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Crucial Needs, Weak Incentives: Social Sector Reform, Democratization, and Globalization in Latin America

reviewed by Carol Huang - 2005

coverTitle: Crucial Needs, Weak Incentives: Social Sector Reform, Democratization, and Globalization in Latin America
Author(s): Robert R. Kaufman and Joan M. Nelson (Editors)
Publisher: Johns Hopkins University Press, Baltimore
ISBN: 0801880491, Pages: 542, Year: 2004
Search for book at Amazon.com

Crucial Needs, Weak Incentives: Social Sector Reform, Democratization, and Globalization in Latin America, edited by Robert R. Kaufman and Joan M. Nelson, is a huge book with gigantic scope.  It analyzes two major social sector reforms: health care and educational reform in Latin America.  The social sector reforms were further examined with two major “macrotransformation” frameworks (p. 4): democratization and globalization from the 1980s through the 1990s. Contrary to the most of the research on this topic which is concerned with the design and impact of reform, the book focuses more on the political processes through which such reforms are brought about, diluted, or blocked (p. 3).It uses case studies of individual countries to explore who were “the principle actors in the reform stories and their preferences, power resources and the way their choices were shaped by domestic and international institutions”(p. 4) to tell a story of the dynamic character of social policymaking and implementation.

The book is divided into two major parts focusing on health care and educational reform. Each part has a well written cross-national analysis and comparison of the particular reform. At the end, a conclusion compares both reforms cross-nationally by examining their similarities and differences, and, of course, their effectiveness. Several countries are covered in both sectors, including Mexico, Argentina, Colombia, and Brazil. The reform story of Mexico is paired with another book, Opening Mexico: the Making of Democracy, (Preston and Dillon, 2004) to produce an interesting reading of the reform story. The reforms in Brazil that avoided major interventions from international organizations paint an alternative route to globalization and democratization.  Argentina’s cases give an example of nasty stakeholders’ competition under a collapsed economy. In the section on health sector reform, Costa Rica and Peru are included for their unique political infrastructures and socio-cultural dramas which expand and deepen the scope of the book.  In the education reform section, Nicaragua and Venezuela are included.  Nicaragua provides an interesting view into the anti-Sandinista government’s top-down decentralization reform with the backing of international finance institutions and donor communities to promote parental contribution but not control of schools.  Venezuela’s case includes the most recent development of educational reform under the Chavez administration.

The case studies applied a wide range of methods.  The common method shared across all cases is historical archival research on institutional dynamics of reforms using mostly governmental documents and reports, union papers, and newspapers, as well as some interviews of key administrators and stakeholders in the reform. Limited by the length of the book, some cases are a condensed version or summary of some authors’ long-standing works on Latin America, such as that of Merelle Grindle (2004) who already published a book on educational reform in Latin America and Sonia M. Draibe whose research on Brazil’s educational reform was well published. The second type of research includes interviews to gather primary source material such as Mary A. Clark’s work on health care in Costa Rica and Pamela S. Lowden’s work on education reform in Colombia. The third type is exemplified by the work of Josefina Bruni Celli, who relied heavily on governmental reports.  The authors’ research methods and expertise on the particular country impact their overall mastery in presenting their cases. For instance, Grindle and Draible were able to apply theoretical frameworks they generated to write clearer stories that are easier to read than others.  The most valuable part of the book is in the introductory chapters of each sector and the concluding chapter where a cross-national and cross sector analysis takes place.

The major finding of the book is clearly indicated in its title “crucial needs, weak incentives” – crucial needs in terms of the general social desire incubated under repressive regimes for social reform and changes in order to meet the perceived new needs pushed by the emerging global market economy to increase their stock of human capital and to improve the equity, quality and efficiency of their health care and educational systems; weak incentives in terms of reform agendas struggling in the existing power structure to get the resources and funding to create a more democratic and equitable society in a period of economic distress. The whole continent was facing the constraints of economic restructuring due to pressures from within, such as economic crises, and from without, such as pressure from international institutions like the World Bank and the World Trade Organization.  The book indicates that decentralization, efficiency, equity, and equality were some key trends of reform agendas in the 1990s. With the wide array of tactics and instruments available and the tremendous variety of contexts and circumstances in different cases, the book confesses: “it falls short of delineating ‘best practice’” (p. 510). This might be the best lesson learned.  Yet, through each chapter, the context of reform is mapped out, and the ways in which key actors played their roles are somewhat expected, but their effectiveness depends on too many variables. Thus it is difficult to generate universal guiding principles.

