horizonte. The difficulties in democratizing the process, especially concerning the assurance that the government would implement decisions made by the Council. Similarly, the authors analyze the important achievements made in the growth of citizen participation over decisions about healthcare policies and management and in the consolidation of the Council as a consultative agency affecting the management of healthcare on the municipal level.
Conclusions: Meaningful citizen participation in the exercise and control of healthcare policies emerged in Belo Horizonte. This participation deepened due to the historical context of broader political processes at the municipal, state, and national levels.
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