Abstract
Abstract The aim of this study was to describe the challenges and opportunities faced by local health council presidents in their practice of participatory governance. In-depth interviews were conducted with six presidents at health posts at six neighborhoods located in a single region in a peripheral neighborhood in Fortaleza. The interviews were complemented by participant observation of local health council meetings conducted over a three-year period (2015-2017), and interviews with presidents of the municipal, regional and state health councils, as well as with more than twenty actors from government agencies and local associations. The data were analyzed with the help of Atlas.ti, and resulted in the identification of four core topics: the weakness of community representation, the generation of new health initiatives, the concern with the physical and material infrastructure of the councils, and the linkages between council Presidents and the historical network of community-based organizations (Associações Voluntárias) in the region in which the health posts were situated. The local health councils included in this study faced similar challenges to those documented by prior scholars, but also demonstrated the potential to cultivate local ideas for new health initiatives.
Highlights
O objetivo deste estudo foi descrever os desafios e oportunidades enfrentadas pelos presidentes de conselhos de saúde locais em executar governança participativa
All seven neighborhood health posts visited for this study maintained at least one dentist and an on-site pharmacy, as well as what were described by council presidents as “the latest modernization efforts”: flat screen TVs in the patients’ waiting areas, and an electronic medical record system
Most of the accomplishments that presidents in this study described had more to do with day-today improvements at their health posts, or with improving the care of specific individuals
Summary
O objetivo deste estudo foi descrever os desafios e oportunidades enfrentadas pelos presidentes de conselhos de saúde locais em executar governança participativa. Besides advocating for residents and looking after the physical structure of their posts, several presidents described examples of initiatives they had implemented based on suggestions made by community-patient representatives at local health council meetings.
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