This research focuses on agencification and quangocratisation (AQ) through a comparison of the experiences of South Korea and the UK. Although a number of studies of AQ have been produced recently, these reforms remain inadequately understood. Since AQ involves the structural disaggregation of administrative units from existing departments, executive agencies and quangos have distinct characteristics which are quite different from ordinary core departments. There are a number of factors which influence these changes; and this thesis explores nine existing theories which are available to explain these phenomena. Case studies are presented of Tate Modern in the UK and the National Museum of Modern and Contemporary Art (MMCA), which are carefully analysed to examine the validity of those nine arguments. Although cultural agencies, which show some unique features, have become increasingly an essential part of the national economy, they have scarcely been researched from the viewpoint of public policy. This thesis endeavours to explore distinctive characteristics of this policy area; and moreover, it examines the diverse variables which have an impact on policy formation and its results through the process of comparison of arguments. The major tasks of this thesis are to investigate the applicability of the nine arguments and to weigh their merits. As a corollary of this comprehensiveness, it examines the whole public sectors of both countries, in order to show the broader picture and to understand the processes of changes and their backgrounds. More profoundly, similarities and differences between both countries are compared from both macro and micro perspectives. At the same time, the results of AQ are analysed through the comparison of outputs or outcomes before and after these changes, with a view to exploring whether their rationales are appropriate. Furthermore, it also examines the institutional constraints which influence not only the change of agencies but also their performances. Besides which, it seeks to find strategies for overcoming these constraints. This thesis adopts systematic and comprehensive approaches regarding basic concepts and data. It draws on theories of comparative research, the scope of the public sector, the classification and analysis of agencies and quangos, and theories underlying the detailed components of each argument and epistemological assumptions. Therefore, it suggests various aspects which enable us to broaden our understanding of the changes within the public sector; and to generate practical understanding to inform real world reform.

This dissertation investigates the mutual life project of Signe (1896-1988) and Axel Höjer (1890-1974), a married couple who were key actors in the construction of the Swedish welfare state. It emphasises the ways in which they went about asserting a special public health expertise in different contexts. As starting points I take the malleability of the concept folkhälsa (people’s health or population health) and the centrality of expertise in the governance of modern societies. Theoretical concepts such as gender, policy transfer, biopower and governmentality are central to the analysis. The dissertation includes three parts. The first part investigates how the Höjers agreed to coordinate their work and how they, with reference to ideas picked up in France and England at the end of World War I, attempted to reform mother and child health care in Sweden. Their strategies where rhetorical but also practical, using Hagalund outside Stockholm as their experimental ground. The second part investigates, firstly, how Axel Höjer, as General-Director of the Medical Board of Sweden (1935-52) asserted a sociomedical expertise, integrating the emerging social sciences and universalist views on the organisation of the welfare state into the realm of medicine, in order to launch ideas of a thorough reorganisation and expansion of the Swedish health care system. His focus was on preventive medicine and health care, with the complete physical, mental and social health of the whole population as an explicit goal. Secondly, it explores how Signe Höjer at the same time tried to launch ideas on health and wellbeing as a social politician and a public committee member. She also tried to define family policy as a specific policy area. However, despite her training as a nurse and a social worker, she was largely confined to asserting a particularly ”female” expertise, which made her position rather ambiguous in terms of authority. The third part investigates how the Höjers, in the 1950s and 60s, worked with international health, Axel mainly for the WHO in India and Ghana, Signe as a policy entrepreneur, primarily in the fields of childcare and family planning. My findings partly confirm theories that see development aid as an extension of domestic social policy, but they challenge the view of aid as a simple one-way process. I demonstrate how the Höjers at least tried to adapt their projects abroad to meet local circumstances, and also show how they brought lessons from the third world to a domestic public. In the latter case they did not primarily act as experts of Swedish-style social policy, but as experts on the developing countries and on development aid.

