Brazil's health councils: The challenge of building participatory political institutions

This article examines the experience of municipal and district health councils in the city of Sao Paulo in the light of the literature on citizen participation in Brazil. This literature has attributed the success or failure of participatory mechanisms either to the degree of civil society involvement or to the level of commitment to such mechanisms on the part of the political authorities. This begs the question of what happens where both factors are present but the participatory mechanisms nevertheless remain relatively ineffectual as institutions for promoting the interests of the excluded. Drawing on research into participation in Sao Paulo's health councils, the article argues that the success of this type of participatory mechanism depends not only on the involvement and commitment of civil society and state actors, but also on their willingness and ability to promote institutional innovations that guarantee clear rules of political representation, and processes of discussion and decision making that lead to effective participation by representatives who command less technical knowledge and fewer communicative resources.