[View of the different social agents on the social participation in the health system in northeastern Brazil. A qualitative approximation].
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.
Navarrete
M Luisa Vázquez
ML
CHC Consultoria i Gestió, SA, Avda. Tibidabo 21, 08022 Barcelona. mlvazquez@chccig.com
da Silva
M Rejane Ferreira
MR
Campos
Eliane Siqueira
ES
Pereira
Ana Paula Campos
AP
Diniz
Alcides da Silva
Ada S
Veras
Ida Leite
IL
de Arruda
Ilma Kruze Grande
IK
D001938:Brazil; D003256:Community Participation; D005069:Evaluation Studies as Topic; D006801:Humans; D012961:Sociology