Implementation of public health policy and its challenges in the digital age

Abstract This article analyzes the implementation of public policy on regulation of beds in intensive care units, considering the formulated policy, the institutional conditions and the strategies used by the state and municipalities of Bahia, Brazil. A literature review is carried out, based on the rational choice institutionalism, as well as a qualitative study with three groups of street-level bureaucrats. Results show a gap between the policies formulated and implemented and the influence of bureaucrats in the implementation of public policies in health. In addition, the research observed the use of information and communication technology such as social media (WhatsApp) as regulation strategies. The informal control and assignment of beds using WhatsApp is a clientelistic strategy, indicating that, even under the aegis of the managerial state, clientelistic and patrimonial practices persist.

摘要 本文围绕巴西巴伊亚州（Bahia）及下属市政当局的重症监护病房床位监管公共政策实施情况展开分析，综合考量政策文本制定、制度环境以及当地州、市政府所采用的实施策略。本研究基于理性选择制度主义（rational choice institutionalism）开展文献综述，并针对三类一线街头官僚（street-level bureaucrats）开展质性研究。研究结果表明，政策制定与实际执行之间存在显著落差，同时官僚群体对卫生领域公共政策的实施具有重要影响。此外，本研究观察到研究团队将社交媒体WhatsApp等信息通信技术作为监管策略的实践。借助WhatsApp开展的非正式床位管控与分配属于庇护主义策略，这显示即便处于管理型国家（managerial state）的治理框架下，庇护主义与家产制实践依然存续。