relation to healthcare in Delhi – there is little impetus for reform and delivery remains poor.
Where
collective actors
are less
engaged in
social
accountability
there is little
impetus for
reform and
delivery remains
poor.
Networks linking public and private actors are critical to shaping public policy, and network structures influence the way they interact with the state
Much of the debate about how to strengthen the capacity of poor and marginalised people to shape public policy has focused on formal institutions for citizen participation, either individually or collectively. These participatory institutions are often seen as key to providing a way of connecting under-represented groups in society with policymakers, and giving them a ‘voice’. Donor programmes tend to prioritise financial and management support for particular organisations. State and societal actors (including social movements and advocacy NGOs) are often portrayed as distinct, relatively autonomous entities (Houtzager and Castello 2009). The CFS research calls into question important aspects of this narrative. Rather than focusing directly on participatory mechanisms and particular civil society organisations, the research starts with a detailed analysis of the networks of relationships within which public policymakers and civil society leaders operate. It finds that how state-society interaction plays out depends not just on the nature of public sector reform or on opportunities to participate through formal mechanisms, but on complex networks linking public and private actors. Moreover, the nature of civil society networks shapes the way they interact with the state.
Civil society networks and public-private relationships and alliances are very diverse, and rooted in both context and history. For example, the health movement in São Paulo goes back to the early 1980s, well before the ending of military rule: this helps to explain both its success in permeating state institutions (Houtzager and Dowbor 2010), and its strongly rights-based commitment to social and political reform (Dowbor 2008). The health network in India appears to have two distinct strands, with origins respectively in narrowly defined population programmes, and movements to promote general health and reproductive rights
(Narayanan, forthcoming). The nature of networks is also influenced by broader political, social and cultural environments: Phase 1 of the CFS research, for instance, highlighted the different orientations of civil society organisations in São Paulo and Mexico City, linked to different
configurations of state, church and political parties (IDS 2005: 24). In India, networks tend to be elite-led rather than organisation-led (Pande, forthcoming).
Researchers in São Paulo interviewed key individuals involved in debates on health and social assistance policy, and constructed the ‘issue networks’ of which they were the most important part. These networks were
composed of people claiming to represent low-income service users, professionals and experts, trade union leaders, service providers and public officials.
C H A p T E R 4 m o b I l I s I n g f o r b e t t e r P U b l I c s e r v I c e s
The research found that:
i) People who occupied seats on the formal participatory councils covering health and social assistance were relatively marginal players in their respective issues networks. Although the councils have legally mandated budgetary oversight and decision-making powers, they were not found to be a critical channel for policymaking, or a space within which key players in health and social assistance networks operated. ii) This did not result in a lack of connection between the state and actors
representing poor and marginalised groups. Instead, the two issues networks permeated the state: members of the networks held key positions within the state – in municipal secretariats, the city assembly, and in state and federal government. This provided them with multiple formal and informal channels through which to influence policy. However, while the networks gave people access and influence, they did not capture decision-making processes; nor did they become clientelistic. iii) Who is able to influence policy, and the strategies they adopt, depend
on the internal structure of the networks. The health network in São Paulo is relatively horizontal and inclusive, providing multiple links between societal actors and policymakers. By contrast, the social assistance network is hierarchical, and bifurcated: a small number of well-positioned service providers control access to some parts of the state, while a distinct group of social assistance experts enjoys a high level of access to another part. User groups barely feature in this latter network at all.
iv) Professional groups – public health professionals in the case of health, and economists in the case of social assistance programmes – played a strong role in influencing reform. This is unexpected as such groups are often portrayed as having vested interests in opposing public sector reform.
CFS research in Delhi also emphasises the importance of networks linking public and private actors, not just formal participatory mechanisms, in shaping reforms. In Delhi, research found that local actors who are linked into broader city-wide or national policy networks are more likely to engage in collective action, because they are better informed about policies and programmes, and better able to use networks to support their mobilisation and monitoring activities. As noted above, for
example, in the PDS sector local organisations were able to use Right to Information legislation effectively because they were well connected to the RTI movement.
Moreover, just as different structures of health and social assistance networks in São Paulo affect their impact and strategies, so in India the