A practical guide to citizen-centred evaluation for more equitable and responsive health systems
1
Brazilian Center of Analysis and Planning, São Paulo, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A1328
ABSTRACT
BACKGROUND:
Brazil's constitutionally-recognised health councils give citizens formal powers in the governance of primary care in the Unified Health System (SUS). However, their actual influence in the design of policy and service models is limited(1,2). This is partly because evaluation of system performance follows a standardised, managerial approach that focuses on service volumes, excluding citizen perspectives and rendering localised determinants of health and experiences of vulnerable groups invisible. This reduces the system’s potential to tackle inequality. This panel discussion offers a guide to a co-creation methodology, implemented in the municipalities of São Paulo and Fortaleza, to overcome this through a more democratic evaluative approach that empowers citizens to produce, interpret and act on knowledge about the performance of public policies(3–5).
METHODS:
Participants will be taken through the design and results of our three-stage process: (1) diagnosing the disconnect between participatory forums and technical accountability frameworks like state-provider contracts and municipal health plans; (2) developing a theory of change; and (3) using nominal group and focus group techniques to identify neglected dimensions like respectful treatment by staff, health system navigability, coordinated care, and barriers to access like scheduling systems and neighbourhood violence; and then using workshops to co-produce indicators to measure them. We will also discuss strategies for validating and integrating community-generated evidence into official performance evaluation systems.
RESULTS:
This session is designed for researchers, practitioners, and policymakers seeking actionable methods to transform participatory governance from a merely consultative exercise into a driver of equitable health system change.
CONCLUSIONS:
Our work ensures that evaluations become more inclusive while also measuring whether services are truly reducing disparities and advancing social justice. This could provide a replicable strategy for strengthening health system governance in other contexts.
Brazil's constitutionally-recognised health councils give citizens formal powers in the governance of primary care in the Unified Health System (SUS). However, their actual influence in the design of policy and service models is limited(1,2). This is partly because evaluation of system performance follows a standardised, managerial approach that focuses on service volumes, excluding citizen perspectives and rendering localised determinants of health and experiences of vulnerable groups invisible. This reduces the system’s potential to tackle inequality. This panel discussion offers a guide to a co-creation methodology, implemented in the municipalities of São Paulo and Fortaleza, to overcome this through a more democratic evaluative approach that empowers citizens to produce, interpret and act on knowledge about the performance of public policies(3–5).
METHODS:
Participants will be taken through the design and results of our three-stage process: (1) diagnosing the disconnect between participatory forums and technical accountability frameworks like state-provider contracts and municipal health plans; (2) developing a theory of change; and (3) using nominal group and focus group techniques to identify neglected dimensions like respectful treatment by staff, health system navigability, coordinated care, and barriers to access like scheduling systems and neighbourhood violence; and then using workshops to co-produce indicators to measure them. We will also discuss strategies for validating and integrating community-generated evidence into official performance evaluation systems.
RESULTS:
This session is designed for researchers, practitioners, and policymakers seeking actionable methods to transform participatory governance from a merely consultative exercise into a driver of equitable health system change.
CONCLUSIONS:
Our work ensures that evaluations become more inclusive while also measuring whether services are truly reducing disparities and advancing social justice. This could provide a replicable strategy for strengthening health system governance in other contexts.
| eISSN: | 2654-1459 |
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