Participatory budgeting and health and wellbeing: a systematic scoping review of evaluations and outcomes

Abstract

BackgroundParticipatory budgeting enables communities to decide how public funds are spent, with citizens deliberating among themselves and sometimes with government officials, and ultimately deciding how to allocate funds for public goods. This process has been increasingly implemented across the UK, Europe, and worldwide and is endorsed as good practice by institutions including the World Bank and the UN. It is unclear which evaluations have been conducted on the impact of participatory budgeting on health and wellbeing. This scoping review assessed the study design, analysis, outcomes measured, and location of evaluation studies reporting on health, social, political, or economic outcomes of participatory budgeting. MethodsWe searched 21 databases (appendix), with no restrictions on publication date or language. The search term “participatory budget” was used as the relevant global label for the intervention of interest. Studies were included if they reported primary data or original analysis of health, social, political, or economic and budgetary outcomes of participatory budgeting. Two reviewers independently screened 10% of references and extracted the data from 20% of included studies. Findings are reported narratively. FindingsFrom 1277 identified references, 34 studies were included: most (n=23) evaluated participatory budgeting in Latin America, but six were in Europe. Health or social outcomes, including infant mortality, poverty rates, education, and access to sanitation, were examined by five quantitative observational studies of population-level data. Most evaluations were case studies (n=21) conducting ethnography and surveys, focusing on political outcomes such as involvement in participatory budgeting or impacts on political activities. One randomised controlled trial, seven quantitative observational studies, and five case studies reported on economic impacts; outcomes included tax revenue, municipal spending on health care, sanitation, and housing. InterpretationThis review applied systematic, transparent methods and found that, despite increasing interest in participatory budgeting, evaluations applying robust methods to analyse health and wellbeing outcomes are scarce, particularly beyond Brazil. Therefore, implementation of participatory budgeting schemes should be accompanied by rigorous qualitative and quantitative evaluation to identify impacts and the processes by which they are realised. There is considerable scope for public health research to contribute to evaluating participatory budgeting outcomes with reference to two global policy agendas, democratic innovation and social justice. FundingWhat Works Scotland (ESRC ES/M003922/1 and Scottish Government). MC and PC are supported by the Medical Research Council (MC_UU_12017-15).