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.

New Zealand's public sector reforms have been hailed as a model of theoretical consistency and coherence. The associated financial management reforms, known internationally as new public financial management (NPFM), were world-leading although they are no longer unique. The underlying nature and intent of public sector reforms have been the subject of considerable debate internationally. Early public sector reforms openly sought privatisation, often on ideological grounds. However, in the face of gathering public opposition, public discussion of privatisation softened. NPM and NPFM have been promoted instead mainly on more pragmatic grounds such as improving public sector performance. In New Zealand, the Public Finance Act 1989 is the key legislation underpinning the financial management reforms. The Act delegates regulatory powers to the Treasury and, over time, a considerable body of secondary regulation, including accounting rules, has been developed. However, this secondary regulation, and its contribution to the success or otherwise of the public sector reforms, has not been examined in detail to date. In 1999, New Zealand s Controller and Auditor-General suggested that the financial management system erodes government departments resources and that somehow this resource erosion escapes parliamentary scrutiny. The Treasury, on the other hand, defended the foundations of the financial management system as solid, arguing that retention of the existing framework would allow further and faster progress towards improved performance and value-for-money than would be achieved by a new set of reforms. This debate prompts questions whether and, if so, how and why a financial management system, ostensibly implemented to improve the performance and accountability of the public sector, could be linked to such effects, and whether parliamentary scrutiny is indeed avoided. This thesis examines the secondary regulation and explains the development of the financial management system with the intention of answering those questions. The analysis undertaken in this thesis suggests that New Zealand's public sector financial management system fabricates the conditions under which privatisation initiatives might be accepted for pragmatic reasons. The erosion of departments financial resources is an essential mechanism in that fabrication process. As this system has developed, the time available for parliamentary scrutiny has reduced and the Controller and Auditor-General s controller function has been eroded, while the control and discretion exercised within the Treasury has increased. Arguably, these developments have helped to conceal the system s privatising intent. The thesis identifies features of the financial management system used to rationalise the financial resource-eroding processes. It also notes that if New Zealand's financial management system is no longer unique, then other NPFM systems may contain a similar combination of features.

Reform ideas, such as results measurement and management, tend to come and go in different ‘tides of reforms’. The purpose of this thesis is to increase our understanding of tides of reforms by identifying and discussing mechanisms that drive the rise, as well as the fall, of management reforms. This is done by studying four so-called ‘results initiatives’ launched at Sida, the Swedish International Development Agency in 1971, 1981, 1998 and 2012. The thesis tries to understand what happened both in Sida’s external environment as well as within the agency prior to the initiation, during implementation and when the four results initiatives fell out of favor. The life of each of the four results initiatives can be understood as having taken place in five phases: 1) the pressure phase, 2) the launch, 3) implementation, 4) point of re-do or die, 5) phase of opening up for something new. During these five phases different internal and external mechanisms contributed to either further institutionalization or to de-institutionalization of the results measurement and management ideas and technologies. It is argued that the need to gain legitimacy can be seen as the main mechanism that has driven the initiation of the results initiatives. During implementation, problems and difficulties arise. It is argued that whilst resistance towards the initiatives, as well as changed external demands, accelerates de-institutionalization, these mechanisms do not explain why the initiatives fall. In turn, the failure to find a standardized reporting category for “results”, the non-use of the results information produced and the fact that the initiatives no longer fulfill the function of providing legitimacy, are mechanisms that lead to the final death of the initiatives. The study concludes that whilst different external pressures can be considered important in initiating reforms, it is mainly internal mechanisms, within the organization, that explain the reason why the initiatives fall. Earlier literature has argued that tides of reforms are driven by hope and optimism to be and to be seen as effective. The findings in this study show that also the solidarity rationale, i.e. the wish to do good for someone else, and the feeling of doing so, drives the reforms. It is moreover argued that the reforms are also driven by fear and other emotions. In general, the occurrence of tides of reforms can be understood by the tension between the two rationales in development aid: solidarity and effectiveness. The study contributes with insights to what happens within an organization and over a longer time perspective when public agencies are faced with conflicting demands. It provides a broader understanding of reasons behind the quest to report on results and also what happens when results are not reportable. Since new and similar reforms will most probably arise in the future, findings from this study ought to be interesting not only in development aid but in all public policy sectors, for any policy maker or practitioner involved in the implementation of such reforms. / <p>Degree: Fil Dr in Economics </p><p>Research funder: Sida, Swedish International Development Agency </p> / The results agenda in Swedish Development Cooperation /SCORE

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.

