PI: Patricia McManus Co-PI: Shiri Noy Institution: Indiana University
International financial institutions, in particular, the International Monetary Fund and the World Bank, have played a critical role in spreading ideas about health reform to developing nations. In this study, Latin American countries' different responses to the efforts by international financial institutions are investigated including identifying the factors that explain the variation in responses. Interviews will be conducted with key informants and a content analysis will be carried out on policy documents to examine how different levels of state capacity and autonomy shaped health reform in three countries: Peru, Costa Rica and Argentina.
Broader Impacts: This project will be of interest to political and medical sociologists, public health scholars, policy researchers, and Latin Americanists as it extends sociological theories and examines the process of health sector reform in a new context. The results should be of interest to policy makers who may find this information valuable in the construction of future plans, agreements and reforms.
This study examines the role that International financial institutions (IFIs), in particular the World Bank, have played in health sector reform in three Latin American countries, between 1980 and 2005: Argentina, Costa Rica and Peru. This NSF award was used to fund travel to Argentina, Costa Rica and Peru between May and November 2011 where I was able to conduct over 90 interviews with policy makers and international financial institution personnel and conduct archival research and gain access to IFI documents as well as national health plans and other related documents in these three countries. Interviews and discursive analysis of the documents indicate that the different constellations of health sector institutions help us account for the ways in which the national governments of Argentina, Costa Rica and Peru negotiated and developed World Bank loans and health sector related projects. In particular, variation in the agencies responsible for healthcare provision (the ministry of health versus social security agencies) as well as existing private sector involvement in healthcare provision in 1980, help explain variation in both the types of projects and the extent of involvement of the World Bank in health sector reform in these three countries between 1980 and 2005. Finally, existing state autonomy as it relates to the health sector: that is, the state’s ability to formulate coherent goals and an agenda for the health sector as well as state capacity, the ability of the state to then implement its proposed agenda (contingent on resources, political or other opposition and blockage, etc.) also help account for the trajectories of health sector reform in these countries and may provide a valuable framework for examining and explaining health sector reform in other countries. This research therefore contributes to our information on the processes of health sector reform in Latin America, and in particular, the role of IFIs in health sector reform and the ways in which national institutions, agencies and governments shape both the extent and form of IFI involvement and eventual health sector reforms.
