Construction of emancipatory practices with health councilors through educational workshops and concept maps
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DOI: 10.1590/1413-81232021262.40962020 387
Construction of emancipatory practices with health councilors
article
through educational workshops and concept maps
Violeta Campolina Fernandes (https://orcid.org/0000-0001-5549-072X) 1
Regina Stella Spagnuolo (https://orcid.org/0000-0002-6977-4165) 1
Abstract The aim of the study was to find out
how community participation occurs within the
scope of professional training of municipal heal-
th councilors through educational workshops and
concept maps. This is a research-action, qualita-
tive study, developed in three municipalities be-
longing to the Health Region of Cuesta Pole, São
Paulo, Brazil, with 28 councilors. Educational
workshops and concept maps were carried out and
data were analyzed according to the dialogic the-
matic analysis and semiotic image analysis. The
discussion was supported by the Significant Lear-
ning Theory. The results showed the importance
of the Primary Health Care regarding qualified
listening and health promotion and prevention
actions. For the participants, exercising the role of
councilor means being present at meetings and re-
presenting their segment to the population. They
feel important as collaborators in the creation of
public policies and assistance to other governing
bodies related to budgetary and fiscal control.
Educational workshops and concept maps were
shown to be pedagogical strategies to be worked
with health councilors, as they allowed moments
of learning, exchanges of experiences, interaction
and creation of bonds.
1
Faculdade de Medicina Key words Learning, Health councils, Health
de Botucatu, Universidade
Estadual Paulista. Av. education, Social participation, Public health
Prof. Montenegro s/n,
Rubião Junior. 18618-970
Botucatu SP Brasil.
vicampolina@gmail.com388
Fernandes VC, Spagnuolo RS
Introduction Conselho Nacional de Saúde), highlighting edu-
cation initiatives for social control that contrib-
As a guideline of the Brazilian Unified Health ute to the development of the action of the social
System (SUS, Sistema Único de Saúde), com- subject, with participatory methodologies that
munity participation is guaranteed by Law N. value people’s experiences and are not restricted
8,142/1990, having the health councils and con- to councils and, thus, involve the entire popula-
ferences as collegiate bodies. Health councils are tion regarding the improvement of SUS9.
responsible for strategies and for controlling the The working group of the aforementioned
health policy implementation, including those policy became the Inter-Sectoral Commission
related to the economic and financial aspects, of Permanent Education for Social Control in
being constituted by government representatives, SUS (CIEPCSS, Comissão Intersetorial de Edu-
service providers, health professionals and users1. cação Permanente para o Controle Social no SUS),
Participating in the creation and control of through Resolution N. 374, of June 14, 2007, with
public policies requires empowerment, auton- the objective of assisting CNS in monitoring the
omy, engagement, knowledge of the legal bas- Permanent Education Policy for Social Control
es of the health system, definition of strategies, in SUS at the national level, training multipliers
capacity for socio-political analysis for decision and trainers to strengthen social control and ar-
making, understanding the concepts, respect for ticulate a national permanent education network
others and good communication, and there are for social control10.
many difficulties to be faced in order to establish It is necessary to progressively stimulate the
the role attributed to the actors who participate citizens’ autonomy through emancipatory prac-
in the health councils. tices, understood as those that make it possible to
The main obstacles to community participa- contribute and improve life conditions, respond
tion are related to the lack of health information critically and assume the freedom. These prac-
and knowledge about the councilor’s role; irreg- tices teach the subjects to access their rights and
ularities regarding the composition, ownership fight for them, encouraging solidarity values and
and frequency of meetings; lack of knowledge to rescuing the human condition as a social condi-
analyze the financial management and account- tion11.
ability; the population’s lack of interest in collec- Based on this scenario, the following question
tive issues and low motivation for participation2-6. arises: did educational workshops result in sig-
Therefore, in order to support the exercise of nificant learning based on the reality experienced
social control in health policy, it is necessary, for by health councilors?
the political subjects involved in it, to effectively This study aimed to find out how commu-
know SUS and its legislation, its epidemiological, nity participation occurs within the professional
assistance, financial, political, cultural and social training setting of municipal health councilors
paradigms, aiming at monitoring and evaluating through educational workshops and concept
the health information system at the municipal, maps.
