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Engaging citizens: Lessons from building Brazil's national health system

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  • Cornwall, Andrea
  • Shankland, Alex

Abstract

Brazil's Sistema Único de Saúde (SUS), a universal, publicly-funded, rights-based health system, designed and put in place in an era where neo-liberal reforms elsewhere in the world have driven the marketization of health services, offers important lessons for future health systems. In this article, we focus on the innovative institutional mechanisms for popular involvement and accountability that are part of the architecture for governance of the SUS. We argue that these mechanisms of public involvement hold the potential to sustain a compact between state and citizens and ensure the political momentum required to broaden access to basic health services, while at the same time providing a framework for the emergence of "regulatory partnerships" capable of managing the complex reality of pluralistic provision and multiplying sources of health expertise in a way which ensures that the needs and rights of poor and marginalised citizens are not relegated to the periphery of a segmented health system.

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  • Cornwall, Andrea & Shankland, Alex, 2008. "Engaging citizens: Lessons from building Brazil's national health system," Social Science & Medicine, Elsevier, vol. 66(10), pages 2173-2184, May.
    • Handle: RePEc:eee:socmed:v:66:y:2008:i:10:p:2173-2184
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    References listed on IDEAS

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    1. Bloom, Gerald & Standing, Hilary, 2008. "Future health systems: Why future? Why now?," Social Science & Medicine, Elsevier, vol. 66(10), pages 2067-2075, May.
    2. Haas, Peter M., 1992. "Introduction: epistemic communities and international policy coordination," International Organization, Cambridge University Press, vol. 46(1), pages 1-35, January.
    3. Weyland, Kurt, 1995. "Social movements and the State: The Politics of health reform in Brazil," World Development, Elsevier, vol. 23(10), pages 1699-1712, October.
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    Cited by:

    1. Dale, Elina & Peacocke, Elizabeth F. & Movik, Espen & Voorhoeve, Alex & Ottersen, Trygve & Kurowski, Christoph & Evans, David B. & Norheim, Ole Frithjof & Gopinathan, Unni, 2023. "Criteria for the procedural fairness of health financing decisions: a scoping review," LSE Research Online Documents on Economics 119799, London School of Economics and Political Science, LSE Library.
    2. Maya Unnithan & Carolyn Heitmeyer, 2014. "Challenges in ‘Translating’ Human Rights: Perceptions and Practices of Civil Society Actors in Western India," Development and Change, International Institute of Social Studies, vol. 45(6), pages 1361-1384, November.
    3. Bloom, Gerald & Standing, Hilary & Lloyd, Robert, 2008. "Markets, information asymmetry and health care: Towards new social contracts," Social Science & Medicine, Elsevier, vol. 66(10), pages 2076-2087, May.
    4. Waters, Hugh R. & Bós, Antonio M., 2008. "The financial protection impact of the public health system and private insurance in Brazil," Revista CEPAL, Naciones Unidas Comisión Económica para América Latina y el Caribe (CEPAL), August.
    5. World Bank Group, 2014. "Strategic Framework for Mainstreaming Citizen Engagement in World Bank Group Operations," World Bank Publications - Books, The World Bank Group, number 21113.
    6. Bloom, Gerald & Wolcott, Sara, 2013. "Building institutions for health and health systems in contexts of rapid change," Social Science & Medicine, Elsevier, vol. 96(C), pages 216-222.
    7. Gaitonde, Rakhal & San Sebastian, Miguel & Muraleedharan, V.R. & Hurtig, Anna-Karin, 2017. "Community Action for Health in India’s National Rural Health Mission: One policy, many paths," Social Science & Medicine, Elsevier, vol. 188(C), pages 82-90.
    8. Bloom, Gerald, 2011. "Building institutions for an effective health system: Lessons from China's experience with rural health reform," Social Science & Medicine, Elsevier, vol. 72(8), pages 1302-1309, April.
    9. Paulo Ivo Garrido, 2020. "Health, development, and institutional factors: The Mozambique case," WIDER Working Paper Series wp-2020-131, World Institute for Development Economic Research (UNU-WIDER).
    10. Carlos Octávio Ocké-Reis, 2009. "Série Seguridade Social - A Constituição de um Modelo de Atenção à Saúde Universal: Uma Promessa não Cumprida pelo SUS?," Discussion Papers 1376, Instituto de Pesquisa Econômica Aplicada - IPEA.

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