Social participation in the unified health system of Brazil: an exploratory study on the adequacy of health councils to resolution 453/2012

Abstract

Introduction Social participation is one of the guidelines of the Brazilian health system. Health councils are collegiate instances of participation established by Law 8.142/90. The most recent legal regulation for council organization and functioning was established through Resolution 453/2021. The institution of health councils has a permanent and deliberative nature to act in the formulation, deliberation and control of health policy implementation, including in economic and financial aspects. Objective To evaluate the compliance of health councils with the directives for the establishment, restructuring and operation of the councils from Brazil, based on Resolution 453/2012. Methods An exploratory, descriptive study that used the Health Council Monitoring System as a data source. Qualitative variables were selected to identify the characteristics related to the councils’ establishment (legal instruments for establishment), the strategies adopted for restructuring (budget allocation, existence of an executive secretariat, provision of a dedicated office) and the characteristics of the health councils’ operation (frequency of regular meetings, existence of a board of directors, the election of the board of directors). Results The study analyzed three groups of characteristics related to the constitution, strategies adopted for restructuring and the functioning of the councils. Regarding the constitution of the councils, the findings revealed that the vast majority was constituted in accordance with the legislation and, therefore, is in compliance with Resolution 453/2021. In the second group of characteristics that describe the restructuring of councils, the study found that less than half of registered councils are in compliance with the standard. And, finally, in the third group of characteristics, it was found that the boards have adopted different frequencies for regular meetings and approximately 50% of the boards studied have a board of directors. Conclusions The councils still do not meet the minimum conditions necessary to fulfil their role in the Unified Health System (SUS), as stipulated in Resolution 453/2021. This situation requires monitoring by public oversight agencies. Despite the increase in popular participation with the creation of the health councils, this study demonstrated that most councils still do not meet the minimum conditions for monitoring public health policy. The improvement of the Health Councils Monitoring System (SIACS) to become an instrument for monitoring the councils, with the definition of goals and results, may contribute to the organization of the councils and, therefore, to the realization of social participation in Brazil.

Piercing the veil on the functioning and effectiveness of district health system governance structures: perspectives from a South African province

“…Our study illustrates that the existence of enabling legislation is insufficient to foster optimal functioning. This was also found in an exploratory study on the adequacy of health councils in Brazil, showing that these councils did not meet the minimum conditions necessary to fulfil their role [ 46 ]. Given that there is an association between the quality of governance and health outcomes [ 5 ], the absence of these structures in two large metropolitan areas of the Gauteng province is likely to hamper efforts to improve PHC service delivery and the health outcomes of communities served in these two health districts.…”

Piercing the veil on the functioning and effectiveness of district health system governance structures: Perspectives from a South African province

“…Our study illustrates that the existence of enabling legislation is insu cient to foster optimal functioning. This was also found in an exploratory study on the adequacy of health councils in Brazil, showing that these councils did not meet the minimum conditions necessary to ful l their role (45). Given that there is an association between the quality of governance and health outcomes (5), the absence of these structures in two large metropolitan areas of the Gauteng province is likely to hamper efforts to improve PHC service delivery and the health outcomes of communities served in these two health districts.…”

Strategies for involving patients and the public in scaling initiatives in health and social services: A scoping review

“… 65 For example, in Brazil, PPI may be referred to as ‘social participation’ and has been integral to the healthcare system since its establishment in 1988. 66 On the other hand, researchers may consider patient involvement ‘less urgent’ in LMICs that lack basic HSS; also poverty, cultural stigma around illness, and patients’ not valuing their own voice or experience all prevent more patient involvement in research. 67 Patient and public mobilization, leveraging partnerships for financial support, peer‐to‐peer mentorship and psychosocial support and education could increase PPI in LMICs.…”

“… 70 In addition, implementation of HSS in community‐based primary healthcare initiatives are known for involving the communities in question, even if they have never named it PPI. 66 That PPI in scaling is found predominantly at the primary care level also suggests a lack of skills necessary for PPI at the secondary and tertiary levels of care, such as in hospitals and diagnostic centres. These are usually more specialized and distant from both the community and policy decision‐making contexts, and an important barrier in these contexts is competing organizational priorities.…”