Crucial Needs, Weak Incentives studies the politics of efforts to reform education and health services in Latin America in the 1990s. Both sectors were common targets of reform—education because of its economic importance, health care because of needs to reduce great inequities of access and opportunities to increase domestic savings presented by reforms. Both sectors also have large numbers of unionized public employees, whose presence affects patronage as well as political power.

The book presents case studies that offer a wealth of new information not previously accessible to the English-speaking academic and policy community. For health care, these cover Mexico, Argentina, Colombia, Brazil, Costa Rica, and Peru; for education, Mexico, Argentina, Colombia, Brazil, Nicaragua, and Venezuela. Four chapters by the editors set out for each sector the goals, structure, and outcomes of reform efforts.

Contributors are Marta Arretche, Josefina Bruni Celli, Mary A. Clark, Javier Corrales, Sônia M. Draibe, Christina Ewig, Alec Ian Gershberg, Alejandra González Rossetti, Merilee S. Grindle, Peter Lloyd-Sherlock, Pamela S. Lowden, and Patricia Ramírez.

Robert R. Kaufman is a professor of political science at Rutgers University. Joan M. Nelson is a senior scholar at the Woodrow Wilson International Center for Scholars and a scholar in residence at the School of International Service at American University.


Tables and Figures
Abbreviations and Acronyms

1. Introduction
Robert R. Kaufman and Joan M. Nelson

Part One: The Politics of Health Sector Reforms
2. The Politics of Health Sector Reforms: Cross-National Comparisons
Joan M. Nelson
3. Change Teams and Vested Interests: Social Security Health Reform in Mexico
Alejandra González Rossetti
4. Ambitious Plans, Modest Outcomes: the Politics of Health Care Reform in Argentina
Peter Lloyd-Sherlock
5. A Sweeping Health Reform: the Quest for Unification, Coverage and Efficiency in Colombia
Patricia Ramírez
6. Toward a Unified and More Equitable System: Health Reform in Brazil
Marta Arretche
7. Reinforcing a Public System: Health Sector Reforms in Costa Rica
Mary A. Clark
8. Piecemeal but Innovative: Health Reforms in Peru
Christina Ewig

Part Two: The Politics of Education Sector Reforms
9. The Politics of Education Reform: Cross-National Comparisons
Robert R. Kaufman and Joan M. Nelson
10. Interests, Institutions, and Reformers: The Politics of Education Decentralization in Mexico
Merilee S. Grindle
11. Multiple Preferences, Variable Strengths: The Politics of Education Reforms in Argentina
Javier Corrales
12. Education Reform in Colombia: The Elusive Quest for Effectiveness
Pamela S. Lowden
13. Federal Leverage in a Decentralized System: Education Reforms in Brazil
Sônia M. Draibe
14. Empowering Parents While Making Them Pay: Autonomous Schools and Education Reform Processes in Nicaragua
Alec Ian Gershberg
15. Innovation and Frustration: Education Reform in Venezuela
Josefina Bruni Celli

Part Three: Conclusions
16. Conclusions: The Political Dynamics of Reform
Robert R. Kaufman and Joan M. Nelson



“This is an excellent book that provides a much-needed, thorough, and comprehensive analysis of decision making in two crucial areas of social policy in Latin America: education and health care. It will serve as a very important point of reference for the academic and policy community for years to come.”—Kurt Weyland, department of government, University of Texas at Austin

“A comprehensive and vital contribution to the study of social sector reform.”—Wendy Hunter, Latin Americanist

“Essential reading for all people interested in education and health policy in Latin America and beyond. Highly recommended.”—Choice

“Presents a wealth of information and advice for policymakers, reformers, consultants, and academics; a great source.”—Thomas J. Bossert, Latin American Politics and Society