What did we learn about citizen involvement in the health policy process: lessons from Brazil

Abstract

In this paper I argue that citizen involvement helped to promote a more equitable distribution of public health services in Brazil. This achievement involved a balance of contributions from social actors and health system managers in forging policy innovations and institutional arrangements that linked bottom up innovation with national policy leveraging and decentralized implementation. The paper briefly describes this cycle and its relation with the implementation of a national network of forums for citizen involvement in health policy, inquiring in more detail the conditions that favor the association between these forums and the policy making process. Our results do not corroborate the idea that deliberative arenas should be insulated from political passions; rather, they suggest that participation of mobilized social actors contributes to the effectiveness of these forums. This contribution happens both due to the knowledge that these actors bring about problems in the area and to their insertion in networks that connect forums to a wide set of social organizations and political, governmental, and health institutions, which in turn facilitate the dissemination and negotiation of the proposals and demands formulated by the forums. However, our results also suggest that the inclusion of these actors increases confrontation to the detriment of deliberation, which brings us to the discussion of the role that could be played by mediators who are well-equipped to construct deliberative processes.