state and federal levels. Therefore, the learning
can be built through experiences in which sub-
jects interact in search of the same ideal. Method
In this sense, initiatives by the Ministry of
Health, such as the issuing of Ordinances N. This article is part of the Ph.D. thesis “Mobiliza-
198 of 2004 and N. 1,996 of 2007, assumed the tion strategies for the community participation
management responsibility with the training of of municipal health councilors”, based on ac-
human resources through Permanent Education tion research, developed in three municipalities
in Health, in which qualification actions were in- that belong to the Health Region of Cuesta Pole
corporated with the integration of teaching, ser- (RSPC) - Regional Health Department (DRS) VI
vice and community, transforming professional Bauru / Regional Health Care Network (RRAS)
practices and work organization in a problemati- 9 – of the state of São Paulo, Brazil.
zation perspective7,8. The RSPC consists of 13 municipalities, com-
Aiming to promote a more effective practice prising a territorial area of 6,394.44
km² and a
of health councilors and strengthen participatory population of 279,329 inhabitants12. This region
democracy, in 2006 the National Policy of Per- was chosen by a non-probabilistic convenience
manent Education for Social Control in SUS was sample, as we sought a population sample that
approved by the National Health Council (CNS, was more accessible to the researcher.389
Ciência & Saúde Coletiva, 26(2):387-398, 2021
The selection criteria of the municipalities Ten educational workshops were held, 4 in the
were established according to the population MGP, three in the MPP1 and three in the MPP2,
profile, as follows: a small municipality 1 (MPP1), from December 2016 to October 2017, through
with up to 20,000 inhabitants, a small municipal- participatory observation, field diary and con-
ity 2 (MPP2), from 20,001 to 50,000 inhabitants cept maps during the educational workshops.
and a large municipality (MGP), with 100,001 to The Educational Workshop is characterized
900,000 inhabitants. by a space provided for interaction, reflection
The study participants consisted of the mu- and exchange of knowledge that allows students
nicipal health councilors, members and / or their to expose and assimilate new knowledge about
respective alternate members, from three mu- the topic being presented13. At the end of each
nicipalities in the Health Region of Cuesta Pole, educational workshop, the concept map (CM)
state of São Paulo, who agreed to participate in was used as a measure to monitor and evaluate
the research, after signing the Free and Informed the councilors’ learning.
Consent (FIC) form, totaling 28 councilors, 15 A CM is defined as a hierarchical diagram
from the MGP, 8 from the MPP2 and 5 from the of the relations between concepts that allow the
MPP1. organization and representation of knowledge,
Analyses of documents from the municipali- aiming at providing greater understanding and
ties and councils belonging to the Health Region assimilation of the study topic14. CMs contain
of Cuesta Pole were carried out and, subsequent- concepts, usually depicted inside circles or charts,
ly, educational workshops. and the relations between the concepts, which are
This analysis allowed the characterization of represented by lines that interconnect them. The
the municipality, according to the main activity words on these lines, which are connecting words
developed, predominant area of activity, eco- or phrases, describe the relations between the
nomically active population, year of creation and two concepts14,15.
the internal regulations of the municipal health Additionally, there are propositions in the
councils. These data were requested from the CM, which are statements about an object or
Municipal Health Secretariats and also from sec- event. A proposition is formed when two con-
ondary sources, such as the minutes of council cepts are interconnected through words, phras-
meetings, which were also used to complement es or symbols to constitute a meaningful state-
the information on the profile of the municipal- ment14.
ity and the council. This profile was necessary to Data analysis was carried out according to
support the choice of topics and promote the dis- the suppositions of Bakhtin’s dialogic thematic
cussions during the workshops. analysis16, which proposes the definition of top-
For the creation of the first workshops, topics ics and the description of dialogic processes as
proposed by the participants were collected ac- a way to understand interactions at the time of
cording to the local reality experienced by them. the construction of information, being extremely
The topics chosen from the MGP workshops dynamic, flexible and non-linear, along with the
were: “Organization and function of the health semiotic analysis of still images17.
system”; “Health planning: budget and financ- For Penn17, the image itself is its description
ing”; “The control of SUS policies and actions: as it is seen, that is, its denotative quality. The cul-
monitoring, evaluation and inspection mecha- tural dimension of the elements, which are the
nisms” and “Main responsibilities of the council- formed propositions that integrate the image,
or”. In the MPP2 the choice of topics comprised: represent the connotative level, that is, the exist-
“Organization and function of the health sys- ing relations of the elements with the connection
tem”; “Health planning: budget and financing”; of words.
