Realizing Health Rights in Brazil: The Micropolitics of Sustaining Health System Reform

Abstract

Brazil’s ‘Citizens’ Constitution’ of 1988 established health as ‘the right of all and the duty of the state’. It also guaranteed the right of citizens to participate in the governance of the Sistema Único de Saúde (National Health System; SUS for short) through institutions created at municipal, state and national level. Nowhere else in the world have such ambitious and far-reaching efforts been made to institutionalize citizen participation in the governance of health systems. Yet the dominant tone in the literature on participation in Brazil’s SUS is largely negative, with many observers questioning whether these institutional arrangements have had any significant impact on improving efficiency, shifting priorities towards the needs of the poorest or promoting genuinely accountable health system management.²

The case study material in this chapter derives from work carried out by the authors with Siívia Cordeiro, Nelson Giordano Delgado, Renato Athias and Raimundo Nonato during the Olhar Crítico project, funded by the UK Department for International Development (DFID) Brazil office and coordinated by Sue Fleming of DFID Brazil and Jorge Romano of ActionAid Brasil. The authors would like to thank the Centro das Mulheres do Cabo, Associação Saúde Limites, the Federação das Organizações Indigenas do Rio Negro and the organizers of the 12^th Conferência Nacional de Saúde (especially Artur Custódio and Crescêncio Antunes Silveira Neto) for their assistance with the case study research. They would also like to thank the editors of this volume, Marcus André Melo, Newton Sérgio Lopes Lemos, Jason Lakin and other participants in the seminars on ‘Explaining Brazil’s policy successes’ (at the Institute of Development Studies, University of Sussex, July 2005) and ‘Politics and health policy in Brazil, Mexico and the UK’ (at the Centre for Brazilian Studies, Oxford University, December 2005) for their insightful comments on earlier versions of the text.