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Patronage systems in public service are reviled as undemocratic and corrupt. Yet patronage was the prevailing method of staffing government for centuries, and in some countries it still is. Grindle considers why patronage has been ubiquitous in history and explores the processes through which it is replaced by merit-based civil service systems.

The Soldier and the Changing State is the first book to systematically explore, on a global scale, civil-military relations in democratizing and changing states. Looking at how armies supportive of democracy are built, Zoltan Barany argues that the military is the most important institution that states maintain, for without military elites who support democratic governance, democracy cannot be consolidated. Barany also demonstrates that building democratic armies is the quintessential task of newly democratizing regimes. But how do democratic armies come about? What conditions encourage or impede democratic civil-military relations? And how can the state ensure the allegiance of its soldiers? Barany examines the experiences of developing countries and the armed forces in the context of major political change in six specific settings: in the wake of war and civil war, after military and communist regimes, and following colonialism and unification/apartheid. He evaluates the army-building and democratization experiences of twenty-seven countries and explains which predemocratic settings are most conducive to creating a military that will support democracy. Highlighting important factors and suggesting which reforms can be expected to work and fail in different environments, he offers practical policy recommendations to state-builders and democratizers.

Following on from the success of the editors' previous book, New Public Management: The Transformation of Ideas and Practice, which examined the public reform process up to the end of the last decade, this new volume draws on the previous knowledge both theoretically and empirically. It examines and debates the post-new public management reform development in Denmark, Norway, Sweden, Australia and New Zealand. The ideal follow-up to the previous volume, this book includes many of the same contributors in addition to some fresh voices, and is a must for anyone looking for an integrated framework of analysis. Comprehensive and analytical, it is an important contribution to the study of public administration and particularly to the reform of public management. Tom Christensen is from the University of Oslo and Per Lægreid is from the University of Bergen, both in Norway. Contents: Preface; Introduction - theoretical approach and research questions, Tom Christensen and Per Lægreid; Still fragmented government or reassertion of the centre?, Tom Christensen, Amund Lie and Per Lægreid; Reform design and performance in Australia and New Zealand, John Halligan; Types of state organisations: arguments, doctrines and changes beyond new public management, Paul G. Roness; Convergence and standardization in telecommunications regulation: trajectories of change and reform in the Asian Pacific regulatory state, Martin Painter; Organizing immigration - a comparison of New Zealand and Norway , Tom Christensen, Per Lægreid and Richard Norman; Central banking reform across the world: only by night are all cats grey, Martin Marcussen; Quests for transparency: signs of a new institutional era in the health care field, Maria Blomgren and Kirstin Sahlin-Andersson; Public-private partnerships: a comparative perspective on Victoria and Denmark, Carsten Greve and Graeme Hodge; (The difficult art of) outsourcing welfare services: experiences from Sweden and New Zealand, Anders Forssell and Lars Norén; New public management and the ghost of Max Weber: exorcised or still haunting?, Robert Gregory; Bibliography; Index.

