Representação e mobilização social nos conselhos de saúde: implicações para ação participativa

Abstract

The present study aimed to analyze the exercise of social participation within the scope of municipal health councils based on representation mechanisms and factors that influence the mobilization of individuals and entities. This is a qualitative research carried out in three municipalities in Bahia state: Urandi, Guanambi and Vitória da Conquista. Data and information were obtained through 30 semi-structured interviews with health counselors, direct observation of health council meetings and document analysis. The theoretical-methodological framework was based on two theoretical models for analyzing social participation in health: the model of the domains of the decision-making process and the model of the chain of participation. Based on this theoretical framework, an analytical matrix structured around the axes of analysis was developed: Representation and Representativeness within the scope of health councils; and Social Mobilization and Participation in health councils. The results were presented through two scientific articles. The first article aimed to analyze the mechanisms of representation and forms of representation within the scope of health councils in municipalities of different population sizes. The results revealed that the choice of representatives occurs predominantly based on non-electoral criteria. The relationship between representatives and represented is marked by the isolation of the representative and reduced accountability. Representation also proved to be weakened by the professionalization of representation. Individual awareness predominated in the definition of positions by the counselors. Representation on health councils was also influenced by the population size of the municipalities. In the municipality with the smallest population, consistent weaknesses in the exercise of representation were evident. The second article aimed to analyze social mobilization strategies and the performance of representative entities in health councils. The results revealed a fragile mobilization for social participation in individual dimensions, representative entities or health council spaces. A fragile participatory culture and a decline in the tradition of participation were revealed. Representative entities appear demobilized with few strategies to promote a culture of participation. Health councils experience a context of fragile civil society involvement. The need to bring representatives closer to the represented segments, qualification of representatives, greater information and dissemination of the actions of health councils and transparent management mechanisms that value social participation as a means for the production of public policies is highlighted. effective.