What Reverses Decentralization? Failed Policy Implementation, Civic Supporters, or Central Bureaucrats’ Expertise? The Case of Brazil’s AIDS Program

Abstract

This article argues that Brazil's success in responding to the AIDS epidemic rested in the government's pursuit of a reversal of decentralization, which entailed the government's delegation of policy-making autonomy, funding, and discretionary fiscal transfers to the national AIDS program. AIDS bureaucrats achieved this by establishing close partnerships with social health movements and AIDS nongovernmental organizations advocating policy ideas with a historically proven track record of success while resembling similar social health movements in the past. This partnership, in turn, provided AIDS bureaucrats with the legitimacy and influenced needed for policy reform.

Institutions, Policy, and Non-Communicable Diseases (NCDs) in Latin America

“…Researchers have recently investigated the relationship between concentrations of policy-making authority within political institutions, political representation, health policy design, and implementation (Gauri and Khaleghian, 2002, Gómez, 2018a, 2014Immergut, 1993;McGuire, 2010;Nathanson, 1996). Our assumptions about the public health policy advantages of institutions exhibiting strong agenda-setting powers in health policy reform stem primarily from the historical institutionalism literature in social and public health policy (Gómez, 2006;Nathanson, 1996;Amenta and Skocpol, 1986).…”