340 Accountability through Public Opinion
Table 22.2. Indicators of Participation Variable 1. Selection procedures 2. Facilitation 3. Agenda (who sets; issues in discussion) 4. Information provided 5. Right to speak 6. Environment (deliberations, persuasion, and confrontation) 7. Decision-making method 8. Accountability to constituencies 9. Satisfaction
Instrument Field observation, minutes Field observation Minutes, discussion analysis, field observation Minutes, discussion analysis Minutes, discussion analysis Minutes, discussion analysis, field observation Minutes, field observation Questionnaire, field observation Questionnaire
Source: Author.
Other features highlighted are related to the transparency and structure of the meetings. In this sense, it is necessary to verify who sets the agenda, how the process unfolds, and who speaks and is listened to. Furthermore, with reference to the quality of the debate, it is necessary to observe if the discussions are deliberative, if much negotiation takes place, and if the environment is one of dialogue or confrontation. How are decisions made, through quantitative procedures or consensus agreements? Finally, it is necessary to analyze what new information is added and what kinds of decisions are made. Many authors justify participatory processes based on their potential to bring to light information about the demands and the quality of services that the population receives, as well as inform the population as to what is being debated in terms of health policies. The argument is that by broadening the available information, the possibilities for innovation and adjusting the terms of supply and demand increase (Coelho and others 2010). In short, to what degree do different methods of selecting representatives, facilitators, well-structured meetings, the availability of information, and mechanisms for publicizing the decisions contribute to the establishment of a democratic process? From this starting point, we defined nine variables, as listed in table 22.2. Connections What enables us to describe, compare, and evaluate the participatory process in terms of its links with the policy process? Here again, there is no simple answer, because considerable debate surrounds what type of connection and what level of coordination are important. We evaluate the existing connections between the LHCs and the policy processes that take place in the executive and legislative branches at the municipal, state, and national levels. We also refer to the connections with other participatory forums, with other institutions in the health system, and with other public and private organizations. From this starting point, we defined five variables set out in table 22.3.