In developing countries healthcare reforms are increasingly advocated and implemented in association with global developmental agendas. This thesis analyses the process of health sector reforms in Punjab by looking at the reform drivers, strategies and implementation and examines the elite motivation to reform. Responding to the empirical gap, one underlying objective is to map health sector reforms in Punjab at the primary and secondary level health facilities with respect to drivers, content, design and implementation. Bureaucrats and administrative elite hold a central role in the design and implementation of public management reforms, but in the context of developing countries with political instability and chronic budget deficits; it evaluates how the bureaucratic elites adopt, design and implement reforms. An abductive research approach is used, to investigate Punjab as a case study of health sector reforms at the primary and secondary level health facilities. The organisational context of the study enables the investigation of seven health reform programmes in Punjab, managed and implemented at the provincial and district level. The central argument of the thesis is that the process of reforms in developing countries is a political one. Administrative elites, central to the design and implementation of reforms tend to focus more on the reform trajectory and “what” to implement, and underemphasise implementation. Using data from an in-depth case study of Punjab with two embedded subunits of Lahore and Kasur selected on the basis of urban and rural demographics, this research triangulates between different datasets (bureaucracy, professionals, staff and service users) and documentary sources such as reports, documents, legislation etc. in addition to locating findings and arguments in public management, as a field of literature. The study provides evidence that devolution and the United Nations Millennium Development Goals largely drive health care reform in Punjab. Both reform and development agendas are funded by financial assistance from international financial institutions and donor organisations, and the implementation is top-down with little or no engagement with professionals, staff and service users. There is lack of motivational engagement with professionals and staff, who have no input in decision-making. The reform process lacks citizen engagement (ignorant service user) and accountability from the citizens. The adoption of reform agenda is highly driven by the fact that reforms consistent with global development agendas like UNMDGs bring in funds and resources in economically unstable environment faced by the country in general. Findings suggest that the reform process in developing countries needs to be understood in a much broader context and needs to incorporate the role international organisations play in determining the reform agenda. Reform adoption is highly dependent on the political activity and motivations of the administrative elites. Firstly, the existing models of reform are inadequate and focus on the institutional forces, rather than the individual motivations of the policy makers. Secondly, developing countries facing fiscal and economic stresses as well as unstable political institutions suffer from a skewed power imbalance where the power is concentrated in elites that results in a self-serving bureaucracy. This study contributed to the literature on reform process in developing countries by suggesting implications for research on reforms in the developing world, which includes the political and tactical motivation of the key actors in the reform process.

Submitted by Marcio Zylberman (zylberma@terra.com.br) on 2015-05-19T11:15:43Z No. of bitstreams: 1 TFC Márcio Zylberman.pdf: 1338115 bytes, checksum: c24f8d2dd2ba15e0062b11edfc7f9cbd (MD5) / Approved for entry into archive by ÁUREA CORRÊA DA FONSECA CORRÊA DA FONSECA (aurea.fonseca@fgv.br) on 2015-05-19T12:33:24Z (GMT) No. of bitstreams: 1 TFC Márcio Zylberman.pdf: 1338115 bytes, checksum: c24f8d2dd2ba15e0062b11edfc7f9cbd (MD5) / Approved for entry into archive by Marcia Bacha (marcia.bacha@fgv.br) on 2015-05-21T17:14:39Z (GMT) No. of bitstreams: 1 TFC Márcio Zylberman.pdf: 1338115 bytes, checksum: c24f8d2dd2ba15e0062b11edfc7f9cbd (MD5) / Made available in DSpace on 2015-05-21T17:25:51Z (GMT). No. of bitstreams: 1 TFC Márcio Zylberman.pdf: 1338115 bytes, checksum: c24f8d2dd2ba15e0062b11edfc7f9cbd (MD5) Previous issue date: 2015-04-14 / From the 2000s, in the context of state management reforms, the Brazilian states began an ongoing process of managerial improvement in purchases, due to the need to streamline procedures and the use of financial resources to improve the quality of your spending and meet the prerogatives of the Fiscal Responsibility Law. The possibility of reducing prices by economies of scale, better monitor the hiring processes, standardize the purchased items and more efficiently manage their procurement activities and contracting, has led some states to choose to centralize, to a greater or lesser degree, your purchases in a governing body. However, in other states predominated the idea of centralizing only the regulation and standardization of procedures or maximum control of some processes, keeping the execution of purchases, decentralized? This study aimed to identify the factors that influenced the State of Rio de Janeiro to maintain its decentralized purchases, despite potential gains from centralization. Methodologically, the research was a qualitative approach, which led to the interpretation of elements detected in field research, aligning them to the researched theoretical material. The research facilities were the case study, the literature and desk research. The instruments used in the field research were observation