International Development Research Centre, Ottawa, Canada.
Collaborative Program in Global Health, Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
Int J Equity Health. 2020 Oct 26;19(1):173. doi: 10.1186/s12939-020-01278-1.
Participatory governance is about state and society jointly responsible for political decisions and services. The origins and trajectory of participatory governance initiatives are determined by the socio-political context and specifically the nature of state-society relations. Participation by communities in health interventions has been promoted globally as a strategy to involve citizens in health decision-making but with little success. Such participatory governance in health should be seen not as a strategy alone but as a political project in which organized communities challenge the status-quo in health.
This paper deals with the wider socio-political context of participatory governance initiatives. It uses comparative politics literature to analyze socio-political context in Brazil and Venezuela, historically spanning half century prior to 2015, to assess whether it was conducive to participatory governance. The focus of this paper's analysis particularly is on the socio-political changes that were taking place in Brazil and Venezuela in the decades of the 1980s and 1990s. Those decades formed the bedrock on which the two countries experienced democratization and a socialist transformation that has lasted well into the first decade of the twenty-first century. The situation in the health sector is also described for the two countries showing a parallel trajectory to the wider political context and that reflected the political ideology. For this assessment, we use a contemporary framework called the 'socialist compass' which links dynamics of power relations in various ways among three domains of power, namely, state power, economic power, and social power. Socialist compass can be used to assess whether such reforms are moving towards or against social empowerment.
Our analysis reveals that both Brazil and Venezuela were moving in the direction of social empowerment until at least the year 2015, just before the political turmoil started engulfing the left-leaning regimes in both the countries.
参与式治理是指国家和社会共同负责政治决策和服务。参与式治理倡议的起源和轨迹取决于社会政治背景，特别是国家与社会关系的性质。全球范围内，社区参与卫生干预措施已被作为一种将公民纳入卫生决策的策略而得到推广，但收效甚微。这种参与式治理不应仅仅被视为一种策略，而应被视为一个政治项目，在这个项目中，有组织的社区挑战卫生领域的现状。
本文探讨了参与式治理倡议的更广泛社会政治背景。它利用比较政治学文献分析了巴西和委内瑞拉的社会政治背景，历史跨度为 2015 年之前的半个世纪，以评估其是否有利于参与式治理。本文分析的重点特别放在巴西和委内瑞拉在 20 世纪 80 年代和 90 年代发生的社会政治变化上。这几十年是两国经历民主化和社会主义转型的基础，这种转型一直持续到 21 世纪的第一个十年。本文还描述了两国卫生部门的情况，展示了与更广泛政治背景的平行轨迹，并反映了政治意识形态。为了进行这种评估，我们使用了一个当代框架，称为“社会主义指南针”，它以各种方式将权力关系的动态联系在国家权力、经济权力和社会权力这三个权力领域之间。社会主义指南针可以用来评估这种改革是否朝着或反对社会赋权的方向发展。
我们的分析表明，巴西和委内瑞拉都在朝着社会赋权的方向发展，至少在 2015 年之前是这样，就在这两个国家的左翼政权开始陷入政治动荡之前。
