the question of resources set aside, in order to achieve long-term changes in the social determinants of health and in health equity, a long-term commitment is required. Experiences of PB in Brazil have been maintained beyond single administrative terms and this might be an indicator of PB’s potential as a process that is sustainable through political changes.
Support for the PB in Porto Alegre and Belo Horizonte has been high (Souza 2001b: 176). However, local expenditure did not reflect the priorities of the poorest groups in these cities, as the great majority of poor citizens do not actively participate in the programmes. According to the results of a 1991 survey in 150 municipalities across Brazil analyzed by Desposato, the poorest and less-educated voters mentioned economic survival concerns (job opportunities, cost of living, low salaries) as their top priority and not infrastructure, which is PB’s main focus of investment. Also, while women’s participation equalled that of men, according to Santos (1998) this was reported to decrease as the scale of decision-making rose.
Avila (2002) cautions that, in countries characterized by deep-rooted political, social, and economic disparities such as Peru, no straightforward relationship exists between civil society and participation. He therefore stresses the need to take into account the socio-political and historical context and to pay attention to factors such as gender, class and ethnicity in analyzing the meaning of citizenship and participation. Existing profound inequities will be particularly poignant in analyzing the responses to fundamental questions of: Who participates? Who decides? How the decision-making process does takes place?
According to Michaela Hordijk (2005), who describes the experience of PB in Villa El Salvador, Peru, the most remarkable achievement of participatory planning and budgeting in Villa was the revitalization and renewal of popular participation in municipal governance. However, she also reports that although the participatory process of formulating the comprehensive development plan was important, it got stuck after the vision and strategic objectives were developed, and the different proposals that were developed in thematic and neighbourhood workshops were never merged into a coherent document.
Hordijk (2005) argues that this highlights the inherent tension in planning and governance - how to adequately combine spatial neighbourhood with sectoral (health) planning - and the fact that participatory planning and budgeting provides no solution to this. However,