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Community participation as a strategy in health aims to increase the role of citizens in health decision-making which are contextualised within the institutions of democracy. Electoral representation as the dominant model of democracy globally is based on the elite theory of democracy that sees political decision-making a prerogative of political elites. Such political elitism is counter to the idea of democratic participation. Neoliberalism together with elitism in political sphere have worsened social inequities by undermining working class interests. Latin America has seen adverse consequences of these social inequities. In response, social movements representing collective struggles of organised citizens arose in the region. This paper explores the theoretical underpinnings of democratic participation in contemporary Latin American context at the nexus of emerging social movement activism and policy responses. The paper will use empirical examples to highlight how such democratic practices at the societal level evolved while demanding political inclusion. These societal democratic practices in Latin America are redefining democracy, which continues to be seen in the political sphere only. Health reforms promoting participatory democracy in several Latin American countries have demonstrated that establishing institutions and mechanisms of democratic participation facilitate collective participation by the organised citizenry in state affairs. [ABSTRACT FROM AUTHOR]

The Venezuelan health reform Barrio Adentro (BA), initiated in 2003, aims to improve population health and promote popular participation. Access to healthcare has improved but the distinguishing feature of BA is participation by communities. Popular participation has been institutionalized through the formation of health committees and communal councils. We explored the challenges/barriers faced by these community groups in BA. A mixed-methods participatory methodology was used involving 31 participants selected through non-random purposive sampling from five Venezuelan states. Results indicate that implementation issues challenge participation. There is political will at the highest level but the opposition political parties, Venezuelan Medical Federation, and the private media oppose the reform. Public participation in state affairs is facilitated if there are popular arenas of participation that promote engagement of organized citizenry with the state and an ongoing interaction between state and civil society in order to radically transform the state. [ABSTRACT FROM AUTHOR]