<b>Background</b>: In order to protect the poor from health shocks, the Government of India launched Rashtriya Swasthya Bima Yojna (RSBY) in 2008. The objectives of this study are: a) to assess the changes in the financial burden of health care on the poor population; b) to estimate the effects of RSBY in reducing the financial burden on the poor; and c) to examine the impact of RSBY on the labour supply of the poor. <b>Methods</b>: The study is based on data from the National Sample Survey Organisation (NSSO). The sample size is between 100-125 thousand households at the all-India level. The study uses pooled cross-section regression analysis to assess the changing pattern of out-of-pocket (OOP) payments on healthcare. The impact of RSBY on financial risk protection and labour force participation rate in India were estimated using the difference-in-differences (DID) method. <b>Findings</b>: My thesis consists of three papers. The findings in the first paper, changing pattern of out-of-pocket payments, reflect that the poorest 20% of households, compared to the richest 20%, realised a slower increase in out-of-pocket as a share of the household’s total expenditure (-0.5%) and catastrophic payments (-2%) during the period of 2000-2012. However, during the same period, Scheduled caste/tribe and Muslim households reported an increased burden of out-of-pocket. The second paper finds reduction in the probability of incurring ‘any inpatient expenditure’ and ‘catastrophic inpatient expenditure’ after RSBY intervention but marginal increase in the ‘per person monthly inpatient expenditure’ and insignificant change in ‘inpatient expenditure as a share of households’ total expenditure’. The effects of the scheme on the total out-of-pocket payment are negligible and non-drug expenditure reflected significant increase. The third paper finds that women’s labour supply increased (3% per annum) but the elderly labour supply declined (1.5%). Further, men switched from self-employment to casual work while women moved to wage-paid regular and casual jobs at the cost of being self-employed. <b>Discussion and conclusion</b>: The poor and other less advantaged population groups realised an increasing OOP burden mainly on account of two factors: i) outpatient care is not covered under RSBY; and ii) the benefit package under the scheme is very modest. Women’s labour supply increased and the elderly labour supply declined in favour of leisure because of possible improvements in health. However, the overall labour supply did not change. The Indian government needs to consider broadening the benefit package and including outpatient coverage under RSBY.

Medicaid expansion under the Affordable Care Act (ACA) facilitates access to care among vulnerable populations, but 21 states have not yet expanded the program. Tennessee’s Medicaid program experienced a dramatic Medicaid contraction when the program disenrolled approximately 170,000 nonelderly adults in 2005. Pre-ACA expansions were associated with better access to and utilization of healthcare services. However, little is known about the effect of these policy changes on improvement in health outcomes for women diagnosed with breast cancer, access to care for cancer survivors, and the effect of generosity and duration of expansion on access to care. This dissertation has three objectives. First, to assess the effects of the Tennesse’s Medicaid disenrollment on stage at diagnosis and delay in surgery for breast cancer among nonelderly women. Second, to compare access to care between cancer survivors living in non-expansion states and survivors living in expansion states. Third, to examine the effect of generosity and duration of the pre-ACA Medicaid expansions on access to and utilization of healthcare services. I use three different types of datasets: the 2002-2008 data from Tennessee Cancer Registry, the 2012 and 2013 Behavioral Risk Factor Surveillance System (BRFSS), and the 2012 Medical Expenditure Panel Survey (MEPS) data. I estimate difference-in-difference models and perform multiple logistic regression models to examine the impact of these policy changes on the different measurement outcomes. While many states are expanding Medicaid eligibility under the Affordable Care Act, there has been discussion among policymakers in some states about reducing eligibility under the Affordable Care Act once full federal funding expires. This study suggests that Medicaid disenrollment leads to later stage at diagnosis for breast cancer patients, indicating negative health impacts of contractions in Medicaid coverage. Prior to the passage of the Affordable Care Act, cancer survivors living in expansion states had better access to care than survivors living in non-expansion states. Failure to expand Medicaid could potentially leave many cancer survivors without access to routine care. The study informs policy makers that, relative to no expansion, moderate or generous expansion is associated with improvement in access to and utilization of healthcare services.

