Community involvement in health and available resources: the experience of non-institutionalized participation in Brazil

Background In Brazil, social participation through health councils constitutes an inclusive and consolidated experience. However, little has been studied about non-institutionalized participation initiatives. In this context, an important aspect is how resource availability favors or hinders community mobilization. This study aimed to analyze how resource availability influences communities’ engagement in non-institutionalized participatory health practices in Brazil. Methods This is a multiple case study with embedded levels of analysis. We investigated six cases of non-institutionalized participation initiatives developed in three municipalities in Bahia state, Brazil. Data were collected through semi-structured interviews and direct observation of non-institutionalized participation settings. We conducted 16 interviews with lay participants, community leaders, and health professionals. To analyze the data, we used an analytical framework composed of four strategic dimensions related to the influence of resources on participatory experiences: time, financial condition, skills, and confidence. Results The availability of resources exerted a significant influence over individuals’ participation in non-institutionalized forums and initiatives. Time availability emerged as a limiting factor for involvement in association activities, especially for formal sector workers and women. Since non-institutionalized initiatives do not receive government support, participants must bear participation costs, which limits their ability to participate. Regarding skills, the participatory experiences of people with lower levels of schooling provided the domain content of specific themes and the development of political skills. The participants showed high self-confidence and confidence in the participation initiatives. A relevant highlight of the study was identifying strategies to overcome resource limitations and the willingness to participate despite scarcity. Conclusion Our study revealed that the scarcity of resources has a negative impact on community involvement in health issues. This finding suggests that the social participation of non-institutionalized initiatives can be improved through the provision of resources, the development of training and the promotion of skills.