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Audacious Reforms examines the creation of new political institutions in three Latin American countries: direct elections for governors and mayors in Venezuela, radical municipalization in Bolivia, and direct election of the mayor of Buenos Aires in Argentina. Diverging from the usual incremental processes of political change, these cases marked a significant departure from traditional centralized governments. Such \"audacious reforms, \" explains Merilee S. Grindle, reinvent the ways in which public problems are manifested and resolved, the ways in which political actors calculate the costs and benefits of their activities, and the ways in which social groups relate to the political process. Grindle considers three central questions: Why would rational politicians choose to give up power? What accounts for the selection of some institutions rather than others? And how does the introduction of new institutions alter the nature of political actions? The case studies of Venezuela, Bolivia, and Argentina demonstrate that institutional invention must be understood from theoretical perspectives that stretch beyond immediate concerns about electoral gains and political support building. Broader theoretical perspectives on the definition of nation and state, the nature of political contests, the legitimacy of political systems, and the role of elites all must be considered. While past conflicts are not erased by reforms, in the new order there is often greater potential for more responsible, accountable, and democratic government.

Leadership and Innovation in Subnational Government takes stock of promising innovations that began to appear in local government across the region of Latin America and the Caribbean during the 1990s. The purpose of this work—in contrast to many reports which document best practice—is to deepen our understanding of the genesis and evolution of change as local leaders cope with the challenges of governing in decentralized democracies. One of the most striking features exhibited by the cases in this volume is that local authorities have been change makers often without help from outside, from national or international agencies. The authors, Tim Campbell and Harald Fuhr, call these local enterprising risk takers an \"engine of change.\" Twenty specific cases of innovation have been documented in the study covering the core business areas of cities—finance, popular participation, service delivery, privatization, and personnel management. The book aims to show, in policy and practice, how to sustain this engine of change. One of the central messages of this work is that by supporting key steps in the process of innovation, donors can enjoy cost-effective impacts and help to achieve the next stages of reform in the region. But to do so, donors must focus on management and learning at the local level, building on the foundations of broad participation in public choice and working more actively to help local actors learn from each other.

Bringing together comparative case studies from Central Europe and South America, this book focuses on 'new' regions - regions created as political projects of modernization and 're-scaling'. Through this approach it de-codes 'New Regionalism' in terms of its contributions to institutional change, while acknowledging its contested nature and contradictions. It questions whether these regions are merely a strategy of neo-liberal adjustment to changing political and economic conditions, or whether they are indicative of true reform, greater citizen participation and empowerment. It assesses whether these regions are really representing something new or whether they are a reconfiguration of traditional power relationships. It provides a timely critical analysis of 'region-building' and the extent to which national processes of decentralization and sub-national processes of regionalism can enhance the effectiveness and responsiveness of governance.

The resurgence of the Left in Latin America over the past decade has been so notable that it has been called “the Pink Tide.” In recent years, regimes with leftist leaders have risen to power in Argentina, Bolivia, Brazil, Chile, Ecuador, El Salvador, Nicaragua, Uruguay, and Venezuela. What does this trend portend for the deepening of democracy in the region? Benjamin Goldfrank has been studying the development of participatory democracy in Latin America for many years, and this book represents the culmination of his empirical investigations in Brazil, Uruguay, and Venezuela. In order to understand why participatory democracy has succeeded better in some countries than in others, he examines the efforts in urban areas that have been undertaken in the cities of Porto Alegre, Montevideo, and Caracas. His findings suggest that success is related, most crucially, to how nationally centralized political authority is and how strongly institutionalized the opposition parties are in the local arenas.

What explains why some governments advanced decentralized education in the 1990s while others shied away from such efforts? Some arguments suggest that decentralization was pursued to improve the coverage and quality of education. Others point to partisanship, ideology, or diffusion. Drawing on case studies of El Salvador and Paraguay, I argue instead that governments pursued education decentralization in part because it could be deployed as a political weapon to weaken teachers’ unions affiliated with the opposition, thus depressing mobilization and votes for their rivals. These findings contribute to the literature on decentralization by highlighting a new political motivation fueling decentralization efforts across the developing world—the demobilization of the opposition.

Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel’ perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive–interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives, strengthen the state planning and supervision functions and improve professional working conditions and skills.

