Social participation and planning in Brazil’s Unified Health System: the case of Maranhão

Abstract

The legislation that structures Brazil’s Unified Health System (SUS) integrates planning and social participation in the organization of the system at each federative unit. This study aims to analyze the effectiveness of this legal framework in the state of Maranhão. It investigates, from the perspectives of the involved parties, how the interaction between the State Health Secretariat (SES) and the State Health Council (CES/MA) unfolded in the development of management instruments; in other words, how receptive the Secretariat was to the Council’s inputs and the extent to which the Council contributed to shaping Maranhão’s health policy. To this end, a case study was conducted, comprising an analysis of State Health Council meeting minutes from 2023 to 2024, as well as interviews with council members and Secretariat staff. The hypothesis that both council members and Secretariat employees perceive the CES/MA as having had limited effectiveness in this process was partially confirmed: while the Council views the process negatively, Secretariat staff believe the Council's contribution to SUS planning in Maranhão aligns with what the legislation prescribes. The problems reported by both groups, along with experiences documented in the literature, reveal obstacles to the impact of participatory institutions in public policy, underscoring the need to better understand the relationship between the State and civil society within each federative unit analyzed.