AEGIS ECAS 2007 - View abstract

Panel	10. Theorizing African State Trajectories
Paper ID	373
Author(s)	Leenstra, Melle
Paper	No paper submitted
Abstract	This paper is a reaction to a stream of intellectual debate problematising the African state. The paradigm of neo-patrimonialism has influenced a view of contemporary African states as pathological deviations from the Weberian ideal of a rational-legal bureaucracy. This view has corresponded well with donor practice throughout the nineteen-nineties of prescribing institutional reforms to deal with the ailments of African bureaucracies. These prescriptions however resulted in what van de Walle phrased the syndrome of partial reform. Explanations for this were sought within the neo-patrimonial character of the African state. This paper will analyse a empirical case of reform, namely the Zambian health reforms, following the neo-patrimonial paradigm as a frame of reference. This will provide the basis for further research into the workings of the Zambian health bureaucracy within its political context characterised by donors-government interaction. Health reforms in Zambia were initiated after the advent of the MMD government, following the restoration of the multiparty system in 1991. The health paragraph in the MMD manifesto launched a vision for the health sector that was to guide reforms in subsequent years. This vision was inspired by current thinking in international health policy and academic circles on health systems at that time. As such it reflected a rational-legal ideal with liberalist and welfare-statist influences. The reform package consisted of i.a. a focus on a basic health package, decentralisation of certain responsibilities to a district health system, direct funding of district health systems, cost-recovery by means of user fees and delinkage of health providers from the civil service. The implementation of this package progressed well up to the mid-nineties. Political leadership within the ministry of Health, good donor-government relations and ample financial support contributed to early achievements. Later, however under different leadership relations with donors soured over suspicions of graft. Also political opposition was mobilised against elements of the reform package, notably those affecting employment issues. This led to a freeze and eventually the overturn of certain reform efforts. From a neo-patrimonial perspective, one could argue that patrimonial interests have manipulated the reform process leading to partial reform. On the other hand certain reform measures have proved more durable, such as the delegation of responsibilities, direct transfers of resources to districts and financial and information systems. This has arguably strengthened rational-legal systems, positively impacting on the functioning of the sector. At first glance the concept of neo-patrimonialism seems relevant when applied to the case of Zambian health reforms. The case shows that policy implementation can be seen to follow the interrelated patrimonialist and rational-legal logics. Both seem to play a real role in determinating the outcome of a political-bureaucratic process. More importantly, policy interventions aimed at strengthening rational-legal functioning seem, at times to be successful, partially at least. On the other hand, this initial analysis does beg for a closer look at the key actors in this process, their incentives and relations, would this also reflect neo-patrimonialism?

Beyond the FaCade Neo-patrimonialism and the Zambian health reforms