In this paper I argue that citizen involvement helped to promote a more equitable distribution of public health services in Brazil. This achievement involved a balance of contributions from social actors and health system managers in forging policy innovations and institutional arrangements that linked bottom up innovation with national policy leveraging and decentralized implementation. The paper briefly describes this cycle and its relation with the implementation of a national network of forums for citizen involvement in health policy, inquiring in more detail the conditions that favor the association between these forums and the policy making process. Our results do not corroborate the idea that deliberative arenas should be insulated from political passions; rather, they suggest that participation of mobilized social actors contributes to the effectiveness of these forums. This contribution happens both due to the knowledge that these actors bring about problems in the area and to their insertion in networks that connect forums to a wide set of social organizations and political, governmental, and health institutions, which in turn facilitate the dissemination and negotiation of the proposals and demands formulated by the forums. Despite these achievements the results also call attention to a slight increase in inequality in the distribution of basic services between the poorest regions.

In the two decades since military rule ended in Brazil,there has been a remarkable flowering of new democratic practices and spaces for participation. Brazil’s 1988 ‘Citizens’ Constitution’ created the legal basis for some ofthe world’s most progressive democratic institutions. Democratic innovations such as participatory budgeting (orçamento participativo) have brought Brazil to the forefront of debates on tackling democratic deficits through participatory governance. Brazil’s social movements and left-wing political parties have played an active part in this process of democratisation, engaging citizens in making demands on the state and claiming their rights, and promoting new, expanded understandings of citizenship and democracy. What lessons do Brazil’s democratic experiments offer other countries? This briefing shares some of the insights that arose from a DFID-Brazil funded project called Olhar Crítico– ‘a critical look’– that brought together activists, academics and practitioners in an innovative research process,to enquire,with a critical eye,into Brazil’s experiences with participation in governance.

Call me romantic, but there’s something about ordinary people feeling as if they have a right to have a say about what their government does that moves me. Picture these scenes. A bus, a mode of transport used only by the poor, rolls through the countryside in northeast Brazil. We are surrounded by sugar cane plantations, scenes of some of the most brutal exploitation and inspiring activism in this region. The man in front of me reaches into his bag and pulls out a book...

This two-page case study summary describes how in a city in the UK with a troubled political history, residents in one neighbourhood discovered that the Health Authority was planning to close their health centre, so they mobilised and undertook research to stop the closure.

This two-page document summarises a study of the role of Aboriginal people in the deliberative aspects of the Romanow Commission, established in April 2001 by the Canadian government to deliberate with citizens on the future of healthcare in Canada.

This two-page document summarises research into Bangladesh's attempt to enhance community participation in the public health sector.

Due to copyright restrictions, we can only share the first three pages of this chapter online. The book can be ordered from Zed Books at www.zedbooks.co.uk/citizenship or purchased at the IDS bookstore.

Brazil’s participatory policy councils may have gained less international attention than Participatory Budgeting. Yet the thousands of sectoral participatory policy councils that have come into being since the early 1990s, with their hundreds of thousands of civil society representatives, are as significant a democratic innovation. As the literature on Brazilian health councils continues to grow, it has become evident that the promise of these new democratic spaces is proving less easy to fulfill than their architects might have imagined. Analysts have drawn attention to the gap between the ideals of deliberative governance and the realities of pervasive cultures of politics and the replication of embedded inequalities in conduct within these spaces. The tension between the assumptions about participation, accountability and democracy that are embedded in contemporary debates about participatory governance and deliberative democracy, and the understandings and practices of the actors who animate these institutions is under-explored in this literature, and forms the focus for this paper. Through an extended case study of an incident in the life of a municipal health council in a small municipality in the impoverished north-eastern Brazilian state of Pernambuco, it seeks to explore the meanings and practices associated with democracy in this context. To do so, it deploys a technique unfamiliar in much of the literature on governance: ethnographic ‘thick description’. By evoking everyday meanings and practices of democracy in the council, the paper seeks to demonstrate the importance of locating the normative assumptions that are embedded in theories of deliberative democracy and participatory governance in lived experience in particular cultural, historical and political contexts.

Due to copyright restrictions, we can only share the first three pages of this chapter online. The book can be ordered from Zed Books at www.zedbooks.co.uk/citizenship or purchased at the IDS bookstore.