[Social participation in health services: concepts of users and community leaders in two municipalities of Northeastern Brazil]. / Participação social nos serviços de saúde: concepções dos usuários e líderes comunitários em dois municípios do Nordeste do Brasil.

Social participation in management of the health care system at different levels of government is one of the key policies promoted by the Unified National Health System (SUS) in Brazil. As with any new policy, success hinges on several factors such as stakeholders' interests and opinions, which have not always been considered in the past. This paper analyzes the underlying concepts of two groups of stakeholders with respect to social participation in health and the potential influence of these concepts on the effectiveness of policy implementation. A case study of two municipalities in Northeast Brazil was conducted using a combination of qualitative and quantitative social science research methods. Health services users and community leaders were interviewed. Various concepts were found in which the participatory approach to health policies was only partially reflected. Likely influences on stakeholders' concepts of social participation in health are the evolution of the broader Brazilian social context and the traditional performance of health services. Particular attention should be paid to stakeholders' opinions and concepts if policy effectiveness is to be improved.

Participaçäo social nos serviços de saúde: concepções dos usuários e líderes comunitários em dois municípios do Nordeste do Brasil / Social participation in health: concepts of users and community leaders in two municipalities of Northeastern Brazil

A participaçäo da sociedade na gestäo do sistema de saúde, nas diferentes esferas do governo, é uma das políticas promovidas na construçäo do Sistema Unico de Saúde no Brasil. O sucesso na implementaçäo de qualquer nova política depende de diversos elementos, entre eles, os interesses e opiniöes dos atores principais envolvidos e que nem sempre säo considerados. Neste artigo säo analisados os conceitos de participaçäo social nos serviços de saúde de dois grupos de atores e como estas concepções podem influir na implementaçäo da política de participaçäo em saúde no Brasil. Realizou-se um estudo de caso em dois municípios do Nordeste do Brasil, utilizando uma combinaçäo de métodos qualitativos e quantitativos das ciências sociais. Foram entrevistados usuários e líderes comunitários. Encontrou-se uma grande variedade de conceitos, que só limitadamente coincidem com o enfoque de participaçäo contemplado nas políticas. Conceitos provavelmente explicáveis pela evoluçäo da sociedade e do sistema de saúde no Brasil, que requerem ser trabalhados na perspectiva de melhorar a eficácia da política de participaçäo social

[View of the different social agents on the social participation in the health system in northeastern Brazil. A qualitative approximation]. / Visión de los diferentes agentes sociales sobre la participación social en el sistema de salud en el nordeste de Brasil. Una aproximación cualitativa.

BACKGROUND: Social participation in the health system constitutes one of the basic principles of Brazilian health sector reform. This paper analyses the concepts held by different groups of stakeholders with respect to social participation in health and identifies their opinions on hindering and enabling factors for this participation. METHODS: A qualitative study was conducted using individual interviews (II) and focus groups (FG) with different groups of stakeholders: 135 users (II, GF), 14 community leaders (II, GF), 12 Municipal Health Council (MHC) members (II), 8 policymakers and (II) 37 health personnel (II, GF) were interviewed. A narrative content analysis of the results was conducted. Two municipalities in North-eastern Brazil, Cabo de Santo Agostinho and Camaragibe, made up the area of study. RESULTS: In all groups, a distinction between individual and group participation emerged and reached different levels of elaboration. Many informants' ideas described also their own ways of action. Individual participation concepts and the utilization of health services were predominant among users. Population and institutional factors were identified as obstacles to participation: users and community leaders referred both type of factors, while the health personnel and MHC members put more emphasis on the former. Some informants among the health personnel did not identify any barriers. Policymakers emphasised the lack of political will. The enabling factors mentioned reflected the same logic. CONCLUSIONS: Concepts and perceived hindering factors to participation which were described appear to show different ways of interaction among the diverse stakeholders and the health services. The results point towards a limited effect of the health policy on social participation. Elements that could contribute to an improvement are identified.