“The control of SUS policies and actions: mon- The field diary and workshop observation
itoring, evaluation and inspection mechanisms”. were used to analyze the production that accom-
In the MPP1, the choice of topics comprised: panies the images. Based on this material, the
“Health planning: budget and financing”; “The correlation between scientific knowledge and
control of SUS policies and actions: monitor- constructed learning was interpreted. Thus, when
ing, evaluation and inspection mechanisms” and analyzing the image, the stories developed by the
“Main responsibilities of the councilor”. The participants were used to understand them.
days, time and frequency of the workshops were The theoretical framework used in the study
agreed upon according to the participants’ avail- started from the conceptual supposition for the
ability. use of the CM of the Meaningful Learning Theo-390
Fernandes VC, Spagnuolo RS
ry (MLT) by constructivist David Ausubel18. The service users, 21.45% represent health service
TML proposes that, for a more efficient learning, providers, 17.85% represent health workers and
it is necessary that knowledge be understood, sig- 17.85% represent health service managers.
nificantly relevant and well-integrated14,18. Regarding the learning demonstrated in the
Meaningful learning consists in the integra- educational workshops of the MGP, Figure 1
tion of new concepts into the learner’s cognitive shows the key concepts that most frequently ap-
structure, considering their previous knowledge, peared together with the connecting words used
aiming at demonstrating interrelated learnings, by the councilors (Figure 1).
which facilitates the establishment of solid con- A total of 61 concepts were included in the
ceptual associations18,19. synthesis CM, which were related to the concepts
At the end of each workshop, individual CMs subordinate to the general ones: “Organization
were applied and after that, the synthesis CM and function of the health system”, “Budget”,
was applied by the researcher, created based on “Management Report” and “Councilor’s role”.
the observed similarities and word repetitions. Regarding the map structure, 100% were se-
The ten educational workshops resulted in 63 quentially diagrammed, with hierarchy and de-
individual CMs, 32 from the MGP, 19 from the velopment of some cross-links.
MPP2 and 12 from the MPP1, which were syn- Most propositions presented logical mean-
thesized one per municipality, with the purpose ings, and the words selected to interconnect the
of joining individual production and construct concepts showed to be adequate to disclose the
synthesis maps about the meanings that the par- nuances of meanings attributed at the systemati-
ticipants attributed to the workshop topics. Thus, zation of knowledge.
three synthesis CMs were disclosed, one for each It is noteworthy the fact that the concept
municipality, containing the meanings attributed “Enlightening the population” was the most fre-
to the workshop learning. quently mentioned (nine times) in individual
Finally, a new synthesis of the three resulting CMs, followed by “CMS approval” and “Control
maps was applied, creating a new map, called of health expenses” (both seven times), highlight-
the final semiotic map containing the most sig- ing the relevance that councilors attribute to the
nificant data and their main relations with the dissemination of information to the population
meanings expressed by the councilors. regarding health issues and their responsibility of
The project was approved by the Ethics Com- approving and controlling health expenditures20.
mittee of Research with Human Beings of the The councilors’ mastery regarding the dis-
School of Medicine of Universidade Estadual cussed topics was observed, since the created
Paulista “Júlio de Mesquita Filho” (UNESP), at CMs allowed them to visualize the integration of
the Botucatu campus and received financial sup- contents covered in the workshops, that is, as a
port from Fundação de Amparo à Pesquisa of the new key concept was learned, it was integrated
State of São Paulo - FAPESP. The study was car- into the CM, both coherently and homogenous-
ried out with the authorization of the Municipal ly. Moreover, we observed the councilors’ inter-
Health Secretariats and the participants’ consent action, collaboration and commitment with the
by signing the free and informed consent form. creation of the CMs, since the doubts and dif-
ficulties were resolved with the other members
of the group, thus demonstrating the teamwork
Results development20.
