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Performance of the local health system and contingent influences in Northeast-Brazil: breaking vicious and virtuous circles

Medeiros, R.L.M.; Atkinson, S.

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Authors

R.L.M. Medeiros



Abstract

Organizational theory has long emphasized the importance of contingent, environmental influences on organizational performance. Similarly, research has demonstrated the importance of local political culture and informal management on the performance of the local health system, establishing vicious and virtuous circles of influence that contribute to increasing inequalities in performance among decentralized local health systems. A longitudinal ethnography studied the relationship between these elements in the same rural municipality in Northeast Brazil after a four-year interval. The second study found the local health system performance much improved. Two main factors appear to have interacted to bring this about: leadership vision and power to implement of one individual; professionalization of the local health system by hiring a significant number of senior health staff. The origins of these influences combine initiatives at local, state and federal levels.

Citation

Medeiros, R., & Atkinson, S. (2013). Performance of the local health system and contingent influences in Northeast-Brazil: breaking vicious and virtuous circles. Ciência & Saúde Coletiva, 18(11), 3431-3442. https://doi.org/10.1590/s1413-81232013001100032

Journal Article Type Article
Publication Date Nov 1, 2013
Deposit Date Oct 3, 2014
Publicly Available Date Mar 29, 2024
Journal Ciência & saúde coletiva
Print ISSN 1413-8123
Electronic ISSN 1678-4561
Publisher Associação Brasileira de Saúde Coletiva
Peer Reviewed Peer Reviewed
Volume 18
Issue 11
Pages 3431-3442
DOI https://doi.org/10.1590/s1413-81232013001100032
Keywords Sanitary reform, Public policies, Decentralization, Clientelism, Local government, Brazil.

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