La coopération au développement met en jeu de puissantes forces de changement et de résistance à l’interface de systèmes d’acteurs paramétrés culturellement, économiquement, politiquement et institutionnellement de manières souvent très différentes. Des demandes d’assistance sont émises et des offres de service sont proposées sur des problèmes pour lesquels doivent être bâties des réponses adaptées aux situations pour lesquelles elles ont été sollicitées. Comment se construisent ces réponses ? Comment sont prises en compte les spécificités des acteurs ? Comment sont intégrées les caractéristiques culturelles, économiques, politiques et institutionnelles des partenaires lorsque ceux-ci se retrouvent en situation d’altérité significative ? Comment finalement s’élabore une solution de développement en coopération ? Ce travail propose des éléments de réponse à partir de la coopération à la protection du patrimoine entre Luang Prabang, Chinon et l’UNESCO de 1995 à 2015 et la mobilisation d’un protocole de recherche dont les principaux outils sont empruntés aux analyses en termes de transfer studies. / The development cooperation brings into play powerful forces of change and resistance at the interface of different culturally, economically, politically and institutionally systems of actors. Requests for assistance are emitted and services offerings are proposed on problems for which must be built answers adapted to situations for which they are requested. How are these answers built ? How are taken into account specificities of the actors ? How are integrated the partners cultural, economic, political and institutional characteristics in situation of significant otherness ? Finally, how is a solution of development in cooperation worked out ? This research proposes replies starting from the cooperation to heritage protection between Luang Prabang, Chinon and UNESCO from 1995 to 2015, and the mobilization of a protocol of research whose principal tools are borrowed from the analyses in terms of transfer studies.

Dans le courant des années 2000, plusieurs Conseils régionaux en Europe ont produit une action publique spécifique sur la démocratie participative (Poitou-Charentes, Catalogne, Rhône-Alpes, Nord-Pas-de-Calais, Toscane…). La thèse analyse de manière comparée les dynamiques d'institutionnalisation des « politiques de participation » menées par deux Conseils régionaux : la Toscane et le Nord-Pas-de-Calais. De prime abord, la comparaison donne à voir des politiques régionales structurées de manière relativement similaire : renforcement de la dimension participative de l'action publique régionale ; soutien à la mise en oeuvre de dispositifs participatifs locaux et mise en oeuvre d'un dispositif de débat publicrégional sur les grands projets d'infrastructures.Adossée à une comparaison transnationale éclairant les processus de circulation desdispositifs et le rôle d'experts de la démocratie participative, la thèse montre que la similarité de ces politiques publiques tient en partie à la circulation de standards internationaux et à l'homologie de position de ces institutions dans l'ordre politico-administratif national. Néanmoins, en prêtant attention au cas particulier de la circulation du modèle du débat public français, dans et entre ces deux Régions, et à son appropriation différenciée, l'analyse amène à relativiser la thèse de la convergence mimétique de ces politiques publiques. Ellesapparaissent en effet différentes au regard de leur structure et des dispositifs participatifs qu'elles produisent.La question de la convergence/divergence de ces politiques régionales est rendue d'autant plus complexe que les acteurs régionaux de ces offres régionales, pris dans les contraintes inhérentes au jeu institutionnel, participent d'une remise quasi-permanente de la politique sur le métier de la réforme. L’analyse révèle alors une mise en institution à la fois ordinaire (élus délégués, fonctionnaires spécialisés, budgets dédiés) et indéterminée de la démocratie participative : les orientations politiques peinent à se définir tandis que les dispositifs sontsans cesse re-questionnés. L'étude sur le long terme de la mise en oeuvre de ces politiques et de leur réforme donne en effet à voir un arrimage institutionnel ambivalent, à la fois durable et toujours en mouvement, autrement dit, inconsistant. / Over the course of the 2000s, several Regional councils in Europe produced specific public policies of participatory democracy (Poitou-Charentes, Catalonia, Rhône-Alpes, Nord-Pas-de-Calais, Tuscany, etc.) This thesis is a comparative analysis of the dynamics of institutionalisation of “participatory policies” held by two Regional councils: Tuscany and Nord-Pas-de-Calais. At first glance, the comparison shows the structures of the two regional policies are relatively similar : strengthening of the participatory dimension within regionalpublic action; public support for the implementation of local participatory planning and implementation of regional public discussion planning in the framework of major infrastructure projects. Along with a transnational comparison enlightening the processes of participatory planning's circulation and the role of the experts within the field of participatory democracy, the thesis shows that the analogy between these two public policies stands partly in the effective circulation of international standards as well as in the similar position held bythe two institutions within the national politico-administrative system. However, paying attention to the special case of the circulation of the public discussion's french model within and between those two regions, and its differentiated appropriation, the analysis leads to put in perspective the thesis that states the mimetic convergence of these public policies. They actually seem to be different with regard to their structure and the participatory planning they produce.The question of the convergence/divergence of these two regional policies is even more complex as the regional players providing the participatory offers at regional level, caught up in the constraints of the “institutional game”, contribute to the nearly perpetual reassessment of the policy through successive reforms.T h e analysis then reveals how participatory democracy is institutionalised (elected delegates, specialized civil servants, and dedicated budgets) in an ordinary and undetermined manner: political orientations are hardly defined while the participatory dispositions are continuously reassessed. The long-term study of the implementation process of the policies and their reforms actually shows an ambivalent institutional effort, both sustainable and constantly in motion, but altogether inconsequential.