How should the experimental use mechanism be designed in order to maintain the proper balance between the rights of patent holders and the rights retained by the public? The work explores various approaches towards the experimental use exemption in influential regions, such as US UK Germany Japan as well as in international treaties. In each of these systems some degree of vulnerability is found. Either exemption is too narrow or too broad and lacking a dynamic dimension. Therefore, the work sets out to design a dynamic and multi-step experimental use mechanism. The work proposes to view the experimental use mechanism as a right provided to the public and in turn as a duty imposed on the patent holder to suggest path/s of exploration with regard to the patented invention. This approach significantly strengthens the experimental use mechanism as it becomes part of the bundle of requirements that an inventor needs to comply with in order to obtain a patent grant. The scope of the experimental use mechanism will be determined by a three step process. In the first stage the positions and interests of the inventor, invention and researcher will be taken into account in order to determine the incentives needed to cause inventors to stay within the patent system and at the same time prevent researches from migrating to other regions. In the second stage the scope of the experimental use mechanism will be impacted by the determination whether either party adopted anticompetitive behavior. The final step will inquire whether the invention or the research is geared at improving public health. In these instances there will be a tendency to increase the scope of the experimental use mechanism due to the internationally recognized right to health and its global importance. The work incorporates concepts from different legal fields such as competition law and health policy as well as from other disciplines including economics and psychology The three step process has the potential of designing a dynamic and robust experimental use mechanism which may prove to be useful in other patent settings such as the holdup problem or blocking patents. Incorporating a flexible experimental use mechanism may diminish the attempts of patent holders to act opportunistically and curtail the rights of the public. Thus, the work contributes to the current state of the experimental use debate and towards achieving the proper balance between the rights of the patent holder and the rights of the public.

Magister Philosophiae - MPhil / Life expectancy in South African has been fluctuating following the global trends that affects both developed and developing countries. In South Africa the average life expectancy from 1994 to 1996 was higher with an average of 61,3 years. As from 1997 to 1999 it declined to an average of 58,4 years. The difference in years between 1994-1996 and 1997- 1999 was 2,9 years. From 2000-2002, life expectancy continued to decline to an average of 54,6 years. Life expectancy declined in a constant proportion from 2003-2005 and 2006-2008. In 2003-2005 it slightly declined to 52 years and in 2004-2007 it declined to 42,0 years. Life expectancy escalated after the mentioned years to 54,4 years between 2009-2011 and from 2012-2013 life expectancy was 54,0 years on average. This study examined factors or variables that verify the socioeconomic determinants of life expectancy in post-apartheid South Africa. Understanding the relationship between life expectancy and the socioeconomic variables was based on three objectives. The main objective for this study was to determine the impact of socioeconomic variables and health policy efforts on life expectancy, seeking an in-depth understanding by investigating the causality relationship between life expectancy and socioeconomic variables thus later investigating the difference between male and female’s life expectancy. This study was motivated by the fluctuating life expectancy in South Africa. The fluctuation in life expectancy were thus studied in relation to socioeconomic determinants which are government health expenditure, government education expenditure, GDP per capita, total fertility rate, urban population, access to sustainable drinking water and undernourishment. The mentioned variables were used as socioeconomic determinants of life expectancy during post-apartheid South Africa.

No description available.

O presente trabalho consistiu em reconhecer o lugar ocupado por adolescentes concretos no discurso dominante, na área da Saúde Pública, sobre saúde integral do adolescente. Reconhecemos a visão paradigmática biomédica/médico-biológica, como tendência dominante na área de saúde do adolescente, quer na produção do conhecimento, quer na elaboração de propostas de intervenção. Assumimos, como discurso oficial/hegemônico na Saúde, aquele produzido e irradiado por agências internacionais que atuam na área, e que é explicitado no Programa de Saúde Integral do Adolescente, do Plano de AçãO sobre a Saúde do Adolescente nas Américas. Este Programa vem orientando, nesta década, as políticas específicas em países da América Latina e do Caribe, inclusive, no Brasil. Buscamos desvendar o discurso dominante, pela mediação da análise do referido Programa. Recorremos ao emprego de procedimentos metodológicos de ciências sociais, dentro de uma perspectiva histórica, apoiadas em autores que tentam romper com o positivismo - base da visão paradigmática biomédica/médico-biológica. Utilizamos como fontes documentais, além do referido Programa, outras publicações produzidas por organismos internacionais, relacionadas com o nosso objeto de estudo. O processo de desconstruçâo e reconstrução histórica do discurso em estudo, permitiu-nos estar reconhecendo os reais destinatários do Programa de Saúde Integral do Adolescente-adolescentes \"pobres\" - e o lugar, por eles ocupado - objeto, dentro de um projeto, por nós reconhecido como: legistador. ético-moral e pedagógico. / The present study describes and discusses the position held by the \"real\" adolescent in the Public Health context, particularly in the Comprehensive Health Care Program for Adolescent. The biomedical paradigm has hegemonically directed health actions as well as the building of knowledge in this domain. This official discourse is produced and disseminated by international health organizations. The Comprehensive Adolescent Health in the Region of the Americas Program has been used as guideline to determine the adolescent\'s health policies in the Latin America and the Caribbean Region, including the Brazil. The dominant discourse was analysed in order to desclose the \"real\" target population. Social sciences methods, in an historical perspective, were applied to desassemble and to rebuild the discourse, searching out the underlined \"intention\" in that Program. In this investigation, we have taken in account of authors, who disagree with the positivism approach , the basis of the biomedical paradigm. This research allowed us to enhance understandings to whom is adressed the Comprehensive Health Care Program for Adolescents in the Region of Americas. We recognize that the target population of this program are the poor adolescents and they are placed only as an object within the Project. This program contains a legislative, ethic-moral and pedagocic discourse.