However, seven CMs did not have intercon-
The age of the 28 participants ranged from 22 necting words and some concepts showed unre-
to 70 years, with a mean age of 45 years. As for latedness and repetitiveness, especially in the first
gender, 71.42% were females and 28.58%, males. maps, which can be justified by the fact that it
As for the level of schooling, 39.28% had finished was their first contact with the learning tool.
College/University, 28.58% has finished High A total of 53 concepts were included in the
School, 25% had finished Post-Graduation and MPP2 synthesis CM (Figure 2), which were re-
7.14% had finished Elementary School. The most lated to the concepts subordinate to the general
often reported profession or employment status ones: “Problems in health organization and func-
was ‘retired’ (14.29%). tion”, “Budget”, “Financing” and “CMS manage-
Regarding the representativeness in the mu- ment inspection”.
nicipal health councils (CMS, Conselhos Mu- The synthesis CM has a branch stemming
nicipais de Saúde), 42.85% represent the health from the root concept up to six hierarchical lev-391
Ciência & Saúde Coletiva, 26(2):387-398, 2021
MGP learning
Health spending
with Inspect
control
councilor's role
figth for health
is
involves Health system organization
attend meetings represent the population and funtion
demand rights it covers
Management reports
Primary Health
Welcoming
contains Care
Budget
treatment
With actions by
Management progress information
is
promotion
needs
Management tool prevention
needs
CMS approval
Figure 1. Synthesis Concept Map of the MGP, Botucatu, SP, Brazil, 2019.
MPP2 learning
it occurs management
reports supervision in CMS it covers problems in the health
throught
organization and funciton
being them
inadequate physical structure
Management report
detailed report with
Lack of information and
witch is financing guidance of the population
witch is
Budget
it is performed difficulty working
Quaterly anual requires in a network
transfer being necessary
promoting planning
PPA through Encourage
continuos for health
Management through
LDO fund-to-fund training promotion and
transparency
transfer prevention
throught LOA
within the scope
National
Accountability State
Municipal
Figure 2. Synthesis Concept Map of the MPP2, Botucatu, SP, Brazil, 2019
.392
Fernandes VC, Spagnuolo RS
els, which constitute the concepts from the most in the individual CMs, followed by “To carry out
general to the most specific ones, passing through the control and supervise” (four) and “Transpar-
different levels of intermediate concepts and four ency” (three). It can be observed that the most
cross-links, with the concepts and propositions frequently mentioned concepts refer mainly to
being formed 100% in sequential form. the role of the CMS regarding the SUS manage-
Some of the listed propositions were relevant ment, related to the participation of society in the
ones, since the members were not familiar with process of monitoring resources and the progress
the topics, for instance, the proposition consti- of the work carried out by health management
tuted by: “the budget requires planning through with transparency.
the Annual Budget Law (LOA, Lei Orçamentária These concepts are more remarkable mainly
Anual), the Budget Guidelines Law (LDO, Lei de due to the fact that the councilors are, in their
Diretrizes Orçamentárias) and the Multiannual majority, health workers, who know the nomen-
Plan (PPA, Plano Plurianual)”, “financing is car- clature of the performed actions. However, de-
ried out through a fund-to-fund transfer at the spite understanding the vocabulary, acronyms
municipal, state and national levels”, “the man- and other activities that are part of the participa-
agement inspection at the CMS occurs through a tory reality, they are largely unaware of the laws,
report, which is the annual management report, deadlines and goals.
promoting transparency of the management It can be observed that most maps depict a
through accountability”. concern with the interconnecting words, selec-
It is observed that the councilors refer to the tion of concepts and the formation of proposi-
Brazilian budgetary model, the budgetary laws, tions. As the workshop progressed, the concepts
to health financing and inspection, which gener- became more complex and the councilors grad-
ated significant learning, since based on the par- ually improved the creation of the CM, exercis-
ticipants’ observations and the researcher’s field ing their creativity and reflection of the acquired
diary, the councilors did not know about these knowledge.
