Local health governance in central Brazil

Abstract

 Introduction. Local health councils are an important aspect of health reform in Brazil and its focus on primary health care. The purpose of this study was to evaluate the performance of local health councils and their capacity to enhance accountability and improve the delivery and quality of primary health care. These councils are made up predominantly by civil society representatives who play an important role as key stakeholders in the management of health care at the municipal level.
Methods. Exploratory descriptive study carried out in the capital of Brazil and 22 cities located in the surrounding region with the use of structured interviews.
Results. A significant number of the local health councils were created mostly to guarantee the transfer of federal funds and function precariously due to the lack of infra-structure and financial autonomy. They meet regularly but function mostly in a bureaucratic manner. The local health councils analyze and approve health plans and management of public funds, but have little autonomy to define health policies and programs. Although there is an ongoing effort to recruit representatives from diverse social segments, the civil society representatives show low capacity to mobilize and enhance community participation or to articulate with other municipal bodies. Thus, their capacity to improve the access and quality of primary health care is limited, but show increased accountability when compared to the period before their creation.
Conclusion. In order to guarantee better health care delivery, there is the need to enhance the autonomy of local health councils and provide technical qualification for its members, as well as, enhance community participation and their awareness of health needs and rights.
Key words: primary health, governance, community participation, Brazil.