and interviews. It was concluded that the non-adoption of a policy of centralization of purchases by states after the 2000s, as in the case of Rio de Janeiro, is explained by its high population index by its economic size and the characteristics of decentralization reforms management implemented from 2007. Apparently, this option decentralization ended up not bringing greater losses in terms of scale, transparency and control. / A partir da década de 2000, no contexto das reformas de gestão do Estado, os estados brasileiros iniciaram um processo contínuo de aperfeiçoamento gerencial nas compras, em decorrência da necessidade de racionalizar os processos e o uso dos recursos financeiros visando melhorar a qualidade do seu gasto e atender às prerrogativas da Lei de Responsabilidade Fiscal. A possibilidade de reduzir os preços pela economia de escala, monitorar melhor os processos de contratação, padronizar os itens adquiridos e gerir com mais eficiência suas atividades de compras e contratações, levou alguns estados a optarem por centralizar, em maior ou menor grau, suas compras em um órgão gerenciador. No entanto, em outros estados predominou a ideia de centralizar apenas a normatização e a padronização dos procedimentos ou no máximo o controle de alguns processos, mantendo a execução das compras, descentralizada. Este trabalho teve por objetivo identificar os fatores que influenciaram o Estado do Rio de Janeiro a manter suas compras descentralizadas, a despeito de possíveis ganhos com a centralização.Metodologicamente, a pesquisa teve uma abordagem qualitativa, que levou à interpretação de elementos detectados na pesquisa de campo, alinhando-os ao material teórico pesquisado. Os meios de investigação foram o estudo de caso, a pesquisa bibliográfica e a investigação documental. Os instrumentos utilizados na pesquisa de campo foram a observação e as entrevistas. Concluiu-seque a não adoção de uma política de centralização das compras pelos estados após a década de 2000, como ocorreu no caso do Rio de Janeiro, se explica pelo seu alto índice populacional, pela sua dimensão econômica e, principalmente, pelas características descentralizadoras das reformas de gestão implantadas a partir de 2007. Aparentemente, esta opção pela descentralização acabou não trazendo maiores perdas em termos de escala, transparência e controle.

Submitted by Paulo Junior (paulo.jr@fgv.br) on 2011-04-27T19:31:34Z No. of bitstreams: 1 Ciro Fernandes.pdf: 1255722 bytes, checksum: 97776e5ab1e556d90c255bf56e4de6e4 (MD5) / Approved for entry into archive by Paulo Junior(paulo.jr@fgv.br) on 2011-04-27T19:31:56Z (GMT) No. of bitstreams: 1 Ciro Fernandes.pdf: 1255722 bytes, checksum: 97776e5ab1e556d90c255bf56e4de6e4 (MD5) / Made available in DSpace on 2011-04-28T13:07:17Z (GMT). No. of bitstreams: 1 Ciro Fernandes.pdf: 1255722 bytes, checksum: 97776e5ab1e556d90c255bf56e4de6e4 (MD5) Previous issue date: 2010-04-26 / The thesis analyses political change in public procurement policy of Brazilian federal administration describing in a systematic way the six cases in which legal rules and procedures suffered substantial changes affecting general laws or statutes: the centralization of purchases in Vargas period, in two decisive moments (1931 and 1940); the revision of rules for bidding by Decree-law 200, in the context of president Castello Branco administrative reform; the enactment of a statute for biddings (Decree-law 2.300 ) in José Sarney government; the congressional approval of a general bidding law directed to fight corruption and collusion in public contracts (Law 8.666, of 1993 ); the frustrated attempt of a new bidding law aligned with the managerial public management reform of Fernando Henrique Cardoso government and the creation of reverse auction (pregão) as a new modality for bids, in 2000. The research focuses the political process of problem formulation, specification of solutions and decision-making, applying John Kingdon`s model to unfold the flows of political process, problems and solutions in each specific historical context. The six cases are described and compared by means of structured narratives and their analysis is supported on theoretical model categories to elucidate how the process of change is developed and which are the relevant actors, ideas, models and political events that explain their circumstances and result. / A tese analisa as mudanças da política de compras e contratações da administração pública federal brasileira descrevendo de forma sistemática os seis casos nos quais as regras e procedimentos sofrem alteração substancial, na forma de leis gerais ou estatutos: a centralização das compras no período Vargas, em dois momentos decisivos (1931 e 1940); a revisão das regras de licitação pelo Decreto-lei n. 200, no contexto da reforma administrativa do governo Castello Branco; a edição de um estatuto das licitações (o Decreto-lei n 2.300) no governo Sarney; a aprovação no Legislativo de uma lei de licitações voltada para o combate à corrupção e ao direcionamento dos contratos públicos (Lei 8.666); a tentativa frustrada de uma nova lei alinhada com a reforma gerencial do primeiro governo Fernando Henrique Cardoso e a criação do pregão como nova modalidade de licitação, em 2000. A pesquisa focaliza o processo político de formulação dos problemas, especificação de soluções e tomada de decisão, com base no modelo de John Kingdon, desdobrando a análise em fluxos do processo político, dos problemas emergentes e das soluções, em cada contexto histórico específico. Os seis casos são descritos por meio de narrativas estruturadas e comparados a partir das categorias do modelo teórico para elucidar como se desenvolveu o processo de mudança, quais os atores relevantes, idéias, modelos e eventos políticos que explicam suas circunstâncias e resultado.