Brazil

This report on Brazil's health sector is the result of collaboration between the World Bank's Latin American and Caribbean PREM Public Sector Group and the LAC Huma... Show More + n Development Network. This report examines how particular managerial innovations have been applied in two sub-national jurisdictions in Brazil to deliver improved public services from available resources. The health sector in Brazil absorbs approximately four percent of GDP, and its spending level is likely to rise further given the country's demographic and epidemiological profiles. Thus, improving the efficiency of public health spending can have effects beyond the quality of health services, as uncontrolled spending growth could affect the overall health of the country's public finance and macroeconomic stability in the long run. The two cases of public management innovations examined in this report demonstrate two divergent approaches to performance improvement in Brazil's public sector. Sao Paulo has introduced organizational innovation through contracting out hospital management to qualified NGOs in the form of "Social Organizations." Curitiba, in contrast, managed to strengthen performance of its primary care system within the existing human resource regime. In both cases, a central challenge is to motivate staff and align their incentives with the government's broader policy objectives. The case studies explore two types of management tools: i) those that aim to align the expectations of principal and agent and reduce information asymmetry, and ii) those that provide direct incentives to tie an employee's or manager's behavior to performance outputs. The two types are not intrinsically incompatible, but knowing how to combine these instruments is more an art than a science. This study describes the instruments that have proved important to improve service delivery in Sao Paulo and Curitiba. It attempts to explain why these instruments are important, and how they work in combination with others. Show Less -