Social participation and Primary Health Care in Brazil: a scoping review

Buziquia, Sabrina Pontes; Junges, José Roque; Lopes, Priscila Pereira da Silva; Nied, Camila; Gonçalves, Tonantzin Ribeiro

doi:10.1590/S0104-12902023220121en

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Brasil

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Critical Review of Literature • Saude soc. 32 (1) • 2023 • https://doi.org/10.1590/S0104-12902023220121en copy

Social participation and Primary Health Care in Brazil: a scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This article aimed to carry out a scoping review of the literature to understand the formal experiences of social participation that have been developed in the context of the Brazilian Primary Health Care (PHC), since the creation of the Brazilian National Health System (SUS) until November 2020. The databases LILACS, PubMed, PsycINFO, and Sociological Abstracts were searched, and 20 articles were included that described the social participation in the context of PHC. The results found were discussed regarding the profile of the participants and the competence to participate, the process of participation and the building of participatory actions, and the centrality of permanent education as a way to strengthen social participation in health. The research revealed distinct experiences of social participation developed in the territories where the PHC operates, highlighting the difficulties faced in the process of implementing the Local Health Councils (LHC). Thus, it is understood that strengthening the PHC, especially the Family Health Strategy (FHS) model, involves, in a dialectical way, the construction and the qualification of participatory spaces, which would result in a central strategy to defend the SUS at this time of resurgence of democratic relations in Brazil.

Keywords:
Social participation; Health councils; Primary Health Care; Democracy

Author/Year	Study location/collection period	Study design/collection instrument	Participants	Main results	Qualis*
Barroso and Silva (2015BARROSO, K. de A.; SILVA, G. S. O controle social na atenção primária e a atuação dos conselhos municipais. Arquivos de Ciências da Saúde da UNIPAR, Umuarama, v. 19, n. 3, p. 213-219, 2015. DOI: 10.25110/arqsaude.v19i3.2015.5551 https://doi.org/10.25110/arqsaude.v19i3.... )	Datas, Diamantina, Senador Modestino Gonçalves, and Presidente Kubitscheck, Vale do Jequitinhonha, MG. Oct.-Dec./2007.	Cross-sectional; descriptive quantitative/Questionnaire.	Forty municipal councilors.	The identification profile of the councilors: female gender (72.5%), with higher education (52.5%), and with employment ties linked to the public health services of the respective municipalities (35.0%). The proportions of the segments of society represented are health workers (30.0%), users (27.5%), health service providers (12.5%), and government (7.5%). The main form of the election was via indication by the Municipal Health Secretariats (MHS)) (37.5%), followed by referral by some association/entity in which they participate (37.5%). Regarding their performance, most consider themselves very participative in working as councilors (87.5%). Concerning the relationship between municipal health councilors and PHC, while they report knowing the services and their problems, there is low participation in meetings at the Basic Health Units (BHU), where they are users. In conclusion, there is a weakness in exercising social control in the PHC and the need for closer contact between councilors and these services.	B4
Bispo Júnior and Martins (2012BISPO JÚNIOR, J. P.; MARTINS, P. C. Envolvimento comunitário na Estratégia de Saúde da Família: dilemas entre institucionalização e efetiva participação. Physis: Revista de Saúde Coletiva, Rio de Janeiro, v. 22, n. 4, p. 1313-1332, 2012. DOI: 10.1590/S0103-73312012000400004 https://doi.org/10.1590/S0103-7331201200... )	Vitória da Conquista, BA. Mar.-Jun./2009.	Cross-sectional; descriptive quantitative, and qualitative; multiple case study/Document analysis (the period between Mar./2007-Feb./2009, except January) and interviews.	Thirty-six local councilors.	Regarding the frequency of LHC meetings, the majority held those that were planned (53.6%); on the agreed themes, they refer to social mobilization and community participation (37.7%), the internal organization of the LHC (20.8%), difficulty in assisting in the Family Health Program (FHP) and specialized referrals (20 .4%), low community participation, and issues related to the organization of LHC itself (18%). Regarding the performance of the LHC, while there is a consensus on its importance for improving the community’s living conditions, the interviewees perceived it as still incipient due to issues of representativeness and fragility of community organizations. They highlight that the participation of some healthcare users is motivated by individual interests related to facilitating access to health services, demonstrating misunderstandings about the purposes of LHC and the weaknesses of SUS and FHP in guaranteeing dignified assistance to the population.	B1
