Policies for restructuring national health systems in low and middle income countries tend to follow similar packages of prescriptions following the World Development Report of 1993. Research on decentralised health care in Northeast Brazil demonstrates the critical role played by informal aspects of health system management and the political cultures of the wider context on the implementation of policy and the performance of local health systems. Discussion of incorporating these results into policy-making highlights a number of points. Health systems research has failed to take seriously the role of the cultural for various reasons, particularly because of the challenge it makes to our own fundamental values and because of the difficulties in including it into approaches based on rational systems models. More complex and sophisticated explorations of the nature of the cultural domain are not easily drawn upon by applied health system researchers.
Atkinson, S. Political cultures, health systems and health policy. Social Science and Medicine (2002) 55 (1) 113-124. [DOI: 10.1016/S0277-9536(01)00213-1]