Mechanisms of Social Participation in Health in South America


This publication reviews recent experiences of social participation in health, focusing specifically on South America.

There is consensus among the nations of UNASUR that the governance of health should be participatory, promoting health services with universal access, comprehensive and equitable, that address the social determination of health (2). Although unified through UNASUR, each country is sovereign, with specificities that have led to the creation of unique systems and processes to involve citizens in health. Additionally, the UN, WHO, and other intergovernmental and non-governmental organizations have recognized the need to include the population in decision-making. The complexity of the redistribution of power relations is both the attraction and the challenge of community participation (3).

The objectives of the study were to identify common mechanisms of community participation in: design, implementation, monitoring and evaluation of health policy in the countries of South America and its legal framework. A review of the literature was carried out through a systematic search of the Scielo and Lilacs databases, as well as the websites of the Ministries of Health, ISAGS-UNASUR publications and other complementary sources. The search identified 311 articles and the data obtained from each of the 12 countries is presented separately.
The review focused on institutionalized mechanisms, administrative or organizational spaces that allow the participation of groups or individuals without technical specialization or employment within the health or government sector. In its diversity, the participation mechanisms identified in this study can be grouped into 4 categories: advice, mediations, information dissemination and feedback.
The councils: composed of institutional representatives and members of the community, who meet periodically to discuss health policies and / or services.
The forms of mediation: responsible for receiving complaints and suggestions (physical or virtual spaces).
The mechanisms for disseminating information: public meetings used to present data, services or health campaigns, and virtual platforms focused on transparency (among others).
Feedback mechanisms: social networks, suggestion boxes and open periods of public consultation.
The proposed categories promote a common language to compare and analyze the institutionalized mechanisms of community participation in health. The Arnstein ladder (1969) continues to be a useful instrument that shows that not all participation has the same depth (4). In South America, barriers to effective community participation in the region mainly involved issues related to representation, technical knowledge and, most importantly, the redistribution of power. Future studies can analyze the processes within each category to identify the limitations, barriers and possibilities for improvement associated with the type of mechanism. Although participatory processes can not be rigidly standardized, imposed or expected to go beyond the scope of the realities of each context, they can be compared and reformulated in the light of the purpose of participation: to promote the peoples´s health and equity.


  1. PAHO. Declaration of Alma-Ata. International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978. Number IV
  2. ISAGS South American Institute of Government in Health, UNASUR. Health Systems in South America: Challenges for universality, integrality and equity. Rio de Janeiro: ISAGS. 2012. p. 27-28
  3. Morgan, LM. Community participation in health: perpetual allure, persistent challenge. Health Policy & Planning, 2001; 16 (3): 221-230.
  4. Arnstein, SR. A Ladder of Citizen Participation. Journal of the American Institute of Planners, 1969; 35 (4): 216-224.


Prefix Publisher: 80701
ISBN Number: 978-65-80701-05-6
Title: Mechanisms of social participation in health in South America