The literature concerning governmental policy-making generally encompasses the entire policy-making field. This study focused on one particular aspect of this process in the State of Rio de Janeiro, from January 1998 to July 1999: the formal decision-making tiers represented by State Health Council (CES) and the Bipartite Inter-Managerial Commission (CIB), as well as the relationships between these councils and the State Health Secretariat (SES), which holds political responsibility for approving or rejecting decisions and is thus a key player in the implementation of the Unified Health System (SUS) at the State level. Despite the political confrontation among the SES, CIB, and CES, we have observed that the new design in health policy vis-à-vis the decision-making process has fostered increasing influence by social actors involved in decisions and that the negotiated arrangements, although the result of a given correlation of forces, have favored the democratization of policy-making in the health sector.
Health Policy; Policy Making; Decision Making