Author:

• Regianne Leila Rolim Medeiros - Medeiros, R.L.R. - Fortaleza, Ceará - Universidade Estadual do Ceará - <regiannemedeiros@yahoo.com.br>

Thematic Area:

Não Categorizado

Abstract:

Organisational theory has long emphasized the importance of contingent, environmental influences on organisational form and performance. Similarly, research has demonstrated the importance of local political culture and informal management on local health system performance, establishing vicious and virtuous circles of influence that promise to increase inequalities in performance between decentralised local health systems. A longitudinal ethnography studied the relationship between these elements in the same rural municipality in Northeast Brazil at a four year interval. The second study found the local health system performance much improved. The process of improvement had taken two stages: first a reversal of a vicious circle to a virtuous one, but retaining the interdependence of the health system and the local political culture; the second the establishment of a boundary, albeit a permeable one, between the health system and the local political culture. Two main factors appear to have interacted to bring this about: the leadership vision and power to implement of one individual; the professionalisation of the local health system following increased numbers of senior health staff. The origins of these influences combine initiativesthe local, state and Federal scales.
Key words: Sanitary reform, public policy, decentralisation, clientelism, local government, Brazil

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