Digital Inclusion of Health Councils (BR0044)

to develop the Digital Inclusion Program (PID) in all state, district and municipal Health Councils, as a means of contributing to the enhancement of social control in the Unique Health System (SUS).

Commitment 1.8 Digital inclusion of Health Councils

Commitment Text: To develop the Digital Inclusion Program (PID) in all state, district and municipal Health Councils, as a means of contributing to the enhancement of social control in the Unique Health System (SUS).

Responsible institution: Ministry of Health

Supporting institution: None

Start date: Not specified                          End date: 14 December 2014

Commitment aim

This commitment attempted to expand the 2006 Digital Inclusion Program (PID) to health councils at all levels of government. The PID is structured on three pillars — equipment, council qualification, and connectivity — and is a fundamental element of the Single Health System’s (SUS) policy of social oversight.

Status

Midterm: Limited

Completion varied among the commitment’s three pillars. In terms of equipment, 3,200 antenna kits were delivered to health councils, even though many municipal councils still lacked them. As for council training, the “Permanent Education for Social Oversight” policy encompassed both online and in-person training for health councillors. Thirty two hundred council members were trained through the QualiCouncils Program, and 1,850 members were trained in the areas of participatory management and social oversight. The connectivity pillar was not completed.

End of term: Limited

According to the government, it trained more than 4,500 council members through the QualiCouncils Program, and delivered five computers, over 2,000 TVs, and nearly 400 printers by the end of 2015. Completion of the commitment requires finalizing delivery of the equipment, expanding the qualification activities, and universalizing connectivity. The government’s new deadline for implementing the commitment is December 2017.

Did it open government?

Civic participation: Marginal

Public accountability: Marginal

Health councils are key mechanisms of participation in Brazil. There are more than 5,000 councils in the country empowered by law to inspect public accounts and demand accountability. Research has shown that council members “include representatives from social movements, disabled people’s associations, religious groups, civil rights associations, [and] trade unions.”^{[Note 15: Open Government Guide, “Brazil’s Health Councils involve people in governing the health system,” http://bit.ly/2fFMgYc. ]} In addition, half the council members must come from civil society (i.e., health system users), though this rule is followed in only 74% of the councils.^{[Note 16: Conselho Nacional de Saúde, https://goo.gl/qm2cn7. ]} There is also evidence that councils are hampered by their lack of digital expertise^{[Note 17: Ilara Hämmerli et al., “Digital Inclusion and health counselors: a policy for the reduction of social inequalities in Brazil,” 2009, http://bit.ly/2fFOiaG.  ]} and training.^{[Note 18: Jilian Clare Kohler and Martha Gabriela Martinez, “Participatory health councils and good governance: healthy democracy in Brazil?” 19 February 2015, http://bit.ly/2ghGd0s. ]} As a result, the commitment sought to improve social oversight of the health sector by strengthening health councils digitally, through better equipment, connectivity, and training.

While the topic of this commitment is important, its contribution to open government is marginal. Its activities build mostly upon established programs that predate the action plan. The main outcome of the commitment was capacity-building. According to the government’s self-assessment, almost 5,000 council members from government and civil society were trained in participatory management and social oversight in all 26 states and the federal district.^{[Note 19: OGP, Final Assessment Report – Second National Action Plan, October 2016, http://bit.ly/2f1BTQ5.]} A study of these trainings found that students gained a greater understanding of their role in health councils and the political process. This implies a positive — though marginal — change in practice.^{[Note 20: Assis Mafort Ouverney et al, “Democratization and continuing education: perception of former QualiConselhos students about its contributions to the improvement of health councils,” Saúde em Debate 40, no. spe (2016), http://bit.ly/2nPGniy. ]} Researchers at the University of Toronto found that training also remains an important challenge.^{[Note 21: Martha Gabriela Martinez and Jilian Clare Kohler, “Civil society participation in the health system: the case of Brazil’s Health Councils,” 26 October 2016, http://bit.ly/2fhodhz. ]} The other parts of the commitment (improved equipment and connectivity) have yet to be fully implemented.

Carried forward?

The commitment was not carried forward to the next action plan. Still, the government should invest in tools for councillors’ participation, and in greater transparency for cases of resource misappropriation investigated by the councils. A major shortcoming of the commitment’s execution was not delivering connectivity to all health councils.