Objetivo. Investigar as transformações ocorridas com a descentralização da política de saúde, nos municípios do Estado de São Paulo, após a implantação da Norma Operacional Básica- NOB/96, no que diz respeito a aspectos de recursos financeiros e humanos. Metodologia. O universo de estudo constituiu-se de 416 municípios, sendo 311 em condição de Gestão Plena de Atenção Básica, 90 em Gestão Plena do Sistema e 15 não habilitados nas condições da NOB/96. Foram observadas as variações ocorridas, entre 1997 e 1999, no volume, composição das fontes de recursos e tipo das despesas realizadas em saúde, e no volume, composição dos recursos humanos e existência de política de recursos humanos. Resultados. Observou-se aumento nos recursos gastos em saúde, sendo que a maior taxa correspondeu ao grupo em Gestão Plena do Sistema, que também apresentou o maior valor de despesa em saúde per capita (R$ 138, em 1999). Houve incremento no valor dos recursos próprios e federais nos municípios habilitados. Para os não habilitados ocorreu redução significativa (55 por cento) nas despesas realizadas com recursos federais e aumento nas efetuadas com recursos próprios (17 por cento). Quanto aos recursos humanos, verificou-se mudanças na quantidade e na composição do quadro de pessoal da saúde. Observou-se expansão de 15,5 por cento nos postos de trabalho em saúde das prefeituras habilitadas, sendo de 10,4 por cento para os profissionais universitários e de 19,7 por cento para os não universitários. As prefeituras em Plena do Sistema realizaram mais ações de política de recursos humanos do que aquelas em Plena da Atenção Básica, com incremento em todos os itens, destacando-se a valorização da dedicação exclusiva e a contratação por concurso público, nos municípios em Plena do Sistema, e a existência de plano de cargos e salários e concursos públicos, para aqueles em Plena da Atenção Básica Em 1999, 3 7,2 por cento das Prefeituras informaram ter tido dificuldade em contratar profissionais de saúde, sendo maior nos municípios em Gestão Plena do Sistema Predomina a dificuldade de contratar pessoal de nível universitário, especialmente médicos, enfermeiros e farmacêuticos. Entre os profissionais não universitários, a dificuldade concentra-se em pessoal de enfermagem. Conclusões. Os dados apresentados evidenciaram os efeitos do processo de descentralização da política de saúde, onde ressalta-se o maior volume de recursos financeiros gerenciados pelas prefeituras e o seu papel na geração de postos de trabalho. / Purpose. To investigate the changes taken place after the descentralization of the health policy, in the municipalities of the State of São Paulo, in the period following the implement of the Basic Operational Norm. NOB/96, concerning the aspects of financiai and human resources. Methods. The study universe consisted of 416 municipalities, of those 311 in the condition of \"Full Management of Basic Care\" (Gestão Plena da Atenção Básica), 90 in \"Full Management of the System\" (Gestão Plena do Sistema) and 15 not qualified in the conditions of the NOB/96. The variations taken place between 1997 and 1999 were verified, about the arnount, composition o f the sources o f income and type o f expenditures carried into effect in health, as well as the arnount, composition o f the human resources and the existence of a human resources policy. Results. A increase in expenses in health was verified, the biggest raise corresponding the group that was under \"Full Management of the System\". This group also presents the biggest per capita expenditure in health (R$ 138, in 1999). It occurred an increment in the value offederal and municipal avaiable resources, in the qualified cities. As for the non qualified ones it occurred a significant reduction (55 per cent) in the expenditures carried through with federal resources and an increase in those effected by means of proper resources (17 per cent). As for the human resources, changes were verified in the arnount and composition ofthe health staff. An increase of 15.5 per cent in the work positions in health arnong the qualified municipalities was verified, increasing 10.4 per cent for university degree professionals and 19.7 per cent for the non university graduated professionals. The municipalities in \"Full Managernent of the System\" accomplished the human resources policy better than those in \'\'Full Management of Basic Care \", with na increment in ali itens, notably the exclusive job dedication and new hirings by means o f public compention, in the municipalities in \"Full Management of the System\", and the existence of official wage and job prospects in addition to public competitions, for those in \"Full Management of Basic Care\". For the year 1999, 37,2 per cent of the municipalities informed to have the difficulties in contracting health professionals, being that problem worse for the municipalities in \"Full Management ofthe System\". The prevailing difficulty is to contract staff with university degreelevel, especially doctors, nurses and pharmacists. Among the non university degree professionals, the difficulty remains in contracting nursing staff. Conclusions. The data presented indicated the effect of the decentralization process in the health policy. The largert amount of financiai resources managed by the municipalities and their role in generating work positions is emphasized.