Busana, Heidemann, and Wendhausen (2015BUSANA, J. de A.; HEIDEMANN, I. T. S. B.; WENDHAUSEN, A. L. P. Participação popular em um conselho local de saúde: limites e potencialidades. Texto & Contexto Enfermagem, Florianópolis, v. 24, n. 2, p. 442-449, 2015. DOI: 10.1590/0104-07072015000702014 https://doi.org/10.1590/0104-07072015000... )	Municipality of SC. Jun.-Sep./2013.	Cross-sectional; qualitative/Structured questionnaire; field diary; focus group (5 culture circles).	Eleven councilors from a LHC (nine healthcare users and two health professionals).	The characterization of the participants was: age between 37 and 64 years old, seven men and four women; the majority with higher education or complete elementary education; self-employed or retired. The research had five culture circles addressing the potentialities and limits of participation in the LHC. After the meetings, 39 generating themes were coded and decoded. Among its potentialities is the possibility of exercising citizenship, constituting an educational space, and the intention to make decisions representing the community. Concerning the limitations, lack of knowledge about the council’s responsibilities, lack of community participation, and discredit.	B1
Domitrovic, Araújo, and Quintanilha (2013DOMITROVIC, N.; ARAÚJO, M. D.; QUINTANILHA, B. C. O papel do mediador no incentivo à participação das comunidades nas ações de promoção da saúde. Psicologia: Teoria e Prática, São Paulo, v. 15, n. 1, p. 81-91, 2013.)	Vitória, ES. No collection period.	Cross-sectional; qualitative/field diary and interviews.	Eight local councilors (four from each LHC) and two psychologists (one from each BHU).	LHC with monthly meetings, between nine and 10 participants, predominantly female. Thematic axes: reports from partner institutions and instances (Cras, Cajun, and the Management Collegiate - BHU internal instance, meetings between professionals and during working hours); campaigns and programs carried out at the BHU (councilors representing the workers pointed out the low adherence to the actions due to little disclosure, and asked the representatives of the healthcare users to pass on information to the community); structural problems in the neighborhoods served by the BHU (flooding of a square, accumulation of garbage in a vacant lot, faulty wiring, clogged maintenance holes, and lack of recreational spaces for children - expanded notion of health -; some interviewees showed ignorance of the function of the LHC with questions of personal interest); internal problems at the BHU (physical conditions, more professionals, occasional complaints about the functioning of the BHU, emptying of the LHC, participation restricted to the performance of a few representatives). The expressions “we” and “they” frequently appear in the speeches.	B4
Franchi et al. (2012FRANCHI, E. P. L. P. et al. Participação social nos conselhos de unidades de saúde. Cogitare Enfermagem, Curitiba, v. 17, n. 4, 2012. DOI: 10.5380/ce.v17i4.30373 https://doi.org/10.5380/ce.v17i4.30373... )	Botucatu, SP. Sep.-Oct./2008.	Cross-sectional; qualitative/Interviews.	Nine councilors of healthcare users from four Health Unit Councils (CONUS), three Family Health Strategy (FHS), and one Health Center - São Paulo State University (UNESP).	It results in three categories: the first, “Knowing the user/councilor,” presents the profile of the councilors - three women (33.3%) and six men (66.7%) -; aged from 35 to 70 years old, seven (77.7%) of them over 56 years old; the majority (77.7%) retired or housemaker; all attend associations outside the Council, churches, and pastoral care, followed by groups for the elderly, neighborhood associations and councils for the elderly; and most have served more than one term. In the second category, “The Council of Health Units,” most participants learned about the Council from BHU employees and CONUS members. Although they considered the first meeting not very participatory, they positively evaluated the influence of the Council in their lives - emphasis on interpersonal relationships and critical ability. Finally, in the third category, “Participation in the Council,” the majority considers CONUS active, cooperative, and without conflicts; while they believe in social participation, one says that it does not work in practice, that there is little interest from the community; however, the perception of an improvement in health care after the CONUS action is unanimous and that the Council influences health management and political representatives.	B4