concepts before the workshops were held. Based on the synthesis of the concept maps,
The concept “Lack of information and guid- the strategy used to guide the discussion was to
ance to the population” was the most often interrelate the three synthesis CMs, aiming to
mentioned (eight times) in the individual CMs, create a single map that can represent the learn-
followed by “To encourage health promotion ing experienced in the educational workshops,
and prevention”, “Planning” and “Management which were analyzed according to David Ausub-
Transparency” (both four times), demonstrat- el’s significant learning model18. Therefore, a final
ing the councilors are aware that the population semiotic map (Figure 4) was disclosed, contain-
needs to receive more information about health ing the data considered to be the most relevant
actions, which necessitates encouragement by and the main relations of meanings expressed by
councilors, managers and professionals working the councilors.
in health promotion and prevention. Moreover, Based on the synthesis of the maps, the in-
one can observe the emphasis given by the partic- teraction between the learning of all the mem-
ipants to the fact that the budget occurs with its bers that emerged from the experiences of the
due planning and that the councilor has as their educational workshops can be understood and,
primary function the inspection through man- as a final result, a new semiotic map was created.
agement transparency, aiming to carry out the This strategy allowed revealing the meanings at-
social control. tributed by the participants to the topics chosen
The MPP1 synthesis CM (Figure 3) includes by themselves.
35 concepts, which are subordinate to the gener- The final semiotic map demonstrates how the
al one: “Management report”, “Councilor’s role” councilors understand the contents portrayed in
and “Budget and financing”.# the educational workshops. It has 49 concepts ar-
The concepts are placed inside the box, linked ranged inside the boxes, interconnected by link
by interconnecting words, a branch stemming words, three branches from the root concept, up
from the root concept, up to five hierarchical to seven hierarchical levels and two cross-links,
levels, and two cross-links, with the concepts and with the concepts and propositions being pre-
propositions being formed 100% in sequential sented sequentially.
form. It shows us that the context of knowledge
The concept “To check the progress of health” construction involves three important mean-
was the most frequently mentioned (five times) ings, called by Ausubel et al.21 as more inclusive393
Ciência & Saúde Coletiva, 26(2):387-398, 2021
quarterly MPP1 learning
management Budget and
annually is it was discussed
report financing
it is used to requires
role of the
identify councilor planning
the is
to attend
management
Attend meetings
work
represent the priorities
population
analyse
municipality decide finding solutions
and for
health scenario the
perform the control
clarify doubts
PMS goals
check health progress
discuss problems
with
transparency
Figure 3. Synthesis Concept Map of the MPP1, Botucatu, SP, Brazil, 2019.
concepts, namely: health care, inspection and the Thus, councilors understand PHC as a health
role of the councilor (Figure 5). care organization strategy that includes actions
The concept of “Health care” aggregates the of promotion, prevention, reception and treat-
meanings constructed about the Brazilian public ment, in which prevention of injuries and quali-
health, in which one can identify the councilors’ fied listening must effectively occur in health care
perception of the health system organization models, ensuring to the user the necessary assis-
and function. Thus, this concept has different tance to their problem, preventing overcrowding
meanings, ranging from the most comprehen- in the emergency room and allowing network-
sive to the least inclusive concepts, with the most ing20. The abovementioned proposition shows
comprehensive being: a) Primary Health Care that the information stored by the councilors was
as a strategy for health care organization and b) organized and hierarchized, as more specific ele-
Health care barriers20. ments of knowledge were interconnected to and
Primary Health Care (PHC) or Basic Health assimilated into more general concepts, as pro-
Care (BHC) has as its fundamental strategy the posed by Ausubel18,24.
reorganization and articulation of the resources
available in SUS with the purpose of meeting
the demands and needs of the population and Discussion
being included in the context of the health care
network22. The CMs demonstrate the importance that
It is structured as the first place of care and councilors attribute to PHC, especially the per-
the main door into the system, being the orga- formance of qualified listening, so that the us-
nizer of flows and counterflows and the coordi- er’s need is identified, and care is provided, with
nator of the actions and services provided by the health promotion and prevention actions, not
network23. being restricted to the medical consultation20.394
Fernandes VC, Spagnuolo RS
has health Final semiotic map
PHC considers that
focus care
comprehends the
with actions of it has depicts
health inspection
promotion problems as
welcoming councilor's role
prevention
wicth means to of
like control
Attend meetings
little funding
to represent the population
public budget
Lack of humanization Assist the requiring the informing
the menagement
of professionals menager
work that requires
to rigths discussed subjects
develop through Planning
Lack of information and public Anual
policies reports through preventing
guidance of the population menagement
report
being Specific
instruments unnecessary spending
that promotes
detailed report
being
wich is PPA LOA
Action transparency
LDO
Quartely
through
Accountability
that needs
to be
presented
and approved
in the CMS
Figure 4. Final semiotic map. Botucatu, SP, Brazil, 2019.