Philosophiae Doctor - PhD / The prime aim of this thesis is to examine the link between fiscal decentralization and local financial governance in fiscally empowered woreda administrations (districts) of the Amhara region in Ethiopia. Local financial governance has been one of the reasons and arguably the crucial one that drives many countries to subscribe to fiscal decentralization. The presumption is that public finance mobilization and spending can be implemented in a more efficient, responsive, transparent and accountable manner at the local government level than at the centre. Nonetheless, empirical studies show that the linkage between fiscal decentralization and these local financial governance benefits is not automatic. Several developing countries that have tried to implement fiscal decentralization have failed to realise the promised financial governance gains largely due to design and implementation flaws. A review of the various theoretical perspectives suggest that local financial governance is not a factor of just devolution of fiscal power but also other intervening forces such as financial management system, citizen voicing mechanisms and the social and political context. It is within the framework of this theoretical argument that this study sought to investigate how the mixed and incomplete efforts of the district level fiscal decentralization program in the Amhara region has impacted on financial governance of woreda administrations. The study assesses the efficacy and role of various initiatives of the district level decentralization program of the Amhara region, such as the fiscal empowerment of woredas; financial management system reforms; citizen voicing mechanisms and political party structures and system in influencing woreda financial governance. To this end, the investigation process largely took the form of an interpretative approach employing a combination of various methods of gathering the required qualitative and quantitative data from respondents and documents in the selected four case woredas or districts. Findings on the assessment of the intergovernmental relations to measure the adequacy of devolution of fiscal power indicate that, despite the constitutional provision that affords the woredas the power to mobilize and spend public finance for the provision of various local public services, several design and implementation shortcomings have constrained woreda administrations from exercising such power effectively. As a result, the district level fiscal decentralization framework of the Amhara region appears to have features of decentralization by de-concentration rather than by devolution. Despite the extensive financial management reforms that have been undertaken, the research findings indicate that the financial management system in woreda administrations faces a range of challenges triggered largely by important design and implementation shortcomings. It is observed that the ‘getting the basics right first’ reforms in various financial management processes of woreda administrations are not only incomplete but also found to be inconsistent with each other and therefore could not serve their purpose. Furthermore, there has not been any other change in the last two decades since the initial implementation of these reforms despite such serious shortcomings. Most importantly, woreda administrations could not properly implement the techniques, methods, procedures and rules that constituted the reform process due to serious implementation problems such as the lack of manpower competency and problems associated with the lack of administrative accountability. The results of the study’s assessment regarding the practice of social accountability show that currently there is no arrangement for citizens to participate in public financial decisions and controls. In general, people have little interest in participating in the meetings organised by woreda government. Formal and informal community based organizations suffer from important capcity constraints, and the lack of strong civil society organizations to support these community based organizations makes such problems more difficult to resolve. However, local communities did indicate that they would be interested in participating in financial and budgeting processes if a number of conditions were satisfied. These included the availability of adequate and relevant information; the introduction of genuine forms of participation in which citizens were empowered; and evidence that popular participation was making a visible impact on financial decisions related to service delivery in their surroundings. The assessment of the ruling party structure and system suggests that the centralized system of the regional ruling party has created a dominant relationship between party organs at various levels so much sothat it has undermined the fiscal discretionary power of woreda administrations; blurred relationship between party and woreda financial management systems; and undermined direct voicing. Consequently, the genuine devolution of fiscal power, the effective implementation of the decentralised financial management systems, and direct participation of citizens are unlikely to be realised within the current ruling party system and structure. Moreover, the study shows that the intergovernmental relations, the implementation of financial management reforms and direct involvement of people influence each other. The evidence suggests that the effective implementation of the financial management reforms is not possible without genuine devolution of fiscal power and arrangements for the activeinvolvement of citizens. Despite these limitations and shortcomings, the research nevertheless reveals that the decentralization process has achieved some positive results, such as the expansion of access to basic services; the economic use of resources for such expansion; the mobilization of resources from local communities; and the streamlining of a number of bureaucratic processes. However, the prevalence of various financial governance challenges such as excessive budget transfers; low budget execution; uneconomical procurement; illicit spending; budget pressure; inadequate revenue collection; poor financial transparency; and compromised accountability in fiscally decentralized woreda administrations means the promised local financial governance benefits of fiscal decentralization are remain largely unrealized. The evidences in the study strongly suggest that the shortcomings in the design and implementation of intergovernmental relations, financial management system reforms, and direct voicing mechanisms areresponsible in combination with each other for these local financial governance challenges. Thus, the study concludes that local financial governance is a result of a complex network of interactions of intergovernmental relations, public financial management arrangements and social accountability mechanisms. The success of initiatives to improve local financial governance is dependent on contextual factors such as the capacity of civil society organizations and the ruling party system and structure. Therefore, while recommending further efforts of genuine devolution of power, in particular through the continuation of the financial management reform processes towards full-fledged reforms, the study contends that opening enough space for the proliferation of civil society organizations and alternative political parties will be the main priority.

Magistro studijų baigiamajame darbe išanalizuotos ir įvertintos Valstybinio socialinio draudimo fondo valdybos valdymo reformos, iškelta vienos iš jų tikslo – užtikrinti efektyvesnį socialinio draudimo fondo biudžeto lėšų ir žmogiškųjų išteklių naudojimą – įgyvendinimo problema bei pateiktos rekomendacijos Valstybinio socialinio draudimo fondo valdybai ir Lietuvos Respublikos socialinės apsaugos ir darbo ministerijai. Pirmoje darbo dalyje tiriami valstybinio socialinio draudimo valdymo teoriniai aspektai: apibrėžiama socialinio draudimo samprata ir reikšmė, apibūdinama valdymo sistema ir jos funkcijos, analizuojami valdymo problemoms įtakos turintys veiksniai. Antroje dalyje atliekamas Valstybinio socialinio draudimo fondo valdybos valdymo reformų vertinimas: analizuojami valdymo reformų tikslai, apibūdinami ir įvertinami valdymo reformų etapai ir aptariami valdymo reformų rezultatai, palyginant juos tarpusavyje bei pateikiant Valstybinio socialinio draudimo fondo valdybos valdymo reformų SSGG analizę. / There are analysed and evaluated management reforms of the State Social Insurance Fund Board (“Sodra”) in this master‘s thesis. Also it is raised the problem of management reforms purpose implementation which is to ensure a more efficient usage of Social Insurance fund budget assets and human recourses. Finally, recommendations for the State Social Insurance Fund Board and the Ministry of Social Security and Labour are presented. The first part explores State Social Insurance theoretical aspects of management. The concept and the meaning of social insurance are defined, the management system and it’s functions are described, also the factors affecting the management problems are analysed. In the second part the management reforms of the “Sodra” are evaluated analyzing aims, describing and evaluating stages and discussing results. The results are compared. A SWOT analysis of management reforms in the State Social Insurance Fund Board is presented as well.

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.