ABSTRACT
Up to now, community participation in local health systems has been rather limited. To increase this participation, the authors propose organizational and management approaches based on the administrative principle that the primary aims served by health institutions need to be established. These aims should be defined in a way that meets the basic needs of individuals, and main actions should focus on improving the relationship between people and services. The proposed approaches include decentralization and microregionalization of health services. Both these processes, which are complex and subject to conflict, should be implemented in tandem. Their use will allow attainment of greater efficiency, transparency, and debureaucratization of health systems and services and, at the same time, facilitate the direct participation of users in the management of these services.
