Origins of Successful Health Sector Reform: Public Health Professionals and Institutional Opportunities in Brazil

Dowbor, Monika

doi:10.1111/j.1759-5436.2007.tb00421.x

Cited by 6 publications

(7 citation statements)

References 3 publications

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“…More accurate explanations suggest that the reform resulted from gradual changes beginning long before the democratic transition. Dowbor (2008, 2009) demonstrates that the expansion and decentralization of health care began during the military government, prior to the Constituent Assembly that approved the text to create the Universal Healthcare System (SUS). Similarly, Falleti (2010) describes how pro‐reform actors strategically occupied posts in the health sector bureaucracy during the military government and slowly promoted incremental shifts from within the state toward universalization.…”

Section: Health Reform In Brazil: Context and Main Accountsmentioning

confidence: 99%

“…The literature on health reform in Brazil is abundant, and there is a consensus about the role of the sanitaristas , defined as a collective actor established throughout the 1970s from the benches of preventive medicine schools, which gradually incorporated progressive healthcare professionals, union‐organized physicians, 1 intellectuals, and students of medicine (Dowbor, 2008; Escorel et al., 2005). The transformations social protection has undergone in recent decades corresponded to the main guidelines of their redistributive agenda that led to the constitution of a single, decentralized, integrated and participative health system (Costa, 2014, p. 820).…”

Section: Introductionmentioning

confidence: 99%

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Health reform in Brazil: The sanitaristas as programmatic actors

Davidian

2021

European Policy Analysis

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Brazil has one of the largest public health systems in the world. By applying the Programmatic Action Framework (PAF), this study provides an endogenous explanation for the health reform and brings new lenses to understand one of the most successful cases of social protection expansion. It demonstrates the relevance of a group of professionals who had a common perception of why the policy should change and a coherent policy change program. Cognitive frameworks, organizational resources, and strong professional culture allowed the sanitaristas occupying key positions in the state apparatus, behaving strategically as a collective actor. The evidence provided suggests the approach's relevance to this case due to considerations of political‐institutional specificities. Treating the sanitaristas as a programmatic actor is helpful to explain their role in promoting change and the endurance of the programmatic consensus they have built, which has been crucial to support the universal healthcare model in the country.

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Section: Health Reform In Brazil: Context and Main Accountsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Health reform in Brazil: The sanitaristas as programmatic actors

Davidian

2021

European Policy Analysis

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“…These organizing efforts led to translocal activism that would evolve into regional popular health movements (Zona Leste, Centro, Zonas Norte and Sul), which drew in and linked hundreds of neighbourhood associations and groups. The translocal actors we surveyed in São Paulo that were concerned with accountability of healthcare faced a federated system of governance councils running from the local health post to the national ministry of health (Dowbor, 2008;Escorel, 1998;Gragnolati et al, 2013). In São Paulo alone there are 500 health post councils, dozens more for health centres and hospitals providing secondary and tertiary care, and a municipal health council linked to the state and national health council.…”

Section: Legacies Of Earlier Waves Of Mobilizatonmentioning

confidence: 99%

“…The translocal civil society actors we surveyed in São Paulo and the system of participatory health councils that shaped their strategies are a legacy of a cycle of civil society mobilization from the 1980s. The movement contributing to the rapid expansion of coverage of primary healthcare in São Paulo (Dowbor, 2008; Escorel, 1998), and in the context of a transition to democracy, spread quickly beyond São Paulo, leading to the formation of a national coalition seeking to expand health services and create a more transparent and accountable system (Dowbor, 2008; Dowbor & Houtzager, 2014). The national campaign led to the incorporation of Right to Health and participatory governance mechanisms in the Constitution of 1988.…”

Section: Legacies Of Earlier Waves Of Mobilizatonmentioning

confidence: 99%

Social accountability in metropolitan cities: Strategies and legacies in Delhi and São Paulo

Houtzager

Acharya

Amâncio

et al. 2020

Development Policy Review

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Motivation: Social accountability by civil society is an important part of strengthening democratic governance and improving the delivery of public services. Purpose: The article documents the landscape of social accountability in two metropolitan cities. We identify widespread and contrasting forms of activism by the poor in metropolitan Delhi and São Paulo to improve public services, and a mix of factors that allow and impel the poor to engage in social accountability. While impact evaluation studies have identified accountability tools that can, in certain contexts, help improve public services, and case studies have explored accountability campaigns, neither has sought to examine and explain how widespread activism is, its intensity and which strategies are commonly used. Approach and methods: The study is built on an unusual set of nested comparisons and survey method, comparing accountability activism in Delhi and São Paulo, services in healthcare and social assistance, and 40 low-income micro-regions of each city. We leverage these comparisons to identify causal factors that produce the patterns of activism we find. We conducted a survey of civil society leaders in each of these micro-regions. Findings: We find that accountability activism is high on the civil society agenda-it is common in almost all low-income regions of Delhi and São Paulo. Its intensity and strategies vary in unexpected ways across the cities and services, suggesting that no single set of factors can explain all three features of activism. The type of service, presence of translocal actors, and institutions that seek to give citizens greater access to, and control over, government all shape different aspects of accountability activism. Going further along the causal chain, we argue that differences in the presence of translocal actors and institutional context are the legacy of earlier cycles of civil society mobilization. Policy implications: Initiatives to introduce or support social accountability, and research on the topic, need to take account of the various causes of different aspects of accountability, and to take into account the historical formation of the landscape of activism in which they work. K E Y W O R D S cities, Delhi, movement legacies, primary healthcare, São Paulo, social accountability, social assistance, urban poor 60 | HOUTZAGER ET Al. 1 | INTRODUCTION The landscape of social accountability in metropolitan cities (those with more than 4-5 million inhabitants) is largely unknown. Recent impact evaluation studies have documented whether specific accountability tools have any effect on the quality of public services, and the causal chain that produces observed effects (

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“…These professionals were participants in the movimento sanitário, the nonpartisan movement largely responsible for the universalisation of access to public healthcare. The sanitaristas' reformist project emerged under military rule and was put into practice first through local programs and later national ones, as these professionals were able to "occupy spaces" in the health sector's administration (Escorel 1998;Dowbor 2008;Falleti 2010b).…”

Section: Alliances and Institutions In The Foundational Momentmentioning

confidence: 99%

The Role of Professionals in Policy Reform: Cases from the City Level, São Paulo

Dowbor¹,

Houtzager²

2014

Lat. Am. polit. soc.

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A new generation of social policies in Brazil and elsewhere in Latin America are being read by scholars as first and foremost the result of top‐down initiatives by state elites and technocrats. This article explores what role, if any, middle‐class professionals have played and how this role might be framed in analytical terms. The article examines the trajectory of two of the most important new social programs that target the poor in the city of São Paulo, Brazil: the family health program PSF and Renda Mínima. It compares the city‐level reform dynamics that have shaped the trajectory of the programs over 18 years. It finds that networks of reformist middle‐class professionals that traverse public and private institutions played a substantial role in the creation and evolution of the new programs.

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Origins of Successful Health Sector Reform: Public Health Professionals and Institutional Opportunities in Brazil

Cited by 6 publications

References 3 publications

Health reform in Brazil: The sanitaristas as programmatic actors

Health reform in Brazil: The sanitaristas as programmatic actors

Social accountability in metropolitan cities: Strategies and legacies in Delhi and São Paulo

The Role of Professionals in Policy Reform: Cases from the City Level, São Paulo

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