This understanding is in line with the Nation- Moreover, the councilors point out the main
al Primary Care Policy (PNAB, Política Nacional obstacles to health care: the lack of information
de Atenção Básica), which depicts that services and guidance to the population, the lack of hu-
must ensure accessibility and welcoming in an manization by the professionals and the scarce
organized manner, ensuring that all people who funds for health care20.
seek the services be heard in a universal manner The proposition stating that “the final semiot-
and without distinction23. ic map considers that Health Care has problems,
Therefore, health services must assume the such as the lack of information and guidance to
central role of welcoming, listening to, and solv- the population, and it is necessary to disclose
ing most of the population’s problems, mitigat- existing services and enlighten the population”
ing the injuries and suffering, aiming to integrat- is in accordance with a study that points out a
ing the health care network23. difficulty in understanding the variables that in-395
Ciência & Saúde Coletiva, 26(2):387-398, 2021
Health care
Meaning of councilors
Inspection Councilor's role
Figure 5. Meanings of the councilors on the learning from the educational workshops, Botucatu, SP, Brazil, 2019.
terfere with health and disease, as well as with however, Constitutional Amendment 95/16
the health system function by a portion of the freezes public spending for twenty years, without
community, requiring the creation of strategies appreciating the demographic and epidemiolog-
to communicate with this population, aiming to ical changes and the need to include technologies
improve the provided health care25. into SUS. Considering this scenario, it is essential
Regarding the user’s relationship with the to mobilize the population in favor of the fight
health professional, the lack of humanization for democracy and social justice, so that health
of the professionals was demonstrated, indicat- is included in the agenda of the national political
ing the need for continuous training. Thus, it is debate28.
necessary to reflect on the working conditions It can be said that the councilors organized
of health professionals, whether they are able to the knowledge from the workshops based on
guarantee humanized care, since they are usually concise representations of the conceptual struc-
subjected to mechanized work processes and are tures that were taught to them, which probably
weakened by the conditions of work overload, facilitated the learning of these structures as pro-
terms of employment, work turnover and living posed by Ausubel’s Meaningful Learning Theory.
with suffering and death26. According to Ausubel18, the structuring of
Therefore, some actions are crucial to im- knowledge is verified in a non-arbitrary way,
prove access and humanization, as follows: estab- by receiving new information, which allows the
lishing partnerships with training institutions, learner to internalize them, thus making them
building lines of care, encouraging the active par- more understandable. Thus, the concepts inter-
ticipation of professionals in health policies, pro- act with the new contents, helping to assign new
moting meetings between peers aiming at practi- meanings that also undergo changes. This con-
cal reflection (case studies, problem situations), tinuous modification becomes a subsumer, that
permanent education activities, among others. is, a more complex, more differentiated previous
Also noteworthy is the concept of “scarce knowledge, capable of acting as an anchor for the
funds for health care”, demonstrating the coun- acquisition of new knowledge, a sequence called
cilors’ understanding regarding the SUS develop- progressive differentiation.
ment process, the way the transfer is carried out In significant learning, a change occurs with
– through a fund-to-fund transfer to the states, the new information and also in the previous
the Federal District and Municipalities, accord- knowledge, with which the new knowledge es-
ing to Ordinance N. 3,992, which provides for tablishes a relationship, and the product of this
financing, under the responsibility of the three interaction is the incorporation of meanings and
management spheres and the transfer of federal the externalization of knowledge21, as evidenced
resources to SUS public health actions and ser- in the final semiotic map.
vices27. Moreover, the final semiotic map once more
To make the SUS viable, it is necessary to disclosed the understanding of the participants
guarantee sufficient and permanent financing; when exercising the role of municipal health396
Fernandes VC, Spagnuolo RS
councilor, which means being present at the The LDO is responsible for defining the goals
CMS meetings to help the manager to create and priorities of public administration and guid-
public policies and represent the population, in- ing the creation of the LOA, of which main as-
forming the discussed topics and demanding the signment is to establish fiscal targets30.
