Institutional arrangement and the state implementation capacity of the More Doctors Brazil Project (MDBP)

Abstract

The institutional arrangement for implementation of the More Doctors Project Brazil (MDBP) involves various governmental and non-governmental actors at different levels of the federation. It is a complex arrangement conducted in an intersectoral and collaborative manner, which requires mobilization of coordination and articulation capacities of those responsible for its conduct. As a result, we analyzed the implications of institutional arrangements and their interrelationships with state capacities, which may affect the performance and delivery of the intended objectives of the intervention. Materials and methods: To this end, 8 interviews were conducted with key actors, directly or indirectly linked to the implementation of the project at the federal level, from July 2018 to January 2019, as well as documentary analysis. Results: The results indicate that, initially, the arrangement facilitated the construction of technical-administrative and political-relational capacities that allowed to overcome the challenges in terms of coordination of the various actors and bureaucracies at the inter-federative level, in order to take doctors to unassisted or unsafe places, or with difficulties in fixing them. Among other issues, the social acceptance of the intervention, the generation of short-term results and the centrality of the policy on the government agenda contributed to this process. However, changes in the socio-political context, which culminated in government change and central actors responsible for the implementation arrangement, combined with the resistance of pressure groups, weakened the