Civic programmatic participation in public health: the case of Argentina.

Since the Alma Ata World Health Organization Conference in 1978, countries around the world have adopted institutions that promote the participation of citizens in their public health systems. The main objectives of this article are two-fold. First, we describe the origins and implementation of a national-level civic participatory program that was in place in Argentina in the mid-2000s: the Local Participatory Projects (Proyectos Locales Participativos). Second, we analyze the 201 local participatory projects that were carried out in Argentina between 2007 and 2008. We study health and environmental problems that prompt people's participation in the program and the social dynamics through which such participation is executed.

Civic programmatic participation in public health: the case of Argentina / Participação programática cidadã na saúde pública: o caso da Argentina / Participación cívica en programas de salud pública: el caso de Argentina

Abstract: Since the Alma Ata World Health Organization Conference in 1978, countries around the world have adopted institutions that promote the participation of citizens in their public health systems. The main objectives of this article are two-fold. First, we describe the origins and implementation of a national-level civic participatory program that was in place in Argentina in the mid-2000s: the Local Participatory Projects (Proyectos Locales Participativos). Second, we analyze the 201 local participatory projects that were carried out in Argentina between 2007 and 2008. We study health and environmental problems that prompt people's participation in the program and the social dynamics through which such participation is executed.

Resumo: Desde a Conferência de Alma Ata da Organização Mundial da Saúde em 1978, países do mundo inteiro adotaram instituições que promovem a participação dos cidadãos nos sistemas de saúde pública. O artigo teve dois objetivos principais. Primeiro, descrevemos as origens e a implementação de um programa participativo em nível nacional que foi implementado na Argentina em meados da primeira década deste século: os chamados Projetos Locais Participativos (Proyectos Locales Participativos). Segundo, analisamos os 201 projetos de participação local que foram implementados na Argentina entre 2007 e 2008. Estudamos os problemas sanitários e ambientais que motivaram a participação popular no programa e a dinâmica social através da qual essa participação é efetivada.

Resumen: Desde la Conferencia de la Organización Mundial de la Salud de Alma Ata en 1978, varios países alrededor del mundo han creado instituciones que promueven la participación de la ciudadanía en sus sistemas públicos de salud. En este artículo, en primer lugar, describimos los orígenes e implementación de un programa cívico participativo en el territorio nacional, que se realizó en Argentina a mediados de la década de los años 2000, denominado Proyectos Locales Participativos; en segundo lugar, analizamos 201 proyectos locales participativos que se llevaron a cabo en el país entre 2007 y 2008. Estudiamos los problemas de salud y medioambientales que motivaron la participación de la gente en el programa, así como la dinámica social a través de la cual se canalizaba esta participación.

Infiltrating the State: the evolution of health care reforms in Brazil, 1964-1988

This chapter explains the remarkable transformation of the Brazilian health care system - from centralized but narrow to decentralized and universalistic. This change did not occur, as was commonly, but unfolded gradually and under the noses of (indeed, within the very infrastructure set up by) the military regime of the 1970s and 1980s. The analysis here calls into question accounts of institutional change that focus too squarely on critical junctures, as well as analyses of institutional stasis that place unwarranted emphasis on lock-in effects. The study of health care reform in Brazil shows that three main components were necessary to ensure institutional change: subversive actors, infiltration, and expansion. Although Brazil's continental size and immense regional and social inequalities leave statistcs based on national study of policy reforms and their impact on health indicators, thanks to health care reforms that "revolutionized social policy in favor of the poor. It is indeed very likely that universal health coverage and a decentralized structure that is funded with guaranteed federal transfers and that promotes users' participation in health councils are largely responsible for the improvement of Brazil's health outcomes. The evolution of health care reforms in Brazil shows that it is possible to brak away, in a gradual and incremental manner, fromt he historical institutional preconditions that preclude universalization of health. They also appear to indicate that such institutional evolution leads to significantly better public health outcomes.