rights of SUS users. The new ideas and information that were
Health councils have legal and specific at- learned in the individual’s cognitive structure
tributions of social control. Their responsibility were demonstrated, as the formed concepts were
is to contribute to the formation of councilors relevant, inclusive and clear.
committed to the creation of policies, based on The sharing of experiences, aiming to signify
the rights of citizenship of the entire population, the discussed topics, were extremely important
in defense of life and health, with universal, inte- to allow the meaningful learning, since the cre-
gral and equal access9, because they the represen- ated dialogue, and the exposition of experiences
tatives of society, who will lead the participatory complemented each other and were related to the
process, the representative voice of the popula- individuals’ prior knowledge.
tion to formulate and supervise health. Finally, one can infer, considering these re-
The final semiotic map showed the propo- sults, that the work contributed to the advance-
sition comprised by: the inspection of the pub- ment of science, as it was able to provide new
lic budget and management work that occurs knowledge to the participants about important
through reports, including the Annual Manage- topics in the field of health, making them the
ment Report and the Detailed Report, which pro- protagonists in the learning process. This fact
mote the transparency of management actions provided an opportunity for the exchange of
through accountability that needs to be present- knowledge, skills, feelings and experiences, en-
ed to and approved by the CMS, for better exer- couraging them to participate in the community
cise of social control. in an emancipatory, critical and reflexive way20.
The councilors acknowledged the important We expect that the results can be replicat-
role they have in helping other bodies, in over- ed in the different realities of municipal health
seeing and controlling the public budget. How- councils aiming to stimulate and give visibility to
ever, through participatory observation, it was community participation as a SUS guideline. It
observed that this process is still a deficient one, is also important that municipal managers and
as it occurs in a fast and unplanned manner20. universities incorporate community participa-
It is extremely important that health coun- tion in their debate spaces, stimulating the par-
cilors have access to this information in advance, ticipation of the organized civil society through
in order to properly analyze and criticize it, as health councilors, improving better social con-
well as disseminate it in society, making the user trol.
co-responsible for it, through participatory man- As a limitation factor, we mention the resis-
agement20. tance of some councilors regarding the partici-
Also, regarding the public budget, the list- pation in educational workshops, resulting in
ed propositions were extremely relevant, as the different learning for the group members, since
councilors were not yet familiar with the topic. those who participated in the meetings were able
As an example, the following proposition: “The to experience reflections and changes about the
final semiotic map comprises the inspection of performed practice.
the public budget, which requires planning with
responsibility, preventing unnecessary expenses
by means of specific instruments, namely Mul- Final considerations
tiannual Plan (PPA), Budget Guidelines Law
(LDO) and Annual Budget Law (LOA)” makes The educational workshops and concept maps
it clear that the councilors refer to the Brazilian were shown to be excellent pedagogical strategies
budget model and the budget laws used for the to be used with municipal health councilors, as
planning of public resources20. they allowed moments of learning, exchange of
The essential purpose of the PPA is to estab- experiences, interaction and establishing bonds
lish, on a regionalized basis, the guidelines, ob- between the participants.
jectives and goals of the federal public adminis- The group space and the making of concept
tration adequate to the expenditures and those maps allowed the disclosing of ideas, previous
resulting from them and for those related to the knowledge, moments of connection, relation-
continuous duration programs29. ships, exchanges, different worldviews for each397
Ciência & Saúde Coletiva, 26(2):387-398, 2021
of the councilors and the opportunity to build
individual and collective knowledge, therefore
improving the councilors’ performance and, as a
result, increasing the visibility of the community
participation as a SUS guideline.
The analysis of the data through the Dialogic
Thematic Analysis and Semiotic Analysis of the
Still Image allowed dynamicity to the analysis
and the construction of a final semiotic map that
materialized the meanings constructed by the
councilors in relation to the health field topics.
Collaborations
VC Fernandes participated in the study design,
research performance, data analysis, writing and
critical review of the manuscript. RS Spagnuo-
lo participated in the study design, data analysis,
writing and critical review of the manuscript.398
Fernandes VC, Spagnuolo RS
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