Brazil and Peru pool views of their people to set health agenda.

The northern coastal region of Lambayeque in Peru held a referendum last November to ask 123 627 voters to rank health issues in order of importance. Now the authorities there are incorporating this feedback into a five-year plan. Brazil also used a ‘trickle-up’ approach in 2003–04, to craft a comprehensive health research agenda based on feedback gathered at hundreds of meetings from the grassroots to national levels. Planners and participants in both countries said this was no mere communication exercise. Both processes have yielded results already, with new attention being paid to various conditions in Peru and with studies being done in Brazil on threats such as Chagas disease, a parasitic infection that infects 16 to 18 million people in Latin America and kills 50 000 a year. Residents in Lambayeque ranked their top five health priorities as scarcity and deterioration of water services and waste pickup; marginalization of poor to health services; mental health problems; malnutrition; and maternal health problems. The exercise, dubbed the “Citizens’ Consultation”, told authorities where resources would be most useful and gave often disenfranchised Peruvians a voice. It also instilled a sense of responsibility, accountability and commitment among all parties involved, according to Midori de Habich, the head technical advisor to Partners for Health Reformplus (PHRplus), a project of the US Agency for International Development (USAID) that coordinated the ballot initiative. PHRplus worked with Lambayeque’s regional health councils, surveying residents about their health concerns in preparation for the referendum. Then, through focus groups and workshops, they determined how to measure those needs. Civic organizations, university health experts and others also played a role. Habich said that Peru had no background in setting policy on mental health, problems of water and sanitation, and marginalization of the poor from health services. But the vote put these concerns at the top of the priority list. Focus shifted from damages, or treatment of existing illnesses, which is costly, to prevention, which can Some scientists who were not used to debate with community representatives had a hard time [communicating] in lay terms ... But, in my opinion, the conference represented a very important democratic learning process.