Policy researchers have used various categories of variables to explain why policies change, including those related to institutions, interests and ideas. Recent research has paid growing attention to the role of policy networks—the actors involved in policy-making, their relationships with each other, and the structure formed by those relationships—in policy reform across settings and issues; however, this literature has largely ignored the theoretical integration of networks with other policy theories, including the ‘3Is’ of institutions, interests and ideas. This article proposes a conceptual framework integrating these variables and tests it on three cases of policy change in Burkina Faso, addressing the need for theoretical integration with networks as well as the broader aim of theory-driven health policy analysis research in low- and middle-income countries. We use historical process tracing, a type of comparative case study, to interpret and compare documents and in-depth interview data within and between cases. We found that while network changes were indeed associated with policy reform, this relationship was mediated by one or more of institutions, interests and ideas. In a context of high donor dependency, new donor rules affected the composition and structure of actors in the networks, which enabled the entry and dissemination of new ideas and shifts in the overall balance of interest power ultimately leading to policy change. The case of strategic networking occurred in only one case, by civil society actors, suggesting that network change is rarely the spark that initiates the process towards policy change. This analysis highlights the important role of changes in institutions and ideas to drive policymaking, but hints that network change is a necessary intermediate step in these processes. Les chercheurs en stratégies politiques ont utilisé diverses catégories de variables pour expliquer pourquoi les stratégies changent, notamment celles ayant un lien avec des institutions, des intérêts et des idées. Des recherches récentes ont accordé une attention croissante au rôle des réseaux politiques - les acteurs impliqués dans l’élaboration des politiques, leurs relations les uns avec les autres, et la structure formée par ces relations - dans la réforme des stratégies politiques dans tous les contextes et enjeux; cependant, cette littérature a largement ignoré l’intégration théorique des réseaux avec d’autres théories politiques, y compris les « 31 », à savoir, les institutions, les intérêts et les idées. Le présent article propose un cadre conceptuel intégrant ces variables et le teste sur trois cas de changement de stratégie politique au Burkina Faso, répondant à la nécessité de l’intégration théorique avec les réseaux ainsi qu’à l’objectif plus large d’analyse de la politique de recherche en santé fondée sur la théorie dans les pays à revenu faible et intermédiaire. Nous utilisons le répérage du processus historique, un type d’étude comparative de cas, afin d’interpréter et de comparer les documents et les données des entretiens en profondeur dans et entre les limites des cas. Nous avons constaté que les modifications du réseau ont en effet été associées à la réforme de la stratégie politique, et que cette relation a été modifiée par une ou plusieurs institutions, intérêts et idées. Dans un contexte de forte dépendance des bailleurs de fonds, les nouvelles règles des donateurs ont affecté la composition et la structure des acteurs dans les réseaux, ce qui a permis l’entrée et la diffusion de nouvelles idées et des modifications dans l’équilibre global du pouvoir de l’intérêt, qui en définitive aboutit à un changement de politique. La mise en réseau stratégique est survenue dans un seul cas, par le biais des acteurs de la société civile, ce qui laisse supposer que la modification du réseau produit rarement l’étincelle qui déclenche le processus menant au changement de stratégie politique. Cette analyse met en évidence l’important rôle de l’évolution des institutions et des idées devant aboutir à l’élaboration des politiques, mais laisse supposer que le changement de réseau est une étape intermédiaire nécessaire dans ces processus. Los investigadores de políticas han utilizado diversas categorías de variables para explicar por qué las políticas cambian, incluyendo aquellas relacionadas con las instituciones, los intereses y las ideas. La investigación reciente ha prestado cada vez más atención al papel de las redes de políticas -los actores involucrados en la formulación de políticas, sus relaciones entre sí, y la estructura formada por aquellas relaciones- en la reforma de políticas en todos los entornos y los problemas; sin embargo, esta literatura ha ignorado en gran parte la integración teórica de las redes con otras teorías políticas, incluyendo las ‘3Is’ de las instituciones, intereses e ideas. Este artículo propone un marco conceptual integrando estas variables probándolas en tres casos de cambio de políticas en Burkina Faso, abordando la necesidad de una integración teórica con las redes, así como con el objetivo más amplio de investigación de análisis de políticas de salud basada en la teoría en los países de ingresos bajos y medios. Utilizamos el rastreo de un proceso histórico, un tipo de estudio comparativo de casos, para interpretar y comparar los documentos y los datos de entrevistas en profundidad dentro y entre los casos. Se encontró que mientras los cambios de la red estuvieron vinculados a una reforma de la política, esta relación estaba mediada por una o más de las instituciones, los intereses y las ideas. En un contexto de elevada dependencia de los donantes, los nuevos reglamentos de los donantes afectaron la composición y la estructura de los actores en las redes, lo que permitió la entrada y difusión de nuevas ideas y cambios en el equilibrio total del poder de los intereses conduciendo finalmente a un cambio de política. El caso de interconexiones estratégicas ocurrió sólo en un caso, por los actores de la sociedad civil, lo que sugiere que el cambio de la red rara vez es el factor desencadenante que inicia el proceso hacia el cambio de política. Este análisis destaca el importante papel de los cambios en las instituciones y en las ideas para impulsar la formulación de políticas, pero insinúa que el cambio de red es un paso intermedio necesario en estos procesos. 政策研究者使用不同类别下的变量来解释政策变化, 包括与制 度、利益和想法的政策变化。最近的研究增加了对政策改革 中政策网络的关注——政策制定过程中的参与者, 他们之间的 关系, 这些关系构成的结构。然而, 这忽略了与其他政策理论 的理论整合, 包括制度、利益和想法的 “3LS” 。本文提出一 种整合这些变量的概念框架, 并在布基纳法索的三个政策变革 的例子中试验, 旨在提出对理论整合的需要以及在低收入和中 等收入国家以理论为导向的医疗政策分析研究的需要。我们 使用历史过程回溯, 一种案例比较研究, 解释和比较案例中的 文件和深度访谈得到的数据。我们发现随着政策变革网络确 实有所变化, 这种关系被制度、利益和想法中的一个中和了。 在高度依赖捐赠者的情境下, 新的捐赠规则影响网络中参与者 的组成和结构, 这样使新的想法能够进入或者渗透进来, 影响 利益力量的平衡, 最终引起政策变化。策略社交只在一个例子 中出现, 通过公民社会参与者, 这表明网络的变化很少是促进 政策变化的动因。本分析强调了制度和想法在政策制定中的 重要促进角色, 但是网络也是这些过程中必需的中间步骤。

