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Implementation of health policies in Mexico City : what factors contribute to more effective service delivery?

机译:在墨西哥城实施卫生政策:哪些因素有助于提供更有效的服务?

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摘要

Policy failure has been a concern for social scientists during the past four decades, yet there are no clear answers as to why certain policies are not put into practice as intended. Ineffective policy implementation in the health sector may result in poor services with consequences affecting the population’s wellbeing. This thesis addresses the success or failure in translating policy into practice and the issues that contribute to it. In Mexico, two groundbreaking reforms in the health sector were implemented in the first decade of the 2000s: the Popular Health Insurance (PHI) programme and the termination of pregnancy law or interrupción legal del embarazo (ILE). The thesis uses these policies as case studies to understand how different factors influence policy implementation, particularly in Mexico City. Four factors are observed: actors involved and their beliefs, service delivery arrangements, managerial practices, and citizen participation and accountability. Most of these are frequently cited in the literature as key factors in public policy and service delivery. Qualitative methods were used to collect and analyse the data. The main sources of evidence were in-depth interviews, newspaper articles, official documents and other online news services and publications. It was found that the ideas, values and beliefs of actors are relevant throughout the implementation process, beyond agenda-setting and policy design processes. A decentralised service delivery implies relationships between federal and local level health authorities. The two case studies showed that personal values and beliefs of those in strategic positions determined these relationships which, in turn, influenced the implementation of both federal and local health policies. The engagement of citizen and CSOs in the implementation of these policies was also determined by their ideas and beliefs. However, no significant managerial practices were found within implementing agencies. Implementers’ ideas and beliefs seemed to be more relevant in contexts with weak managerial and accountability mechanisms.
机译:在过去的四十年中,政策失败一直是社会科学家所关注的问题,但是对于为什么某些政策没有按计划付诸实施尚无明确答案。卫生部门政策执行不力可能导致服务质量低下,从而影响人民的福祉。本文探讨了将政策转化为实践的成败,以及促成它的问题。在墨西哥,在2000年代的前十年实施了两项卫生领域的突破性改革:大众健康保险(PHI)计划和终止怀孕法或法治间法(ILE)。本文以这些政策为案例研究,以了解不同因素如何影响政策实施,特别是在墨西哥城。观察到四个因素:参与的参与者及其信念,服务提供安排,管理实践以及公民参与和问责制。这些文献中的大多数经常被引用为公共政策和服务提供中的关键因素。使用定性方法收集和分析数据。证据的主要来源是深度访谈,报纸文章,正式文件以及其他在线新闻服务和出版物。结果发现,参与者的思想,价值观和信念在整个实施过程中都具有重要意义,而不仅仅是议程制定和政策设计过程。分散的服务提供意味着联邦和地方卫生当局之间的关系。这两个案例研究表明,处于战略地位的人的个人价值观和信念决定了这些关系,进而影响了联邦和地方卫生政策的实施。公民和公民社会组织参与这些政策的执行也取决于他们的想法和信念。但是,在执行机构内部未发现重要的管理实践。在管理和问责机制薄弱的情况下,实施者的想法和信念似乎更为相关。

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    Blanco-Mancilla Georgina;

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  • 年度 2011
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  • 原文格式 PDF
  • 正文语种 English
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