Jerome (2018JEROME, J. S. Governança participativa no contexto de conselhos locais de saúde: entrevistas com seis presidentes de conselhos locais de saúde no Nordeste do Brasil. Saúde e Sociedade, São Paulo, v. 27, n. 3, p. 740-753, 2018. DOI 10.1590/S0104-12902018180226 https://doi.org/10.1590/S0104-1290201818... )	Fortaleza, CE. 2015-2017 (second half of each year).	Cross-sectional; qualitative/participant observation and interviews.	Seven BHU; six presidents of LHC.	All seven BHU had at least one dentist and one pharmacy on-site, six of which were LHC. Meetings with 12 or fewer participants (half under five), age range, even number of men and women, and high school education. All six LHC presidents resided and grew up in the neighborhoods, and five were former and/or current members of community organizations with active participation in the community’s historic struggle. Main themes presented: missing medicines and problems with staff; deficient infrastructure to carry out the work of the LHC (they asked for adequate space and material resources for meetings, such as its room, air conditioning, pens, and papers); and lack of proper representation at meetings. Difficulties pointed out: the presence of BHU coordinators at meetings inhibits the community from reporting problems (they may need “favors”); socioeconomic and educational differences of the healthcare managers compared to the other members of the LHC. Improvements made: advocating for residents; taking care of the physical structure; hiring a security guard at BHU; constructing a wider concrete perimeter around the school; and creating a revenue collection program at bus terminals (local ideas that impacted health initiatives across the city).	B1
Junglos et al. (2019JUNGLOS, C. et al. Motivações, importância, desafios e perspectivas do controle social em saúde. Cogitare Enfermagem, Curitiba, v. 24, e66874 2019. DOI: 10.5380/ce.v24i0.66874 https://doi.org/10.5380/ce.v24i0.66874... )	Capital in the southern region. Jan.-Mar./2017.	Cross-sectional; qualitative/Interviews.	Fifteen local councilors.	Regarding the councilors’ profile: most are over 50 years old (93%), male (60%), retired (80%), and participated in the councilor training course (66%). Concerning performance time, most have been working for less than two years (40%). Four categories emerged: Motivations for acting in the LHC (improving the community; having a history of social participation; personal indignation; right/duty to participate; being able to help by having a network of favorable relationships); Importance and performance of the LHC for the SUS (information on the health situation of the community; purposeful and supervisory space for health services); Challenges of participation in the LHC (expanding participation, individualism, the influence of party politics, lack of knowledge of the population); Prospects for action and strengthening of the LHC (more willing to help the community, more people participating and efficient management in the SUS).	B4
Lisboa et al. (2016LISBOA, E. A. et al. Conselhos locais de saúde: caminhos e (des)caminhos da participação social. Trabalho, Educação e Saúde, Rio de Janeiro, v. 14, n. 3, p. 679-698, 2016. DOI: 10.1590/1981-7746-sol00013 https://doi.org/10.1590/1981-7746-sol000... )	Anchieta, ES. Jun.-Sep./2013.	Cross-sectional; qualitative/Interviews.	Thirteen local councilors.	From the LHC implementation process, categories emerged: to be or not to be a health councilor? That is the question! (opportunity to vocalize the interests of the community, but still the unpreparedness to exercise the function); non-belonging and non-participation (disbelief of the population concerning the local politics, the community has little knowledge of the LHC existing in the municipality, they only participate in elections; non-belonging can be explained by the turnover of residents due to the installation of multinationals in the territory); and LHC: links, means, and mediations (lack of support and feeling of abandonment by management as discouraging factors in the face of the development of LHC, in addition to disappointments with the Municipal Health Council - MHS).	B1
