Democratization , Health Care Reform , and Ngo - Government Collaboration : Catalyst or Constraint ?

The increasingly diminished role of the state in Latin America has been accompanied by decentralization of health care delivery and an enhanced role of the private sector in delivery of services. Simultaneously, in the process of regional democratization, the number of organized civil society groups, NGOs, has expanded, increasing the alliances formed between NGOs and governments in the process of state reform. This paper examines the experiences of 20 NGOgovernment collaborative health care reform projects undertaken in Guatemala, Chile, and Ecuador. Assessments are made as to how factors, such as civil society-state relations, democratization, state reform, and international pressure, have catalyzed or constrained policies promoting the collaborations. The projects’ implementation processes are analyzed with an emphasis on determining their sustainability, and various aspects of the collaborations — for example, funding, coordinated planning, and training — are evaluated. The paper concludes with a set of policy recommendations for future implementation of similar projects.