Policy Transfer in Global Perspective by Mark Evans

Author:Mark Evans
Language: eng
Format: epub
Publisher: Taylor & Francis (CAM)

In Conclusion: Policy Transfer as Political Strategy

Why was fundholding considered as a reform option for Kyrgyzstan? Quite possibly it was included in the reform plan more to suggest completeness rather than as a realistic option for implementation. The reform plan attempted to be all encompassing, covering issues such as the rationalization of the hospital sector, alternative sources of financing, and revised central-local relations. To omit discussion of the primary care sector would have been remiss. Fundholding was tagged onto the broader agenda simply because it was in vogue in the UK and USAID, in particular, was keen on the policy because of its emphasis on consumer choice. However, the extent to which policy-makers in Kyrgyzstan agreed with fundholding as an appropriate policy option can be questioned. In view of their difficult economic situation, the Kyrgyz were reliant on the support of external agencies and would have been under pressure to develop a reform plan that reflected donor perceptions of the situation and way forward. Lacking an established ‘epistemic community’, the Kyrgyz lacked a knowledge base from which to reject donor suggestions.

If the objectives of policy had been more sharply articulated, alternative instruments of reform may have been considered. The potential to reduce referrals was seen as the main problem to be addressed, but the population was probably more concerned about the access to basic medical treatment. Effort may have been better spent responding directly to the health care needs of the population, for example by financing courses of antibiotics to treat tuberculosis rather than by the current practice of hospitalizing patients for extended periods. In view of this, the government’s promise to provide ‘…sufficient funding for control and prevention of various diseases and for widespread vaccinations for children’ (www.imf.org/extemal/np/pfp/2000/kgz/01/index.htm, 2000) is welcome.

The policy agenda was also limited at an early stage by the composition of the policy transfer network. This was comprised of donor agencies, some of which were explicit about their ideological support for the introduction of market-based mechanisms to the health sector. Local representation was dominated by the medical profession, which would have welcomed private sector initiatives because of the employment and income generating opportunities these promised. If the policy network had been widened to include those already working in the primary care sector or the general public it is likely that a different set of problems and reform options would have been identified. In the future, the network may be widened. Broader representation may be secured following the creation of a Centre for Health Management, as a result of USAID’s assistance in helping to establish a nursing association, and through efforts, sponsored by USAID and UNDP, to encourage greater citizen participation in the democratic process.

What does the preceding discussion add to the policy transfer literature? Four main contributions can be identified. First, at first sight it seems that the reform programme as a whole was undertaken voluntarily by the Kyrgyz, albeit in collaboration with external donor agencies, in response to severe economic crisis. But, having invited external assistance, it is less clear whether specific policy proposals were entered into voluntarily.

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