Bibliography: leaves 268-317 / The challenge of accessing affordable healthcare services in the developing countries prompted the promotion of community-based health insurance (CBHI) as an effective alternative. CBHI has been implemented in many countries of the South over the last three decades for the purpose of improving access and attaining universal health coverage. However, the sudden stoppage of a CBHI programme in rural Nigeria raised a lot of concerns about the suitability of the health financing scheme. Thus, this thesis examines the stoppage of the CBHI programme in rural Kwara, Nigeria. Premised on the health policy triangle as a conceptual framework, mixed methods approach was adopted for data collection. This involved 12 focus group discussions, 22 in-depth interviews, 32 key informant interviews and 1,583 questionaires. The study participants were community members, community leaders, healthcare providers, policymakers, international partner, health maintenance organisation officials and a researcher. Findings revealed that transnational actors relied on various resources (e.g. fund and ‘expertise’) and formed alliances with local actors to drive the introduction of the programme. As such, the design and implementation of the policy were dominated by international actors. Despite the sustainability challenges faced by the programme, the study found that it benefitted some of the enrolled community members. Though, even at the subsidised amount, enrolment premium was still a challenge for many. The main reasons for the stoppage of the programme are a paucity of fund and poor management. The stoppage of the programme, however, signified a point of reversal in the relative achievements recorded by the CBHI scheme because community members have deserted the healthcare facilities due to high costs of care. In view of these, the thesis notes that short-term policies often lead to temporary outcomes and suggests the need to repurpose the role of the state by introducing a long-term comprehensive healthcare policy – based on the reality of the nation – to provide equitable healthcare services for the citizenry irrespective of their capacity to pay. / Sociology / D. Phil. (Sociology)

Power, and how it is exercised within social relations is pivotal in explaining policy change. Hence, this dissertation explores policy change in Kenya by examining the transfer and subsequent adoption of social protection policies in the form of cash transfer schemes. Instead of the current analytical frameworks drawing from political settlements, political institutions, and ideational approaches in explaining policy uptake, the research studies policy making from a policy transfer and power nexus. The study examines power relations among multiple actors in the national context to explain the adoption of social protection policies. Hence this dissertation articulates power dynamics and asymmetries inherent in policy-making involving national and transnational actors as underpinning policy transfer processes. The thesis is premised on the following interrelated arguments; firstly, I show how transnational actors created and manipulated interests and incentives based on their resource base in three significant ways: controlling the policy agenda, constraining the agency of other actors and influencing the preferences of actors in the policy space. The interaction of interests and resources – financial, and ideas and knowledge – converged to bring about policy change. Secondly, I focus on the role of ideas and knowledge within policy space to show how the creation of a discursive hegemony and a structure of knowledge, social construction and policy narratives played a significant role in shaping learning and influencing national actors. Thirdly, I argue that transnational actors used structural mechanisms based on financing and coerced government to adopt social protection policies through a catalysing mechanism and imposition of conditionalities. The study depicts how transnational actors conditioned and manipulated national context and institutions to align with the idea of cash transfers. This thesis employs a qualitative approach to study policy transfer and subsequent adoption of two cases of transfer schemes in Kenya, the Cash Transfer for Orphans and Vulnerable Children (CT-OVC) and the Hunger Safety Net Programme (HSNP). / Sociology / D. Phil. (Sociology)

L'accès aux médicaments essentiels (ME) est un élément clé de la qualité des soins dans un système de santé. Par ailleurs, le financement basé sur la performance (FBP) attire de plus en plus l'attention des décideurs comme une intervention pour améliorer la prestation des services de santé, y compris l’accès aux ME, dans les pays à faible et moyen revenus (PFMR). Malgré l’intérêt croissant de la recherche sur le FBP, très peu d’étude ont porté sur la mise à l’agenda d’une telle réforme ou son maintien à l’ordre du jour au fil du temps, encore moins sur l’influence de celle-ci sur l’accès aux ME dans les PFMR. A travers une analyse du programme de FBP au Cameroun, la présente thèse vise à faire avancer les connaissances en examinant les questions suivantes : qu’est-ce qui explique l’apparition du FBP au niveau de la politique nationale de la santé et quel est l’impact de ce programme sur l’accès aux ME? Le devis de recherche est celui d’une étude de cas et la démarche analytique s’appuie sur la combinaison des données qualitatives, à travers des entrevues réalisées auprès des acteurs clés du programme FBP au Cameroun, et quantitatives, issues de l’évaluation d’impact de ce programme. La perspective conceptuelle est celle