Policy Transfer and Bureaucratic Politics: Insights from Hospital Autonomy Reforms in Malawi

Policy Transfer and Bureaucratic Politics: Insights from Hospital Autonomy Reforms in Malawi

Richard I. C. Tambulasi (University of Malawi, Malawi)
DOI: 10.4018/ijpphme.2012010103
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Abstract

The paper argues that the implementation of health sector reforms modelled on private sector based modularity approaches is mediated by country specific contextual factors. One of such factors is bureaucratic politics. To this end, paper advances that bureaucratic politics have a role to play in the effective implementation of reforms advocated within the international transfer of private sector-based health sector management models. Although, politicians are ultimately the decision makers in terms of which reforms are politically viable, bureaucrats have an input in the process and their behaviours can affect reform implementation. This is true even in the context of coercive transfer to developing countries. Using the case of Malawi’s hospital autonomy reforms, the paper demonstrates that although the failure of hospital autonomy in Malawi has been attributed to political undesirability, bureaucratic politics has also played a pivotal role which cannot be ignored.
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Policy Transfer And The Bureaucratic Politics Model

Amplified by globalisation processes, policy transfer is now becoming a growing subject within the subfield of public policy and management (Dolowitz, 2006; Pollitt, 2004; Common, 2001; Evans, 2009; Lynn, 2001). The basic philosophy about policy transfer is the importation of policy models for the development of policies at home. It highlights the importance of external sources of policy ideas. To this extent, studies of policy transfer settle for the Dolowitz and Marsh’s (2000, p. 5) definition that regards it as a “process by which knowledge about policies, administrative arrangements, institutions and ideas in one political system (past or present) is used in the development of policies, administration arrangements, institutions and ideas in another political system”. Policy transfer can occur through voluntary (lesson drawing) or coercive processes. Lesson-drawing or policy learning is “based on the idea that actors choose policy transfer as a rational response to perceived problems” (Dolowitz & Marsh, 2000, p. 14). It is a “rational, action oriented approach to deal with public policy problems” (Evans, 2006, p. 481). On the other hand, coercive transfer occurs where a “government or supranational institution encourages or even forces a government to adopt a policy” (James & Lodge, 2003, p. 182). In most cases, the “coercive pressures are caused by informal and formal pressures by other organizations upon which organizations are dependent” (DiMaggio & Powell, 1991). For developing countries, the coercive variant has been dominant as donor organizations have utilized their power of the purse to force these countries implement externally developed policies in the name of conditionalities (Minogue et al., 1998; Banik, 2010).

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