Public engagement for public health: participatory budgeting, targeted social programmes, and infant mortality in Brazil

ABSTRACT

Brazil has made striking gains in public health since its democratisation in the mid-1980s. Previous research credits widespread economic growth and the creation of widespread social programmes for these improvements. We take a novel approach by also examining local participatory institutions. Participatory budgeting is a democratic innovation that allows residents to allocate a portion of the local budget directly to local needs, including healthcare. We evaluate whether participatory budgeting also influences infant mortality, a serious health problem facing Brazilian communities. We find that using participatory budgeting substantially reduces infant mortality, even more so when the programme is institutionalised.

KEYWORDS:

• Civil society – Participation
• Social sector – health
• Water and sanitation
• Latin America and the Caribbean

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Michael Touchton is Assistant Professor of Political Science and Faculty Lead for Global Health within the Institute for Advanced Study of the Americas at the University of Miami. He studies development and underdevelopment in a comparative setting, with his most recent research focusing on local governance and human development in Africa and Latin America He is the co-author of two forthcoming books: Salvaging Community: How American Cities Rebuild Closed Military Bases and Democracy at Work: Pathways to Well-Being in Brazil. He has also published in top political science and interdisciplinary journals.

Brian Wampler is a Professor of Global Studies and Political Science at Boise State University. He is a co-author of Democracy at Work: Pathways to Well-Being in Brazil (forthcoming) and author of Activating Democracy in Brazil: Popular Participation, Social Justice and Interlocking Institutions (2015) and Participatory Budgeting in Brazil: Cooperation, Contestation, and Accountability (2007). He has published extensively on democracy, participation, civil society, and institution building.

Notes

1 Amounts vary by family composition. In January 2016 the mean monthly benefit was US$46 (Ministry of Social Development 2016).

2 These cities include over half of Brazil’s population.

3 The mean level of infant mortality is 20.86 per 1,000 births with a standard deviation of 23.37. We find no significant connections between participatory budgeting, the Family Health Programme, or Bolsa Família on hospital access or longevity.

4 Fixed effects are more appropriate than random effects for impact evaluation based on the theoretical arguments in Khandker, Koolwal, and Samad (2010) as well as the results of Hausman tests on our data. Unobserved, time-invariant, municipal characteristics such as a predilection in favour of left-wing policies and health equity could influence participatory budgeting, the Family Health Programme, and Bolsa Família adoption and management. For example, participatory budgeting may have emerged first cities with already-low infant mortality rates because of local commitments to universal health. We use fixed effects to control for potential selection bias in this area. The results of estimation using coarsened exact matching (CEM) to estimate treatment effects are available on request. The coefficients for participatory budgeting as a “treatment” remain statistically significant and in the expected direction.