Deliberating democracy : scenes from a Brazilian municipal health council

Brazil’s participatory policy councils may have gained less international attention
than Participatory Budgeting. Yet the thousands of sectoral participatory policy
councils that have come into being since the early 1990s, with their hundreds of
thousands of civil society representatives, are as significant a democratic innovation.
As the literature on Brazilian health councils continues to grow, it has become
evident that the promise of these new democratic spaces is proving less easy to
fulfil than their architects might have imagined. Analysts have drawn attention to
the gap between the ideals of deliberative governance and the realities of pervasive
cultures of politics and the replication of embedded inequalities in conduct within
these spaces. The tension between the assumptions about participation,
accountability and democracy that are embedded in contemporary debates about
participatory governance and deliberative democracy, and the understandings and
practices of the actors who animate these institutions is under-explored in this
literature, and forms the focus for this paper. Through an extended case study of an
incident in the life of a municipal health council in a small municipality in the
impoverished north-eastern Brazilian state of Pernambuco, it seeks to explore the
meanings and practices associated with democracy in this context. To do so, it
deploys a technique unfamiliar in much of the literature on governance:
ethnographic ‘thick description’. By evoking everyday meanings and practices of
democracy in the council, the paper seeks to demonstrate the importance of
locating the normative assumptions that are embedded in theories of deliberative
democracy and participatory governance in lived experience in particular cultural,
historical and political contexts.
Keywords: participatory governance; health systems; civil society; democracy; Brazil.