Lopes and Almeida (2001LOPES, M. L. da S.; ALMEIDA, M. J. de. Conselhos Locais de Saúde em Londrina (PR): realidade e desafios. Saúde em Debate , Rio de Janeiro, v. 25, n. 59, p. 16-28, 2001.)	Londrina, PR. No collection period.	Descriptive quantitative and qualitative/Interviews.	One hundred eighty-three local councilors (who attended at least one meeting in the first half of 1999).	Distribution of the 38 LHC in the urban area, according to regions: eight are in the east zone, eight in the north zone, seven in the west zone, nine in the south zone, and six in downtown. According to the classification: 25 (65.8%) were active, five (13.2%) were in the formation phase, four (10.5%) were non-existent, three (7.9%) were not functioning, and one (2.6%) was in the reactivation phase. Regarding the profile of the Councilors: 56.3% were women, although men primarily held the positions of presidents (ratio 15 to 10); 38.2% were employed, 30.6% unemployed, and 31.2% self-employed; 47% had an income higher than six minimum wages; 49.8% had never participated in training courses for Councilors. Qualitative analysis concerning the function of the LHC: joint work, need for population organization, supervisory role, space for complaints, participation in planning, and change in the care model. Despite the variety, the speeches were restricted, for the most part, to charging, asking for things, or claiming rights. Regarding the concept of health, most were established by Law No. 8,080/1990 (53.5%), followed by the simple concept of absence of physical illness (25%). Concerning the actions carried out by the Councils: the most brought resolution of problems in the BHU (more doctors, medicines, and services), but there were also actions in the environment and favor of the community. Regarding internal difficulties: lack of physical, financial, and organizational structure, non-compliance with meeting dates and times, and lack of prior agendas and meeting records. Concerning the external difficulties: lack of population participation in meetings and activities. Regarding the relationships between LHC, MHC, RHC, and Higher Education Institutions (HEI): RHC contributes to LHC but could be more participatory; the MHC should be more participative and resolving; HEI helps improve and praises interns. However, a criticism concerns the lack of feedback on survey results and the discontinuity of services after the survey.	B2
Martins and Santos (2012MARTINS, A. de L. X.; SANTOS, S. M. dos R. O exercício do controle social no Sistema Único de Saúde: a ótica do enfermeiro como membro do Conselho Local de Saúde. Saúde e Sociedade , São Paulo, v. 21, supl. 1, p. 199-209, 2012. DOI: 10.1590/S0104-12902012000500017 https://doi.org/10.1590/S0104-1290201200... )	Juiz de Fora, MG. No collection period.	Cross-sectional; qualitative/Interviews.	Fifteen nurses active in LHC (seven councilors, seven BHU management representatives, and one listener.)	Profile: most graduated more than ten years ago (73%), have postgraduate training (87%), most in the collective health (CH) area in FHP (47%), worked in BHU for an average of seven years, worked in LHC for four years. First category: Performance of nurses in the LHC (they believe they contribute to improving health conditions and services provided by the BHU, for some, it is just the role of disseminating, informing, guiding, and raising awareness of the services offered by the BHU). Second category: the participation of the community and the nurse in the LHC (social control can be expanded by interaction with the community, financial resources, social control, and the assistance model for the democratic and sanitary model, councilor as a partner of the BHU, unpreparedness of councilors to act in LHC, clientelism attitudes, or partisan interests). Third category: community, nurse, and the LHC, given the policies defined by the SUS and the health actions carried out by the BHU (LHC performance is good, but only proposals promoted by the BHU are supported).	B1
Mittelbach and Perna (2014MITTELBACH, J. C. da S.; PERNA, P. de O. A percepção dos enfermeiros sobre o seu papel nos conselhos de saúde enquanto segmento dos trabalhadores de saúde. Cogitare Enfermagem , Curitiba, v. 19, n. 2, p. 284-291, 2014. DOI: 10.5380/ce.v19i2.31547 https://doi.org/10.5380/ce.v19i2.31547... )	Curitiba, PR. Jan.-Jul./2012.	Cross-sectional, quantitative, and qualitative/Interviews.	Eighteen nurses from the BHU.	Nurses’ concept of what Social Control is: space for agreement between managers and users (50%), followed by a way for society to improve the SUS (20%). Nurses’ performance in the HC: guide users on how they should participate in HC meetings, explaining the importance and functioning of this space (83%). Limitations for the participation of nurses in the HC: lack of interest in political action (23%), lack of personnel in distant or small BHU (20%), time (night) for meetings (18%), double shifts (18%), loss of interest as it is a space used by users to obtain facilities or personal prestige (12%), the self-indulgence of professionals (9%). Advances in the participation of nurses in the HC: a more significant number of professional nurses in the network (52%), greater politicization of nurses (26%), in the BHU where professionals work, there is no restriction for participation in the LHC (22%). Influence of nurses in LHC on Nursing work: request for security personnel (Municipal Guard) (50%), physical renovations in the BHU (27%), more nursing professionals for the BHU (11%), the definition of points for vaccination outside the BHU during campaign periods (6%), and construction of an access ramp for people with special needs at the BHU (6%).	B4
