Advancing citizen participationh governance and the right to health in brazil : the role of the national health council in healt

Brazil has established a constitutional right to health for its citizens. The attention of commentators and the legal community has been focused on the role of the courts in defining the state’s obligation to provide access to certain forms of healthcare services. This dissertation focuses on a rather neglected aspect of Brazil’s right to health: citizen participation in health governance. In this dissertation I argue that Brazil’s right to health includes a state duty to establish a health system that incorporates citizen participation. The objectives of this dissertation are to analyze the constitutional requirements for citizen’s participation and to examine whether the National Health Council (“NHC”), the participation body at the national level of health governance -- meets these constitutional requirements. In pursuing these objectives, I analyzed Brazil’s constitutional and legislative framework for citizen participation, conducted qualitative interviews with a selection of Council’s members, and carried out naturalistic observations of Council’s meetings. The dissertation uncovers questions and concerns about the National Health Council’s compliance with constitutional requirements. The analysis identifies two key issues: Council members lack clarity with respect to the scope of the Council’s legal role, and the Council has not been given full legal authority to carry out its constitutional mandate. The legal analysis provides an understanding of the body of law governing participation in the NHC and its relation to the right to health requirements. The qualitative research yields important information about the practice of participation in the NHC, including the perspectives, understandings and critiques of NHC members. Together, the legal and qualitative research produce a deeper understanding of the constitutional mandate for citizen participation, as well as specific recommendations designed to ensure that participation in the National Council achieves the benefits sought through Brazil’s ambitious constitutional mandate. In addition, Brazil’s constitutional experience with participation in health may provide useful guidance to other countries considering evidence-based policies to foster responsive and accountable health governance through citizen participation.Law, Peter A. Allard School ofGraduat