Political cultures, health systems and health policy.

Full Abstract

Policies for restructuring national health systems in low- and middle-income countries tend to follow similar packages of prescriptions along the lines of those discussed in the World Development Report of 1993. An ubiquitous reform measure is that of decentralisation. Research on decentralised health care in Northeast Brazil demonstrates the critical role played by informal aspects of health system management and the political cultures of the wider context on the implementation of policy and the performance of local health systems. Discussion of incorporating these results into policy making highlights a number of points. Health systems research has failed to take seriously the role of the cultural for various reasons, particularly because of the challenge it makes to our own fundamental values and because of the difficulties of including it into approaches based on rational systems models. At the same time, health system researchers cannot easily draw upon and operationalise more complex and sophisticated explorations of the nature of the cultural domain. Nonetheless, without a concerted effort to engage with this literature, to bridge the gap to the applied policy world and tackle the challenge of incorporating considerations of political culture into policy making, health system management through decentralisation is likely to increase inequalities between local districts rather than the opposite.

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Author information

Author/s: Atkinson, Sarah (S);

Affiliation: School of Geography, University of Manchester, UK. sarah.atkinson(-atsign-)man.ac.uk

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: Social science & medicine (1982) (Soc Sci Med), published in England. (Language: eng)

Reference: 2002-Jul; vol 55 (issue 1) : pp 113-24

Dates: Created 2002/07/24; Completed 2002/08/02; Revised 2006/11/15;

PMID: 12137181, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

National Health Programs - organization & administration
Organizational Culture
Policy Making
Politics
Power (Psychology)
Regional Health Planning - organization & administration
Social Responsibility

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