Over my lifetime, I have observed several changes in terms and meanings of words within the political arena. Political parties, international agencies and public institutions often absorb words and expressions born from social movements or among leftist academics.
We could compare this process to the children’s game which in Brazil is called “telefone sem fio” (“Wireless Telephone”), where one person whispers a message in the ear of the next person and so on through a line of people. The final message is invariably altered through this process. An even better comparison would be a vaccine, which uses the attenuated form of a virus and no longer causes a disease.
In a similar way, some old “revolutionary” words or expressions are totally attenuated today. These include words such as: freedom, constitution, social rights, civil rights, human rights, citizenship, union, women, gay, sex, equity, inequity and many others. Political parties use most of those words in their speeches and there is an increasing need to explain and clarify their meaning as they do not mean the same thing to everyone.
I would like to reflect on two words that I think are important to those of us contributing to the Unequal Voices project: accountability and participation. ‘Accountability’ and ‘participation’ are two concepts that have become key to development programmes. The meaning of these terms has changed over time and the words associated with these concepts vary in different languages.
I started to think about this issue after reviewing the paper written by our colleagues for the Unequal Voices project, ‘Accountability processes in the construction of the Brazilian Unified Health System’ which will be published shortly.
The words: accountability and participation
The meaning of words is linked to what they represent in a given society.
‘Accountability’ is a word often used by social movements in English-speaking countries to explain the process of getting feedback from politicians and public institutions on their commitments to society, among other meanings. The word itself has no single translation to Latin languages. In Brazil, for instance, we translate ‘accountability’ using a set of words that better represent the meaning of accountability to our society: transparency, ‘responsibilization’, reporting, feedback, participation.
The social movements in Brazil played a very important role in the process of construction of the Brazilian Unified Health System (SUS) after almost 20 years of dictatorship. The issue of participation was considered crucial to the way that accountability was built within the SUS. At that time, participation in the social movements was so strong that Brazil’s new Constitution of 1988 not only considered health as a right but also as an obligation of the state. Social participation was also embedded in the architecture of the SUS through the creation of joint committees at local, state and national levels. There was strong social participation in these joint committees, unlike what we observe today.
The Brazilian Unified Health System in Brazil
Almost 30 years after the new Brazilian Constitution and the SUS the words ‘accountability’ (used in English) and ‘participation’ can now be easily identified in a search of the relevant Brazilian academic literature. There are a large number of articles analysing those key pillars of the SUS. The review carried out for the paper reveals the disturbing fact that the SUS participatory mechanism has been used for political purposes.
At the local, state and national levels researchers observed that society representatives, in many cases, were not nominated by the community but by the politicians. This fact led me to call for the need to review the meaning of the terms ‘participation’ and ‘accountability’. A genuine ‘participation’ of social movements and civil society within the political arena is never a political given but a hard-won battle that is still being fought.
Low and middle-income countries aiming to improve their accountability processes in the area of health should take into account this key point about participatory mechanisms. They need to be aware that emerging terms in the political arena often have a history. To avoid cases of cooptation of civil society representatives by political mechanisms civil society needs to be aware of the situation, able to question and transform it.
Luiz Eduardo Fonseca works for the Centro de Relações Internacionais em Saúde (Centre for International Relations in Health), at the Oswaldo Cruz Foundation (FIOCRUZ), the Brazilian Ministry of Health’s institute of science and technology in health. Luis Eduardo is a member of the international reference group for the ESRC-DFID funded Unequal Voices project, part of the Accountability and Health Programme at IDS.