O presente estudo pretende analisar as características e trajetórias de um grupo de mulheres falecidas de câncer e sua relação com a organização do sistema de saúde que as atendeu. Como base empírica foi considerado um sub-grupo de 181 mulheres retirado da amostra de 953 mulheres incluídas na pesquisa \"Mortalidade de Mulheres de 10 a 49 anos no Município de São Paulo - com ênfase à mortalidade materna\". Pelas informações obtidas com os atestados de óbito corrigidos, histórias familiares e histórias médicas, procurou-se reconstituir as trajetórias que conduziram ao óbito. Nessas trajetórias buscou-se analizar o momento da entrada das pacientes no sistema de saúde, o número de consultas realizadas, o momento do diagnóstico e o início do tratamento, o tempo transcorrido entre esses momentos e o óbito e o tipo de estabelecimento de saúde utilizado ao longo do período. A análise procurou relacionar esses aspectos com as localizações do câncer que constituiram a causa básica de óbito, bem como aprofundar o estudo no caso de câncer da mama e do câncer ginecológico. Essa comparação permite detectar eventuais diferenças devidas à existência de programas de diagnóstico precoce. A análise se completa com a comparação de características sócio-economicas do grupo de mulheres objeto de estudo, com a amostra total da pesquisa de referência. Os resultados assim obtidos são cotejados com as modalidades de ação e organização do sistema de saúde a fim de se detectar fragilidades, deficiências ou obstáculos que se interpõe no sentido de garantir prontidão no atendimento, no diagnóstico e início do tratamento, assim como na extensão da sobrevida possível para essas enfermidades. / This study intends to analyse the characteristics and paths followed by a women group died by cancer and the relationships betweeen these characteristics and the organization of the health system. As empirical data it was used a group involving 181 women, part of a sample of 953 women aged 10 to 49 years, died in the city of São Paulo, between July 1st. and December 31th., 1986. Using information gathered through corrected death certification, family histories and medical records, it was made an attempt to reconstruct the path followed since the diagnoses until death. In these paths, it was analysed the first care facility delivered, the number of medical attendance, the beginning of the treatment and the survival time. It was made a separete analysis according the cancer localization, deapening in the cases of breast and gynaecological cancer. This type of analysis was made because the existence of special public programs for their prevention. Finally, the analysis involve socio-economic characteristics of the women and treats some cases in a qualitative way in order to complete the intended reconstruction. The resul ts are interpreted according the characteristics, organization and functioning of the health system.

