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Policy Transfer and Bureaucratic Politics: Insights from Hospital Autonomy Reforms in Malawi
Abstract
The paper argues that the implementation of health sector reforms modelled on private sector based modularity approaches is mediated by country specific contextual factors. One of such factors is bureaucratic politics. To this end, paper advances that bureaucratic politics have a role to play in the effective implementation of reforms advocated within the international transfer of private sector-based health sector management models. Although, politicians are ultimately the decision makers in terms of which reforms are politically viable, bureaucrats have an input in the process and their behaviours can affect reform implementation. This is true even in the context of coercive transfer to developing countries. Using the case of Malawi’s hospital autonomy reforms, the paper demonstrates that although the failure of hospital autonomy in Malawi has been attributed to political undesirability, bureaucratic politics has also played a pivotal role which cannot be ignored.
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