[Social participation in health in rural northeastern Brazil]

To analyze the social participation taking place through Municipal Health Councils (MHC) in two small towns in northeastern Brazil.

A qualitative, exploratory, multicase study focused on the MHCs of Lafayete Coutinho (state of Bahia) and Groaíras (state of Ceará) was conducted. Data were gathered from February-April 2005 through analysis of documents, direct observation of MHC meetings, and semistructured interviews. Documents analyzed included decrees, laws, and municipal regulations; city health department annual management reports; municipal health plans; and reports of municipal health conferences. MHC meeting minutes for the period between inception of these councils and 2004 were also reviewed. Interviews of 17 council members took place, eight of whom were from Lafayete Coutinho and nine from Groaíras.

Both councils had irregular practices regarding membership structure and nomination of members, such as frequent changes in appointed members and continuous "reshuffling" of council structure. In addition, new council members were appointed each time a new mayor took charge. Sporadic frequency of meetings was also observed. In Lafayete Coutinho, of 96 meetings planned, just 37 took place; in Groaíras, of 186 meetings planned, 93 took place. Analysis of MHC efforts to formulate and control municipal health policies revealed three themes: health status of the population and public policies; organization and functioning of health services; and financial management and accounting. The interviews showed that council members were dissatisfied with the practices of the MHCs and revealed a lack of confidence in how truly representative the councils are and how much power they have.

Social participation strategies in Brazil must be reconsidered with an angle toward promoting political responsibility and raising awareness among citizens.