Miwa, Serapioni, and Ventura (2017MIWA, M. J.; SERAPIONI, M.; VENTURA, C. A. A. A presença invisível dos conselhos locais de saúde. Saúde e Sociedade , São Paulo, v. 26, n. 2, p. 411-423, 2017. DOI: 10.1590/S0104-12902017170049 https://doi.org/10.1590/S0104-1290201717... )	Ribeirão Preto, SP. Oct./2015-Jul./2016.	Cross-sectional; qualitative; case study/Interviews, direct observation, and minutes analysis (2015-2016).	Twenty-two people (16 healthcare users and six local councilors).	Profile of interviewees: mostly women, elderly, retired, with incomplete high school, and who usually attended health promotion groups organized at the BHU. The following categories emerged: LHC invisibility (most are unaware of the LHC, lack of information, LHC activities are not disclosed in promotion groups, there are almost no new participants, healthcare user representatives have a history of participation in conferences and social movements allowing to expand the agenda of the meeting); Ignorance, disbelief, and dependence on competent bodies (healthcare users are unaware of representatives, delay in resolving demands, passive attitude, and dependence on the institution); Alternatives to leave anonymity (Community Health Agent - CHA and their mediating role, expansion of the dissemination of LHC activities and identification of healthcare user representatives, dissemination of the expanded concept of health, strengthening of health promotion groups, training of councilors, and more significant interaction between LHC and MHC).	B1
Oliveira and Dallari (2015OLIVEIRA, A. M. C.; DALLARI, S. G. Participação social no contexto da Atenção Primária em Saúde: um estudo de caso das Comissões Locais de Saúde do SUS de Belo Horizonte. Physis: Revista de Saúde Coletiva , Rio de Janeiro, v. 25, n. 4, p. 1059-1078, 2015. DOI: 10.1590/S0103-73312015000400002 https://doi.org/10.1590/S0103-7331201500... )	Belo Horizonte, MG. Oct./2013-Jun./2014.	Cross-sectional, qualitative; single case study/Document analysis and participant observation (field diary).	Three Local Health Commissions with opposite Social Vulnerability Index (SVI).	Regarding the dynamics of participation and deliberation, two LHC have organization and operating rules established in the statute and are competent to deliberate on problems (the internal regulations also provide decision-making power in the area covered by the BHU). The topics on the agenda were proposed at the last annual meeting and were brainstormed by BHU managers. Discussion themes: garbage issue, violence, elections, and network of connections. When analyzing the local networks and their relationships through the PHC, the horizontal flow of information arising from the discussions that allowed monitoring and monitoring public policies was highlighted.	B1
Pestana, Vargas, and Cunha (2007PESTANA, C. L. da S.; VARGAS, L. A.; CUNHA, F. T. S. Contradições surgidas no Conselho Gestor da Unidade Básica de Saúde da Família de Vargem Grande, município de Teresópolis-RJ. Physis: Revista de Saúde Coletiva , Rio de Janeiro, v. 17, n. 3, p. 485-499, 2007. DOI: 10.1590/S0103-73312007000300005 https://doi.org/10.1590/S0103-7331200700... )	Teresópolis, RJ. No collection period.	Cross-sectional; qualitative; case study/Minutes analysis; interviews.	Councilors of The Management Council (MC) of The Family Health Unit (FHU) - no “n” informed.	Regarding the contradictions of the MC: dissociation between the population’s needs and the proposal of the BHU, based on the government’s health programs; appropriation of the discourse of healthcare managers and health professionals by popular leaders (ideological domination); healthcare users want to be assisted by the BHU doctor (logic of the medical-assistance model); fear of councilors representing healthcare users of confronting health professionals and, in the future, needing assistance; councilors representing healthcare users and health professionals cultivate a dependency concerning the councilors representing the healthcare manager (the meeting is suspended when the representatives of managers do not attend); councilors exercise attributions that are devoid of political sense (MC was unable to interfere in health policy and in the allocation of public funds); members of the Health Secretariat responsible for calling meetings (health professionals and healthcare users represent 75% of the members of the MC, revealing a sufficient quorum to meet and deliberate); MC does not have decision-making power in resolving community demands.	B1
