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Politics and passion deepen democracy in Brazil’s participatory health councils

Political culture, conflict and party politics all play a key part in deepening participatory democracy, according to research from Brazil. Proceedings within participatory health councils in a north-eastern municipality show that these deliberative spaces are often animated by passionate conflict rather than dispassionate deliberation.

Thousands of participatory health councils have emerged in Brazil since the Citizen’s Constitution of 1988. Empowered by law to make binding decisions about health resource allocation, they deal with local concerns, involve a variety of civil society participants and have real consequences for health outcomes. As such they appear to be model institutions of participatory governance. And yet, there is a growing literature suggesting that Brazil’s participatory health councils are failing to live up to their promise. Critics point to inequalities in expertise and voice between participants in the councils and to the problem of municipal governments ‘colonising’ seats with people from their own networks. But little previous research has focused on the understandings and practises of the participants themselves.

Taking an anthropological approach, a research paper from the Institute of Development Studies at the University of Sussex in the UK offers new insights into the dynamics of participatory governance. The paper draws on an extended case study of a municipal health council in a small municipality in the impoverished north-eastern Brazilian state of Pernambuco.

It reveals that:

Ideals and expectations of democracy vary between participants in the health council. These emerge from Brazil’s ‘old’ political culture (authoritarianism, favours and intimidation) as well as from newer traditions (liberation theology, feminism and social mobilisation).
A new culture of politics is also emerging within the health councils that challenges the past and enables real changes in power relations.
Individuals on the health council use different strategies to engage in deliberations depending upon what they wish to achieve and the views of their opponents. These often involve confrontational and passionate speeches, rather than cool and reasoned argument.
More time is spent in debates about the rules and procedures of the health council than debating health policy issues, but this in itself makes a contribution to democratising engagement in this setting - as it is in these debates about democracy itself that citizens come to test and explore the boundaries of the political and the possible.

The paper draws a variety of wider lessons from the case study, of relevance to theorists and practitioners of deliberative democracy and participatory governance:

New institutions of participatory governance cannot be isolated from the wider context of existing political institutions and practises.
Participants in such new institutions bring expectations, experiences, relationships and agendas from other spaces - whether of party politics, business relationships or social networks.
Passionate disagreement is as important a part of deliberative political institutions can as the dispassionate rational forms of argument emphasised by theorists of deliberative democracy.
Passion and contestation in exchanges between participants in deliberative institutions, and arguments about how democracy should work, can deepen the democratic process.

The author concludes that political theorists should pay greater attention to three relatively ignored and under-theorised elements of deliberative and participatory democracy: the culture(s) of politics, the importance of passion and conflict, and the role of party politics.

Source(s):
‘Deliberating Democracy: Scenes from a Municipal Health Council’, IDS Working Paper 292, IDS: Brighton, by Andrea Cornwall, November 2007 (PDF) Full document.
Further details about this research project on the Research for Development Portal Full document.

Funded by: UK Department for International Development

id21 Research Highlight: 29 April 2009

Further Information:
Andrea Cornwall
Institute of Development Studies
at the University of Sussex
Brighton BN1 9RE, UK

Tel: +44 1273 678269
Fax: +44 1273 621202
Contact the contributor: A.Cornwall@ids.ac.uk

Institute of Development Studies

Development Research Centre on Citizenship, Participation and Accountability
Institute of Development Studies at the University of Sussex
Brighton BN1 9RE, UK

Tel: + 44 1273 915689
Contact the contributor: n.benequista@ids.ac.uk

Development Research Centre on Citizenship, Participation and Accountability

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