Blanco-Mancilla, Georgina (2011) Implementation of health policies in Mexico City: what factors contribute to more effective service delivery? PhD thesis, London School of Economics and Political Science.
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Abstract
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.
| Item Type: | Thesis (PhD) |
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| Additional Information: | © 2011 Georgina Blanco-Mancilla |
| Library of Congress subject classification: | H Social Sciences > HC Economic History and Conditions H Social Sciences > HD Industries. Land use. Labor > HD28 Management. Industrial Management |
| Sets: | Departments > Social Policy |
| Supervisor: | Howell, Jude |
| URI: | http://etheses.lse.ac.uk/id/eprint/170 |
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