Ponte et al. (2019PONTE, H. M. S. da et al. Ser enfermeiro, ser conselheiro: despertando para o controle social e saúde pública. Revista Brasileira de Enfermagem, Brasília, v. 72, n. 1, p. 142-147, 2019. DOI: 10.1590/0034-7167-2017-0544 https://doi.org/10.1590/0034-7167-2017-0... )	Sobral, CE. Sep.-Nov./2016.	Cross-sectional; qualitative/Interviews; minutes analysis.	Eight Councilors nurses (having been a Councilor between 2008-2016).	“Awakening to participation and social control” shows that there are few direct relationships with the inclusion of social control in academic training; the nurse-councilors participating in the study unanimously say that the student movements were the first contact with social control as a way to qualify the services provided. Subsequently, joining the PHC universe in the FHS space strengthened this interest. In the entitled “Contributions of participation as a Councilor for professional performance,” they report that being or having been a Councilor at the MHC brought professional and personal development, encouraging a more critical and reflective look at community issues, in addition to humanizing relationships, strengthening bonds and active listening.	B1
Ribeiro and Nascimento (2011RIBEIRO, F. de B.; NASCIMENTO, M. A. A. do. Exercício de cidadania nos Conselhos Locais de Saúde: a (re)significação do “ser sujeito”. Revista Baiana de Saúde Pública, Salvador, v. 35, supl. 1, p. 151-166, 2011. DOI: 10.22278/2318-2660.2011.v35.n0.a153 https://doi.org/10.22278/2318-2660.2011.... )	Feira de Santana, BA. No collection period.	Cross-sectional; qualitative/Interviews, systematic observation, and document analysis.	Seventeen FHU subjects in implementing the LHC (key informant and health committee members).	Understanding social control in the LHC formation process: the representation of the social subject (instrumentalization for the exercise of social control, inexpressive bureaucratic representation); education as fundamental for the implementation of the LHC (healthcare user representatives rarely attended the meetings and, if they were present, they expressed little). The process of social mobilization for implementing the LHC is moving slowly, with few critical, participatory subjects and promoters of the ideal of participation.	B3
Tilio (2014TILIO, R. de. Participação Política? Experiências de um Conselho Local de Saúde no sistema penitenciário. Psicologia Política, São Paulo, v. 14, n. 30, p. 297-311, 2014.)	Uberaba, MG. Jan./2012-Oct./2013.	Cross-sectional; qualitative/Participant observation and field diary.	Health and education team, management, and persons deprived of liberty (PDL) of Professor Aluízio Ignácio de Oliveira Penitentiary (PPAIO).	Participation of PDL in health management in the penitentiary institutional context was based on two actions: (1) training of PDL to be multiplier health agents, and (2) creation of a LHC (considering that PPAIO had a BHU and followed the structuring legislation of the SUS). Two moments are highlighted: the first covers seven meetings and main demands (establishment of the council, the election of members and the board of directors, approval of the internal regulations, questions about the reduced number of medical, dental, and psychological consultations, acquisition of medicines and health materials, mainly dental, clarifications on the distribution of medication and assistance/social security services, such as social benefits for the PDL and their families, the need for fumigation of the pavilions, daily collection and proper disposal of garbage, and the forwarding of demands to the MHC, to make visible the sanitary conditions of the penitentiary. The second moment covers six meetings: with the intensification of the needs of the PDL in the LHC meetings, the penitentiary management responded with the demobilization of the LHC.	B2**
Vale et al. (2017VALE, P. R. L. F. do et al. Movimento social de bairro: potencialidades e limites da participação em conselhos locais de saúde num município de interior no nordeste brasileiro. Saúde em Redes, Porto Alegre, v. 3, n. 3, p. 230-241, 2017. DOI: 10.18310/2446-4813.2017v3n3p230-241 https://doi.org/10.18310/2446-4813.2017v... )	Feira de Santana, BA. Apr.-May/2013.	Cross-sectional; qualitative/Systematic observation and interviews.	Fourteen local councilors.	