Pursuing Centralization amidst Decentralization: The Politics of Brazil's Innovative Response to HIV/AIDS

Abstract

In recent years, Brazil has been highly revered for its response to HIV/AIDS. Despite the government's delayed response, why and how did the national AIDS program eventually become so successful? This is even further puzzling when one considers the challenges associated with Brazil's decentralized response to healthcare needs, lack of subnational resources and political will to effectively implement AIDS policy. This article maintains that Brazil's successful response eventually required the strategic centralization of national AIDS bureaucratic and policy authority, entailing policies designed to aid local governments while creating fiscal policies incentivizing sub-national compliance with the national bureaucracy and more effective policy implementation. Taking advantage of renewed political support, kindled by international pressures and the president's reputationbuilding pursuits, the sources of AIDS officials' success, however, resided not in their technical and financial prowess, but in their ability to forge historically-based partnerships with civic AIDS NGOs and social movements sharing like-minded ideational beliefs in policy centralization. This article also discusses how these findings contribute new insights into theories addressing the reasons for centralization, as well as the ideational sources of gradual institutional change.

Gender differences in non-adherence among Brazilian patients initiating antiretroviral therapy

“…This perception potentially results in poor and delayed searches for care, despite the established capabilities and significant investments made by the Brazilian Health System to help diagnose, treat, and care for people living with HIV and AIDS. We emphasize the need to implement counseling and create alternative facilities for ambulatory care and treatment (27). …”

Indonesia's road to universal health coverage: a political journey

“…Observers of other Southeast Asian countries have noted the importance of bureaucrats in pushing the health reform agenda; their findings mirror similar histories in Latin America ( Nunn 2009 ; Wisnu 2011 ; Gómez 2012 ; Harris 2015 ). Harris speaks of “developmental capture”, a process through which technocrats mobilise social and political networks at home and abroad to achieve reform in the face of conservative opposition.…”

Latin America’s Resurgent Centre: National Government Strategies after Decentralisation

“…The work of Jessica Rich and Eduardo Gómez on AIDS in Brazil has emphasised the ability of the federal government to work with civil society to push for greater compliance with central mandates (Gómez, 2011;Rich, in press). Rich argues that the central government can encourage civil society groups to pressure SNGs to comply with central government initiatives, in what she terms a 'reverse boomerang effect'.…”