This article suggests that a society's religious market structure can explain whether religion is “the opium of the people” or a major source of dissident secular mobilization. I present a simple model explaining why under monopolistic conditions, Catholic clergy in Latin America ignored the religious and social needs of poor rural indigenous parishioners but, when confronted by the expansion of U.S. mainline Protestantism, became major institutional promoters of rural indigenous causes. Catholic indigenous parishioners empowered by competition demanded the same benefits their Protestant neighbors were receiving: social services, ecclesiastic decentralization, and the practice of religion in their own language. Unable to decentralize ecclesiastic hierarchies, and facing a reputation deficit for having sided with rich and powerful elites for centuries, Catholic clergy stepped into the secular realm and became active promoters of indigenous movements and ethnic identities; they embraced the cause of the Indians as a member retention strategy and not in response to new doctrinal ideas emanating from Vatican II. Drawing on an original data set of indigenous mobilization in Mexico and on life histories and case studies, I provide quantitative and qualitative evidence of the causal effect of religious competition on the creation of the social bases for indigenous ethnic mobilization.

Abstract Despite mitigation attempts, the trajectory of climate change remains on an accelerated path, with devastating health impacts. As a response to the United Nations Framework Convention on Climate Change call for National Adaptation Plans, Peru has developed a national and decentralized regional adaptation plans. The purpose of this article is to understand the role and priority status of health within the adaptation planning and process. Peru was used as a case study to analyse the policy process in the creation of adaptation plans, encompassing the need to address climate change impacts on health with a particular focus on marginalized people. An actor, content and context policy analyses were conducted to analyse 17 out of 25 regional adaptation plans, which are available. The national adaptation plans (2002, 2015) do not include health as a priority or health adaptation strategies. In a decentralized health care system, regional plans demonstrate an increased improvement of complexity, systematization and structure over time (2009–17). In general, health has not been identified as a priority but as another area of impact. There is no cohesiveness between plans in format, content, planning and execution and only a limited consideration for marginalized populations. In conclusion, the regional departments of Peru stand on unequal footing regarding adapting the health sector to climate change. Findings in the strategies call into question how mitigation and adaption to climate change may be achieved. The lack of local research on health impacts due to climate change and a particular focus on marginalized people creates a policy vacuum. The Peruvian case study resembles global challenges to put health in the centre of national and regional adaptation plans. In-depth cross-country analysis is still missing but urgently needed to learn from other experiences.

Early advocates of decentralization lauded it as a strategy for strengthening democratic institutions, but later scholarship has emphasized decentralization’s negative consequences, especially for political parties. This article argues that the impact of political decentralization on established parties is shaped by the context in which the reforms occur, with poor economic performance and limited programmatic differentiation making parties more vulnerable to the challenges posed by decentralization. The article explores how decentralization under such circumstances has contributed to party decay in Latin America, where declining support for established parties has been significant, in some places undermining democratic stability and governability. The article employs cross-national time-series analysis and case studies. The quantitative evidence indicates that political decentralization weakens existing parties in contexts of poor economic conditions and little ideological differentiation in the party system. Case studies elaborate the processes through which decentralizing reforms together with economic conditions and party linkages affect party systems. Estudios tempranos sobre la descentralización celebran el efecto positivo de dichos procesos sobre las instituciones democráticas. En contraste, estudios más recientes enfatizan las consecuencias negativas de la descentralización, especialmente para los partidos políticos. Este artículo argumenta que el impacto de procesos de descentralización sobre los partidos políticos depende del contexto en que dichas reformas ocurren. Específicamente, contextos de pobre desempeño económico y falta de diferenciación programática hacen a los partidos más vulnerables a los desafíos planteados por la descentralización. El artículo explora como, en dichas circunstancias, la descentralización ha contribuido al deterioro de los partidos políticos latinoamericanos, en algunos casos debilitando la estabilidad democrática y gobernabilidad. El artículo incluye un análisis estadístico y de casos. El primero muestra como la descentralización debilita los partidos existentes en contextos de pobre desempeño económico y falta de diferenciación ideológica en el sistema de partidos. El segundo ilumina los procesos mediante los cuales las reformas de descentralización, junto con condiciones económicas y mecanismos de vinculación partidaria, afectan al sistema de partidos políticos.