Introduction: The Brazilian Government created Participatory
Health Councils (PHCs) to allow citizen participation in the public health
policy process. PHCs are advisory bodies that operate at all levels of
government and that bring together different societal groups to monitor
Brazils health system. Today they are present in 98% of Brazilian cities,
demonstrating their popularity and thus their potential to help ensure that
health policies are in line with citizen preferences. Despite their expansive
reach, their real impact on health policies and health outcomes for citizens is
uncertain. We thus ask the following question: Do PHCs offer meaningful
opportunities for open participation and influence in the public health policy process?
Methods: Thirty-eight semi-structured interviews with health
council members were conducted. Data from these interviews were analyzed using
a qualitative interpretive content analysis approach. A quantitative analysis
of PHC data from the Sistema de Acompanhamento dos Conselhos de Saude (SIACS)
database was also conducted to corroborate findings from the interviews.
Results: We learned that PHCs fall short in many of the
categories of good governance. Government manipulation of the agenda and leadership
of the PHCs, delays in the implementation of PHC decision making, a lack of
training of council members on relevant technical issues, the largely narrow
interests of council members, the lack of transparency and monitoring
guidelines, a lack of government support, and a lack of inclusiveness are a few
examples that highlight why PHCs are not as effective as they could be.
Conclusions: Although PHCs are intended to be inclusive and
participatory, in practice they seem to have little impact on the health
policymaking process in Brazil. PHCs will only be able to fulfil their mandate
when we see good governance largely present. This will require a rethinking of
their governance structures, processes, membership, and oversight. If change is
resisted, the PHCs will remain largely limited to a good idea in theory that is
disappointing in practice.