Community participation in plural health systems: a scoping review

Abstract Background Many countries are moving towards a plural health service delivery model where private and public healthcare providers are contracted to provide healthcare to achieve Universal Health Coverage. Participation is seen as key to ensuring accountable, responsive health systems and an important component of the right to health. Many countries have participatory structures in public facilities, but little is known about participation in plural health systems. This scoping review aimed to identify participatory spaces in plural health systems and consider their effectiveness in health governance. Methods We searched Lilacs, Scielo, EbscoHost, Pubmed, Scopus and Google Scholar for articles in English and Portuguese published after 1990. We identified 3667 articles. After removing duplicates, reading titles, keywords and abstracts, we included 40 articles in the review. Results The review confirmed a gap in formal mechanisms for participation in plural health systems. Brazil and Thailand stood out as exceptions. Both countries have participatory structures at national, regional, provincial and local levels in the form of meetings and conferences where policy decisions and benefits packages are discussed. In Thailand, citizens are represented in the main medical schemes board and implementation agency, while Brazil has health councils at both municipal level and private and public facilities. In Columbia medical aid schemes are required to form user committees. While the literature on Columbia's user committees indicates that they were not very effective, literature on Brazil and Thailand's participation shows that citizens were able to influence policy, benefit packages and health governance. Conclusions Countries implementing a plural health service provider model will need to consider the role of participation. This could be based on a model that incorporates experiences from the Brazilian and Thai health systems and a human rights framework for participation. Key messages • Few countries have considered how participation features in plural health systems with Brazil and Thailand being exceptions with effective participatory structures. • A model for participation in plural health systems could be built on experiences from Brazil and Thailand’s participatory systems and a human rights framework.