Regarding the councilors’ profile: mostly men; continuous CHA occupation by retirees; age range from 30 to 40 years; black race; married; complete secondary level; Catholics and active in church social actions, political parties, community associations, or residents. Potentialities of the LHC - category “where there are several heads, there are several thoughts” (autonomy in social manifestations, feeling of representing a community and leading manifestation of local social interests, knowledge of the themes of the health sector for the practices of being a councilor and power of argumentation); Limits of the LHC - category “authoritarianism, political co-option, and little support” (little participation of the community and the councilors themselves, party influence, little recognition of the objective of the LHC, dissatisfaction related to the precarious physical structure destined to the meetings of the LHC and authoritarian and bureaucratic character of municipal management, councilor remuneration, articulation between LHC and MHC, decision-making of municipal management is little publicized, and instituted in a descending way.	B4
Vale and Lima (2015VALE, P. R. L. F. do; LIMA, M. M. de. Ser conselheiro local de saúde em Feira de Santana, Bahia. Revista Baiana de Saúde Pública , Salvador, v. 39, n. 4, p. 723-739, 2015. DOI: 10.22278/2318-2660.2015.v39.n4.a1825 https://doi.org/10.22278/2318-2660.2015.... )	Feira de Santana, BA. No collection period.	Cross-sectional; qualitative/Interviews, systematic observation, and document analysis.	Sixteen local councilors (two from each LHC, one representing users and one representing health workers).	The main discussions of the LHC addressed PHC, transportation, and public safety (showing an expanded notion of health). The operation took place in an ample space belonging to the FHU in the neighborhood and complied with the internal regulations, monthly meetings, and maximum time stipulated; the coordinator was a mediator, the secretary was responsible for writing the minutes of the sessions, there was no verification of the quorum (they deliberated anyway). Regarding the experience of being a councilor: the feeling of personal accomplishment, gratification, donation, and help to others, LHC like a potentially transforming body of reality by ensuring the participation of the population in municipal management, LHC with a homologating character of public interests, integration with other segments social projects for intersectoral actions, and training of councilors.	B3
Varela et al. (2020VARELA, L. D. et al. Conselho Local de Saúde: implantação e dificuldades da formação na Estratégia Saúde da Família. Revista Brasileira em Promoção da Saúde, Fortaleza, v. 33, 10908, 2020. DOI: 10.5020/18061230.2020.10908 https://doi.org/10.5020/18061230.2020.10... )	Milagres, CE. Feb.-Jul./2016.	Cross-sectional; qualitative/systematic observation, document survey (between Oct./2013-Jun./2016) interview and focus group (field diary).	Twenty-two local councilors from a rural community.	The LHC is represented by healthcare users (primarily women; aged between 23 and 65 years, with high school education and housework) and workers of the FHS team (one dental surgeon and five CHA; three men and three women, aged between 32 and 65 years; minimum working time of six years and maximum of 25; two with higher education and two with secondary education). The following categories emerged: Contextualities in the implementation of LHC (municipal health conferences, National Program for Access and Quality Improvement in Primary Care (PMAQ-AB) and motivation of the FHS team); Formation of the LHC in the face of the daily situations of the community: health needs, participation, and renewal (organization of the LHC for the mobilization of healthcare users and health workers, highlighting the importance of the CHA); Difficulties faced in organizing the LHC (at first there was low adherence by the population, but the councilors were able to mobilize the community, causing the group to mature and the identity of the LHC to be built).	B3

	N	%
Study Design
Qualitative	16	80
Quantitative	1	5
Mixed	3	15
Data collection instrument*
Interviews/Questionnaires	18	48,6
Focus Group	2	5,3
Observation/Field Diary	9	24,3
Document Analysis	8	21,6
Participatory spaces studied
Local Health Council (LHC)	12	60
Municipal Health Council	2	10
Health Management Council	1	5
LHC+Basic Health Unit	5	25
Regions
Northeast	7	35
Southeast	11	55
South	2	10
Data Collection Period
2007-2011	3	15
2012-2014	6	30
2015-2017	5	25
N/A**	6	30
Publication Year
2001-2006	1	5
2007-2014	9	45
2015-2017	6	30
2018-2020	4	20
Collective Health Qualis
B4	6	30
B3	3	15
B2***	2	10
B1	9	45

Faculdade de Saúde Pública, Universidade de São Paulo. Associação Paulista de Saúde Pública. Av. dr. Arnaldo, 715, Prédio da Biblioteca, 2º andar sala 2, 01246-904 São Paulo - SP - Brasil, Tel./Fax: +55 11 3061-7880 - São Paulo - SP - Brazil
E-mail: saudesoc@usp.br

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[1] Correspondence Sabrina Buziquia Av. Unisinos, 950. São Leopoldo, RS, Brasil. CEP 93022-750