Across the board, the case studies in both the health care and educational sections reflect what Leo Tostoy writes in Anna Karenina: “All happy families resemble one another; every unhappy family is unhappy in its own way.” All successful reforms tell similar self motivated and self initiated stories of clear goals identified through democratic electoral and grass-roots processes to build consensus on a reform agenda, slow progression in implementation to allow structural adaptations and map out clear procedures of implementation including willingness to allocate funding from all levels of government. Each unsuccessful reform tells its unique variations to its downfall.  But at this post-modern age, reform stories reveal a trend of redefining success in a heuristic progression. They conclude: “There is no evidence of a systematic race to the bottom” (p. 487). (On the case of Argentina, Paul Blustein (2005), a staff writer at the Washington Post offers a rather different view.) Even though “Market ideology has not captured public policy in health care and education, but it has injected some new thinking.” As for the impact of international financial institutions on social sector reforms, the editors draw a conclusion that counters a widely shared assumption about the role of these institutions. On the contrary, they state “international agencies attempts to directly influence reform often were ineffective.” They give evidence through examining “several of the more successful reforms—Colombia’s sweeping restructuring of its health sector; unification of Brazil’s health system and financial incentives for state and local reform in both sectors and Costa Rica’s expanded primary health care teams; and Peru’s restructured clinic systems—were almost entirely internal initiatives” (p. 488).

With some cross-continental and cross-era comparison of Latin America’s social sector reform with post-World-War-II Europe using research done by Wallerstein and Lehmbruch, the editors observe that “the types of strong, centralized labor and business association that negotiated new social contracts in much of Western Europe” did not appear in Latin American. Instead, “labor associations have generally eroded in the face of economic crisis and market-oriented reforms.” The editors conclude: “international economic integration and the wave of market ideology that swept the region in the 1990s changed the broad context for and ideas regarding health and education reforms, but in ways more complex than the fairly simple conventional theories suggest.”  They note that “new social contracts to replace older understandings have yet to emerge” (p. 486).

One cautionary note to readers is that the particular editorial structure that uses a cross-national comparison as introduction to each reform leads to an antithesis type of reading because the results and analysis of each reform are laid out before the readers go into the case studies of each individual country. Schematically, it might be easier for readers if the cross-national comparisons were put at the end of each part and not the beginning so the readers go through an individual country orientation and examination before they come to read the comparison. In this way, the readers might appreciate the insights of the editors’ comparison more. Also the countries that were included in the health care reforms do not necessary coincide with the countries studied for educational reform.  For instance, in countries like Mexico, Brazil, Argentina, and Colombia, both the health care and educational reforms were included in the book.  But for Costa Rica and Peru the health care reforms were included, but their educational reforms were not covered, so that readers were left to wonder whether there was no educational reform in these two countries or whether the reforms that were underway were not significant enough for analysis. The same situation occurs when Nicaragua and Venezuela are included in the educational reform section but not in the health care reform section. Chile, where a voucher movement has attracted much educational research, was not included in either sector. An editorial explanation and justification of selection criteria might shed some light on this unusual arrangement. The book provides a rare opportunity to look into cross-sector research and synthesis that is very valuable in examining the social sector reforms in Latin America in the 1980s and 1990s.


Blustein, P.  (2005). And the money kept rolling in (and out):  Wall Street, the IMF, and the bankrupting of Argentina.  New York:  Public Affairs Books.  

Grindle, M.S.  (2004). Despite the odds:  Education reform in Latin America.  Princeton:  Princeton University Press.

Preston, J. and Dillon, S.  (2004). Opening Mexico:  The making of a democracy.  New York:  Farrar, Straus and Giroux.

Cite This Article as: Teachers College Record Volume 107 Number 11, 2005, p. 2476-2479
https://www.tcrecord.org ID Number: 11857, Date Accessed: 12/6/2021 3:21:32 PM

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About the Author
  • Carol Huang
    City College of New York
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    Carol Huang is an assistant professor at City College of New York's School of Education.
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