Canadian Centre for Policy Alternatives
[H]ealth care reform cannot be achieved by relying exclusively on the traditional mechanisms of governance available within liberal democracy: that is, representative government backed up by a hierarchically organized administrative structure. To effectively reform health care (and other public services) and to mobilize sufficient support for reforms in the face of opposition from entrenched interests, the forms of governance must, themselves, be democratized. This will require greater involvement of non-elite individuals and groups in governmental decision-making, as well as new ways of working within and between the public sector and the broader community.
The paper draws on four case studies where the evidence clearly shows that the skillful introduction of more participatory forms of governance increased the effectiveness and capacity for governments to introduce a more egalitarian distribution of societal resources. The four case studies are:
- The Greater London Council, 1981 to 1986
- Kerala, India, 1996 to present
- Porto Alegre, Brazil, 1989 to present
- Ceara, Brazil, 1989 to 1994
In all four examples, more participatory forms of governance increased the effectiveness, creativity, and competence of public sector systems by increasing the capacity of governments to do one or more of the following:
- Provide citizens with new opportunities to monitor and direct government activities;
- Extend the reach, competence and commitment of front-line staff within the public service;
- Bring more experiential and practical forms of knowledge and expertise to the process of policy formation and implementation;
- Increase the openness, transparency and accountability of decision-making within the administrative structures of government;
- Address bottlenecks within the administrative agencies of government that could not be resolved internally; and
- Ensure the durability of reforms beyond the mandate of the sitting government.
No comments:
Post a Comment