In Ethiopia, Maternal, Newborn, and Child Health (MNCH) outcomes have been improving, however, the current level of Maternal and under-five children mortality remains the highest in the world. Despite the rhetoric around the significance of multi-stakeholder engagement as a buzzword in development theories and polices to improve health and other development outcomes, there is limited evidence on how multi-stakeholders intersect and mutually reinforce each other toward the coproduction of improved MNCH outcomes and a resilient community health system. The aim of this manuscript is to examine barriers to and facilitators of coproduction in the context of multi-stakeholder engagement to optimize MNCH outcomes and a resilient community health system in rural Ethiopia. We conducted a qualitative case study in West Shewa Zone, rural Ethiopia. A purposive sampling technique was used to recruit participants. Data sources were two focus groups discussions with CHWs, twelve key informant interviews with multilevel public health policy actors, and a policy document review related to the CHW program to triangulate the finding. Thematic analysis of the qualitative data was conducted. Our study was informed by multiple theoretical frameworks including the World Health Organization's building block framework, state- society synergy model to inform the research processes and analysis. In the context of multi-stakeholder approach, our analysis revealed the multilevel barriers to and facilitators of coproduction in the community health landscape in rural Ethiopia. The major barriers of coproduction include lack of vertical and horizontal alignment, lack of continuum of and sustainable engagement practice,lack of systemic coordination platforms, and Inadequate coordination and implementation capacity. Major facilitators of coproduction include embedded integrated community health system, promising macro-level multi-stakeholder and community-level engagement and coproduction aspects. Our study reveals mixed policy and practice-related results, the current multi-stakeholder engagement is necessary but insufficient and fragmented to coproduce optimized MNCH outcomes and ensure a resilient health system in rural Ethiopia. Moving beyond the current multi-stakeholder engagement as a buzzword in health polices to practice through, embracing meaningful coproduction frameworks is fundamental while building on multi-stakeholder engagement efforts to optimize MNCH outcomes and a resilient community health system. A coproduction framework leverages the intersection and mutual reinforcement of multi-stakeholder synergy throughout the CHWs' program cycle through shared power and joint assessment, planning, implementing, decision making and evaluating. Fostering effective multi-stakeholder engagement synergy requires balanced shared power, alignment to community priorities, systemic mapping, coordination and monitoring, and continuum and sustainability of engagement strategies. Beyond donor initiatives and a dependency approach, proactive health diplomacy strategies are also important to sustain the existing and attract new actors to realize sustainable positive health outcomes and a resilient community health policy and strategy.

Introduction Lebanon is a middle-income country facing substantial fragility features. Its health profile shows a high burden of NCD morbidity and mortality. This paper intends to analyse the political economy of NCD prevention and control in Lebanon. Methods This study adopted a literature-based case study research design using a problem-driven political economy analysis framework. A total of 94 peer-reviewed articles and documents from the grey literature published before June 2019 were retrieved and analysed. Results Lebanon’s political instability and fragile governance negatively affect its capacity to adapt a Health-in-All-Policies approach to NCD prevention and enable the blocking of NCD prevention policies by opposed stakeholders. Recent economic crises limit the fiscal capacity to address health financing issues and resulting health inequities. NCD care provision is twisted by powerful stakeholders towards a hospital-centred model with a powerful private sector. Stakeholders like the MOPH, UN agencies, and NGOs have been pushing towards changing the existing care model towards a primary care model. An incremental reform has been adopted to strengthen a network of primary care centres, support them with health technologies and improve the quality of primary care services. Nevertheless, outpatient services that are covered by other public funds remain specialist-led without much institutional regulation. Conclusion Our study revealed a locked equilibrium in NCD prevention policymaking in Lebanon, but with an incremental progress in service delivery reforms towards a primary care model. Advocacy and close monitoring by policy entrepreneurs (such as civil society) could initiate and sustain the implementation of policy change and care model reforms.