O Sistema Único de Saúde (SUS) é caracterizado por complexas relações intergovernamentais que têm garantido avanços paulatinos na resolução de problemas quanto à prestação de serviços públicos de saúde à população. Enquanto política setorial de governo, o SUS é influenciado pelos esforços recentes de disseminação e prática dos princípios da administração pública gerencial, cujo foco é uma gestão voltada para resultados e o eficiente uso dos recursos. Nesse contexto, a avaliação de desempenho ganha destaque, todavia, a determinação de parâmetros de avaliação pela Controladoria na Gestão Pública não tem sido uma tarefa simples, pois o tipo de controle aplicável às atividades do setor público depende de quatro complexos critérios: ambigüidade dos objetivos, mensuração dos outputs, conhecimento do efeito das intervenções e repetição das atividades. Uma alternativa para contornar as dificuldades da avaliação de desempenho é a sua realização por benchmark. Neste sentido, este estudo teve por objetivo levantar, medir e explicar as variações de desempenho dos Municípios Paulistas quanto à eficiência econômica na aplicação de recursos públicos nas ações de atenção básica à saúde em função do perfil de financiamento dos gastos gerais e específicos de tal área. A eficiência econômica reflete a capacidade de uma entidade obter máximos outputs ao menor custo e foi medida com o uso da metodologia Data Envelopment Analysis (DEA): técnica de otimização baseada em programação linear e projetada para estabelecer medida de eficiência relativa entre diferentes unidades tomadoras de decisão. Por sua vez, a eficiência econômica, parâmetro de avaliação de desempenho do setor público, é influenciada pela forma como os políticos e burocratas lidam com as restrições orçamentárias. A literatura sobre o federalismo prevê que as transferências nãocondicionais e sem contrapartida provocam gasto público com desperdício, ocasionado pelo processo de ilusão fiscal, de redução do poder de barganha e/ou de flexibilização orçamentária. No primeiro estágio do modelo DEA, foram calculados os escores de eficiência com base na despesa liquidada em atenção básica e a quantidade de outputs diretos produzidos em tal subfunção. Os resultados indicaram que somente 17 dos 599 Municípios Paulistas sob análise foram considerados eficientes e que era possível aumentar, consideravelmente, a quantidade de serviços prestados à população sem a necessidade de novas dotações orçamentárias. No segundo estágio do modelo DEA, verificou-se que a maior proporção de idosos em uma jurisdição torna a prestação de serviços mais cara, por sua vez, maiores densidade populacional, grau de urbanização e escala dos estabelecimentos de saúde favorecem o gasto público com eficiência. Estas quatro variáveis não estão sob o controle do gestor público, portanto, os escores de eficiência foram ajustados para refletir o desempenho resultante do seu poder discricionário. A partir dos escores de eficiência ajustados e por meio da análise de regressão, constatou-se que as transferências não-condicionais e sem contrapartida aumentam a ineficiência do gasto público em atenção básica, conforme previsto pela literatura. Por outro lado, os repasses de recursos do SUS, tanto os não-vinculados quanto os vinculados, reduzem a ineficiência, indicativo dos avanços alcançados pela gestão do SUS. Outro fator que possui interdependência positiva com a eficiência é o indicador de escolaridade, sinalizando que uma população mais bem educada pode favorecer a avaliação de desempenho e accountability. Este trabalho pode ser estendido a outras subfunções da área de saúde e mesmo de governo e aprofundado quanto ao aspecto da qualidade. Além disso, estudos longitudinais poderiam ajudar a separar o efeito do processo de ilusão fiscal e redução de poder de barganha daquele relativo à flexibilização orçamentária provocada pela perspectiva de recebimento de socorro financeiro de outras esferas de governo. Acredita-se que este trabalho tenha contribuído para indicar possibilidades e restrições de avaliações comparativas de desempenho no setor público. / Sistema Único de Saúde (SUS)1 is characterized by complex intergovernmental relationships that have granted continuing enhancement in the solution of issues related to public health service rendering to the population. While a governmental sector policy, SUS is influenced by recent efforts in the distribution and performance of the principles of public administration management, whose focus is management centered on both results, and the efficient use of resources. Within this context, the evaluation of performance becomes more prominent; however, the definition of evaluation parameters by the Public Management Controllership has been no easy task, because the type of control applicable to public sector activities depends on four complex criteria: ambiguity of objectives; output measurement; knowledge of effects of intervention, and recurrence of activities. One alternative to circumvent the difficulties with the evaluation of performance is doing it through benchmark. Thus, this study aimed at raising, measuring, and explaining the variations in performance in the municipalities in the State of São Paulo regarding the economic efficiency in the use of public funds in the public health basic actions as related to profile of expenditure financing in such area. Economic efficiency reflects the capability of an entity to obtain maximum output at the lowest cost, and was measured by means of Data Envelopment Analysis (DEA): a technique of optimization based on linear programming and designed to establish the measurement of relative efficiency among different decision making units. In its turn, economic efficiency, a parameter of evaluation of public sector