We use cookies to ensure that we give you the best experience on our website. By continuing to browse this repository, you give consent for essential cookies to be used. You can read more about our Privacy and Cookie Policy.

Durham Research Online
You are in:

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

Medeiros, R.L.M. and 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). pp. 3431-3442.


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.

Item Type:Article
Keywords:Sanitary reform, Public policies, Decentralization, Clientelism, Local government, Brazil.
Full text:(VoR) Version of Record
Available under License - Creative Commons Attribution Non-commercial.
Download PDF
Publisher Web site:
Publisher statement:This article is available under a Creative Commons Attribution License (CC BY-NC 3.0).
Date accepted:No date available
Date deposited:06 October 2014
Date of first online publication:November 2013
Date first made open access:No date available

Save or Share this output

Look up in GoogleScholar