Classical organizational management literature draws clear parallels between organizational culture and climate and effective use of power and influence as key to successful policy implementation of reforms in public sector organizations. On the other hand, the public policy literature, in particular, policy transfer as a strand within policy studies, emphasizes the role of the national context, more specifically, 'facilitators' and 'constraints' of \"politico-administrative culture\" within the national context, as crucial to understanding processes of transfer, convergence, and diffusion of public policy. There is a plethora of studies by Western scholars of public management who have successfully utilized these theoretical underpinnings to study the effectiveness of public service reforms in mature policy environments such as the UK, the US, Australia, New Zealand, and others. However, the public policy and comparative public management literature only offers a limited number of case studies from developing, middle-/upper-middle countries, which rely on concepts of organizational management in addition to narratives on the impact of policy learning from global doctrines, such as Weberianism, New Public Management (NPM), and New Public Governance (NPG), and national politics, on the implementation of administrative reforms in those contexts. Kazakhstan, as a resource-affluent post-Soviet country and a bastion of modernization and 'open government' in Central Asia or the Commonwealth of Independent States (CIS) in the post-Soviet era is a case in point. Based on ethnographic research consisting of interviews with elite academics, civil servants, and think-tank activists, as well as reviews of OECD and government strategy reports in Astana, the findings point to a potential abatement of the impact of context constraints such as large power distance and collectivist behavior by context facilitators such as those surrounding the use of 'trilingualism' and public diplomacy towards reforms in Kazakhstan particularly in recent years.

PurposeThis study aims to explore under which institutional and organizational conditions the national e-government reform efforts of EU member states lead to very high availability of e-services.Design/methodology/approachFollowing e-government literature of information systems and public administration research, this study applies an analytical framework encompassing characteristics of the national politico-administrative system (state structure, government capacity, managerial innovation orientation and civil service system) to understand why a common policy framework does not lead to convergence but great variety in the degree of e-service availability. A comparative case study approach using fuzzy set qualitative comparative analysis (fsQCA) is applied to systematically compare e-service availability in the former 28 EU member states.FindingsThree configurations of sufficient conditions are identified: government capacity in conjunction with either bureaucratic human resource practices, centralized state structure or managerial innovation orientation. Three country clusters are derived: effective bureaucrats, effective centralists and effective managers.Originality/valueThe results demonstrate the importance of administrative effectiveness for the digital transformation. Rather than mimicking best practices, countries are advised to learn from better performing countries that are most similar in terms of institutional and organizational characteristics of the politico-administrative system.

Although universal health coverage (UHC) is a global health policy priority, there remains limited evidence on UHC reforms in low- and middle-income countries (LMICs). This paper provides an overview of key insights from case studies in this thematic series, undertaken in seven LMICs (Costa Rica, Georgia, India, Malawi, Nigeria, Tanzania, and Thailand) at very different stages in the transition to UHC. These studies highlight the importance of increasing pre-payment funding through tax funding and sometimes mandatory insurance contributions when trying to improve financial protection by reducing out-of-pocket payments. Increased tax funding is particularly important if efforts are being made to extend financial protection to those outside formal-sector employment, raising questions about the value of pursuing contributory insurance schemes for this group. The prioritisation of insurance scheme coverage for civil servants in the first instance in some LMICs also raises questions about the most appropriate use of limited government funds. The diverse reforms in these countries provide some insights into experiences with policies targeted at the poor compared with universalist reform approaches. Countries that have made the greatest progress to UHC, such as Costa Rica and Thailand, made an explicit commitment to ensuring financial protection and access to needed care for the entire population as soon as possible, while this was not necessarily the case in countries adopting targeted reforms. There also tends to be less fragmentation in funding pools in countries adopting a universalist rather than targeting approach. Apart from limiting cross-subsidies, fragmentation of pools has contributed to differential benefit packages, leading to inequities in access to needed care and financial protection across population groups; once such differentials are entrenched, they are difficult to overcome. Capacity constraints, particularly in purchasing organisations, are a pervasive problem in LMICs. The case studies also highlighted the critical role of high-level political leadership in pursuing UHC policies and citizen support in sustaining these policies. This series demonstrates the value of promoting greater sharing of experiences on UHC reforms across LMICs. It also identifies key areas of future research on health care financing in LMICs that would support progress towards UHC.