Governance of Public Health
Research Project: Governance of Public Health in Mexico
This project seeks to understand the governance of public health in Mexico as it relates to the dual challenges of: 1) increasing democratic accountability; and 2) improving the provision of public goods and services at the local level. In particular, the research seeks to shed light on whether the devolution of health finance and clinics to state governments in 1995 and the shift in governance after the transition to democracy in 2000 have improved accountability in the provision of basic public health. Particular attention is paid to municipal practices in the delivery of sanitation and to state government finances determining the coverage and quality of health care.
The governance of public health in Mexico has been a “black box” intermediating between seemingly well-designed federal and state health programs that seek to improve the quality and coverage of health provision and services, and public health outcomes. Citizens care enormously about the provision of clinics, vaccines, drinking water and sewerage systems, to name just a few of the health related public goods and services provided in Mexico by various levels of government. But how these services come to be produced is often obscured by insufficient transparency and information flows, a complex web of intergovernmental finances involving federal, state and municipal governments, lack of coordination between several public health systems, weak electoral incentives, and decision-making and oversight processes that are opaque at best.
This project will provide a diagnosis of some of the most serious failures in public health governance in Mexico, in order to offer much needed feedback to decision makers, health advocates, and civil society organization about the way in which health policies are working in practice. The frontline of government interventions that impact public health is often assumed to be primarily about the health professionals (doctors and nurses) and the physical facilities they count on to operate effectively (beds and offices). However, public health impacts depend crucially on sanitation and health conditions in dwellings. The ultimate goal of the project is to empower citizens to demand greater quality in the health related public goods they receive, forcing politicians and health authorities at all levels of government to be more accountable. In the short run, the results from this academic study will provide public information regarding the differential performance of health services across the country, and a diagnosis of the reasons behind such variance in performance.
To download the full propsal for this project, click here.