des cycles de politique, du cadre de transfert des politiques et de la recherche interventionnelle. Les résultats sont structurés en quatre articles scientifiques. La mise du FBP à l’agenda au Cameroun s’est construite à partir des rapports et événements identifiant l'absence d'une politique de financement de la santé adaptée comme une question importante à laquelle il fallait s'attaquer (article 1). L'évolution du discours politique vers une plus grande responsabilisation a permis de tester de nouveaux mécanismes. Un groupe d'entrepreneurs politiques de la Banque mondiale, par le biais de nombreuses formes d'influence (financière, conceptuelle, fondée sur la connaissance et les réseaux) et en s'appuyant sur plusieurs réformes en cours, a collaboré avec de hauts fonctionnaires du gouvernement pour mettre le programme FBP à l'ordre du jour. Des organisations non gouvernementales internationales ont été recrutées au début du programme pour assurer sa mise en œuvre rapide. Toutefois, il a fallu transférer ce rôle aux organisations nationales pour assurer la pérennité, l'appropriation et l'intégration de l'intervention du FBP dans le système de santé (article 2). L'expérience de ce transfert montre que les éléments favorisant la réussite d’un tel processus incluent des directives structurées, une appropriation et planification conjointe de la transition par toutes les parties, et un soutien post-transition aux nouveaux acteurs. Les données qualitatives suggèrent que la mise en œuvre du programme FBP influence l’accès aux médicaments essentiels par l’entremise de plusieurs facteurs, notamment une plus grande autonomie des formations sanitaires, une régulation appliquée des équipes cadre de santé, une plus grande responsabilisation des acteurs du médicament et la libéralisation du système d’approvisionnement (article 3). Cependant, le programme a eu un impact très limité sur la disponibilité des ME (article 4). L'intervention n’a été associée à aucune réduction des ruptures de stock de ME, sauf pour la planification familiale (PF), avec une hétérogénéité des effets entre les régions et les zones urbaines et rurales. Ces résultats sont la conséquence d'un échec partiel de la mise en œuvre de ce programme, allant de la perturbation et de l'interruption des services à une autonomie limitée des formations sanitaires dans la gestion des décisions et à un retard considérable dans le paiement des prestations. / Access to essential medicines (EM) is a key element of quality of care in a health system. Accordingly, performance-based financing (PBF) is increasingly attracting the attention of policy makers as a promising intervention to improve health service delivery, including access to essential medicines, in low and middle-income countries (LMICs). Despite the growing interest in PBF research, very few studies have focused on how such a reform has been put on the agenda or how it has been maintained over time, much less how it has influenced access to EMs in low- and middle-income countries. Through an analysis of the PBF program in Cameroon, this thesis aims to advance knowledge by examining the following questions: What explains the emergence of PBF at the level of national health policy and what is the impact of this program on access to EMs? The research design is a case study and the analytical approach is based on a combination of qualitative data, through interviews conducted with key actors of the PBF program in Cameroon, and quantitative data from the impact evaluation of this program. The conceptual perspective is that of policy cycles, the policy transfer framework and intervention research. The results are structured into four scientific articles. Putting the PBF on the agenda in Cameroon was built from reports and events identifying the lack of an appropriate health financing policy as a critical issue that needed to be addressed (article 1). The evolution of political discourse towards greater accountability made it possible to test new mechanisms. A group of political entrepreneurs from the World Bank, through many forms of influence (financial, conceptual, knowledge-based and networked) and building on several ongoing reforms, worked with senior government officials to put the PBF reform on the agenda. International non-governmental organizations were recruited at the beginning of the programme to ensure its rapid implementation. However, this role had to be transferred to national organizations to ensure sustainability, ownership and integration of the PBF intervention into the health system (Article 2). The experience of this transfer shows that the elements for the success of such a process include structured guidelines, joint ownership and planning of the transition by all parties, and post-transition support to new actors. The implementation of the PBF programme influences access to essential medicines through several factors, including greater autonomy of health v facilities, enforced regulation of district medical teams, greater accountability of drug stakeholders and liberalization of the supply system (Article 3). However, the programme had a very limited impact on the availability of EMs (Article 4). The intervention was not associated with any reduction in EM stock-outs, except for family planning (FP), where the reduction was 34% (P = 0.028), with a heterogeneity of effects between regions and urban and rural areas. These poor results were likely the consequence of partial implementation failure, ranging from disruption and discontinuation of services to limited facility autonomy in managing decision‐making and considerable delay in performance payment.