Effective primary health care should involve community participation in all aspects of service delivery.¹ However, there is often a mismatch of power between health system administrators and health system users, especially in the budgeting process. Participatory budgeting can help align budgets to the needs of the population by building citizen feedback directly in the budgeting process. Participatory budgeting also improves information flows between policy-makers and citizens.

An assessment of participatory budgeting in Brazil from 1990 to 2004 shows increased participation by citizens over time as well as participation becoming increasingly representative over time.² As a result of this approach, budgeting trends also shifted within municipalities with a larger share of budgets being allocated to health and sanitation. This change is correlated with a reduction in infant mortality rates. This suggests that promoting a more direct interaction between service users and elected officials in budgetary policy can affect both the allocation of local resources and health outcomes.  Providing not just a voice but also power to make budgeting decisions to citizens, service users and those who experience the biggest problems and priorities in their communities on a daily basis can ensure that those are the problems and priorities that are being addressed.