performance, is influenced by the way the legislature and bureaucrats deal with budget constraints. The literature on federalism predicts that non-matching unconditional transfers lead to public expenses with waste, brought about by the process of fiscal illusion, by the reduction of trade off power, and/or the softening of budget constraints. In the first stage of the DEA Model, efficiency scores were calculated based on paid out expenses with basic health procedures and the quantity of direct output produced by such sub function. The results pointed out that only 17 out of 599 municipalities in the State of São Paulo under analysis were considered efficient, and that it was possible to raise the quantity of services rendered to the population considerably without the need of other budget grants. In the second stage of the DEA Model, it was possible to notice that the proportion of old people in a jurisdiction causes service rendering to be more expensive; also, higher population concentration, degree of urbanization and level of health facilities favor public expenses with efficiency. These four variables are not under the control of the public manager; therefore, efficiency scores were adjusted to reflect the performance resulting from the discretionary power. Through these adjusted efficiency scores, and by means of a regression analysis it was possible to see that non-matching unconditional transfers increase the inefficiency in public expenditure with basic health procedures, as envisaged in the literature. On the other hand, grants received from SUS, both conditional and unconditional, decrease inefficiency, which indicates improvement reached by the management of SUS. Another factor bearing positive interdependence with efficiency is the schooling index, which shows that a population with higher schooling indices may better the evaluation of performance and accountability. This work may be expanded to other sub functions in the health and even government area and may be deepened as far as quality goes. Besides, longitudinal studies might help distinguish the effect of the process of fiscal illusion and of the reduction in trade off power relating to the softening of budget constraint stemming from the possibility of financial help come from other government tiers. We believe this study has contributed to the suggestion of possibilities and restrictions of comparative evaluations in the public sector. 1 public health system

Este estudo analisou a experiência de construção da participação social no Sistema Único de Saúde, tendo como objeto de estudo o Conselho Municipal de Saúde de Ribeirão Preto, no período de 1991-1998. Construiu-se o referencial teórico a partir da redemocratização do país e da Reforma Sanitária, abordando o objeto de estudo nas dimensões: Direito à Saúde, Participação, Controle Social e Cidadania. A metodologia foi o Estudo de Caso, na abordagem qualitativa da pesquisa em saúde. Procurou-se, a partir de Análise documental e de Entrevistas com Conselheiros e ex-Secretários Municipais de Saúde, através da técnica de Análise Temática, identificar relações estabelecidas entre os sujeitos sociais que compõem o Conselho, projetos de interesse e concepção de Direito à Saúde; buscou-se apontar limites e potencialidades do espaço de participação para a construção da cidadania. Principais limites: os temas são levados ao Conselho, apenas para aprovação, não oportunizando discussões prévias; a vinculação do Fundo Municipal de Saúde à Secretaria da Fazenda, impede Gestor e Conselho de terem autonomia na decisão do uso dos recursos; alguns segmentos não levam para o Conselho suas demandas, utilizando outros canais; o corporativismo de alguns segmentos, impede a publicização de projetos de interesse. Como potencialidade, verificou-se que os entrevistados têm no Conselho, o fórum político legítimo, para discutir e deliberar as diretrizes políticas para a saúde no município, legitimando-o, enquanto espaço público de construção do Direito e da Cidadania. Isto permitiu o funcionamento, nestes 8 anos, sem solução de continuidade. / This study analysed the experience of building social participation in the Unique Health System (Sistema Único de Saúde), having as its study object the Municipal Health Council of Ribeirão Preto, during the period of 1991 - 1998. The theoretical reference was built from the county’s redemocratization and the Sanitary Reform, broaching the study object in the dimensions: the Right to Health, Participation, Social Control and Citizenship. The methodology was Case Study, in the qualitative aspect of health research. We sought, from document analysis and interviews with Counsellors and former Municipal Healt Secretaries, through the technique of Thematic Analysis, to identify relations established among the social subjects which compose the Council, projects of interest and the conception on the Right to Health; we sought to point out limits and potencialities of the space of participation for the construction of citizenship. Main limits: the themes are sent to the Council for aprovement only, not allowing previous discussions; the bond between the Municipal Health Fund and the Secretary of Treasure, obstructs Manager and Council of having autonomy in the decision on the use of resources; some segments don’t take their pleas to the Council, using other channels; the corporativism of some segments don’t allow publicizing projects of interest. As potentiality, we observed that those interviewed have in the Council, the legitimate political forum to discuss and deliberate on the political directions for health in the Municipality, legitimating it as a public space for the construction of Rights and Citizenship. This allowed its functioning, during 8 years, without interruption.