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Going down to the local: incorporating social organisation and political culture into assessments of decentralised health care

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  • Atkinson, Sarah
  • Medeiros, Regianne Leila Rolim
  • Oliveira, Paulo Henrique Lima
  • de Almeida, Ricardo Dias

Abstract

The social organisation and political culture of the society in which an organisation is embedded can have major effects on the way in which organisational policy is implemented and on how that organisation functions. Research on health sector reforms has paid scant attention to this aspect. If the claims made for decentralised management in the health sector are to be evaluated seriously, it is critical to develop concepts and methods to evaluate not only the formal organisation and the outputs of the health system, but also the aspects of local social organisation and political culture within which that local health system is embedded that may mediate their relationship. The paper explores three cases of district health systems in Northeast Brazil in order to identify aspects of local social organisation and political culture that appear to influence the implementation of the reforms and thereby potentially impact upon the quality of the care provided. The results of the study indicate the importance that aspects of local social organisation and political culture may exert on the operations of a decentralised health system. Key aspects identified are: the space for autonomy; the space for local voice in political life; personalised and institutionalised influences on autonomy and local voice; differences of involvement of health staff with the district; different spaces of acceptable practice and accountability. These factors are seen to moderate the intent of the health reforms at all stages in their implementation. Three possibilities are discussed for the nature of the interaction in terms of cause and effect between the formal organisation of the health system and its local context. Seeing this relationship as one of a dialogue offers some cautious optimism for the potential of the reform agenda. The paper closes with suggestions on how to take this line of research forward.

Suggested Citation

  • Atkinson, Sarah & Medeiros, Regianne Leila Rolim & Oliveira, Paulo Henrique Lima & de Almeida, Ricardo Dias, 2000. "Going down to the local: incorporating social organisation and political culture into assessments of decentralised health care," Social Science & Medicine, Elsevier, vol. 51(4), pages 619-636, August.
  • Handle: RePEc:eee:socmed:v:51:y:2000:i:4:p:619-636
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    Cited by:

    1. Atkinson, Sarah & Medeiros, Regianne L., 2009. "Explanatory models of influences on the construction and expression of user satisfaction," Social Science & Medicine, Elsevier, vol. 68(11), pages 2089-2096, June.
    2. Liu, Xiaoyun & Martineau, Tim & Chen, Lieping & Zhan, Shaokang & Tang, Shenglan, 2006. "Does decentralisation improve human resource management in the health sector? A case study from China," Social Science & Medicine, Elsevier, vol. 63(7), pages 1836-1845, October.
    3. Degeling, Chris & Carroll, Jane & Denholm, Justin & Marais, Ben & Dawson, Angus, 2020. "Ending TB in Australia: Organizational challenges for regional tuberculosis programs," Health Policy, Elsevier, vol. 124(1), pages 106-112.
    4. Exworthy, Mark & Frosini, Francesca, 2008. "Room for manoeuvre?: Explaining local autonomy in the English National Health Service," Health Policy, Elsevier, vol. 86(2-3), pages 204-212, May.
    5. Hassan, Afees Olumide (PhD) & Hassan, Hayatullah Boladale & Muslim Akinbola Akintola, 2024. "Benchmarking Public Service Delivery in Sub-Saharan Africa: A Critical Evaluation," International Journal of Research and Innovation in Social Science, International Journal of Research and Innovation in Social Science (IJRISS), vol. 8(7), pages 2248-2258, July.
    6. Anwar Shah, 2005. "Public Expenditure Analysis," World Bank Publications - Books, The World Bank Group, number 7436.

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