Governance reform, decentralization, and teamwork in public service delivery: Evidence from the Honduran health sector
| Published date | 01 December 2021 |
| Author | Tara Grillos,Alan Zarychta,Krister Andersson |
| Date | 01 December 2021 |
| DOI | http://doi.org/10.1111/padm.12722 |
ORIGINAL ARTICLE
Governance reform, decentralization,
and teamwork in public service delivery:
Evidence from the Honduran health sector
Tara Grillos
1
| Alan Zarychta
2
| Krister Andersson
3
1
Political Science, Purdue University, West
Lafayette, Indiana, USA
2
Crown Family School of Social Work, Policy,
and Practice, University of Chicago, Chicago,
Illinois, USA
3
Institute of Behavioral Science, University of
Colorado Boulder, Boulder, Colorado, USA
Correspondence
Tara Grillos, Political Science, Purdue
University, West Lafayette, IN.
Email: tgrillos@purdue.edu
Abstract
Public service delivery improves when civil servants work
together effectively as teams. While decentralization
reforms are common strategies for enhancing the deliveryof
health services in developing countries, moststudies empha-
size their effects through rational-choice mechanisms.Fewer
studies consider the behavioral implications of decentraliza-
tion and its potential to improve or hinder the day-to-day
work environment for health sector staff. We use an incen-
tivized behavioral game to assess the effectiveness of team-
work among civil servants in decentralized and comparable
centrally administered municipal health systems in Hondu-
ras. We find that teams from decentralized municipalitiesare
less effective at working together and that this is driven by
the adverse effects of the reform among existing staff: new
staff pairs are relatively effective, while existing staff do not
work as well with each other and in mixed teams. Our find-
ings suggest that policymakers should take measures to help
ensure that governance reforms do not underminethe effec-
tiveness of existing staff.
Governments often engage in institutional reforms with the goal of improving public sector performance. These
reforms commonly try to reshape governance, namely, the public decision-making processes through which socially
binding agreements are created and enforced (Andersson et al., 2009; Root et al., 2020). For example, decentraliza-
tion, which is one of the most widely implemented governance reforms of the last several decades, shifts power and
responsibilities, and sometimes resources as well, away from central organizations and toward more local organiza-
tions (Faguet, 2014; Rondinelli et al., 1989). This is often done in an effort to improve accountability and thereby
produce better public services for local communities (Blair, 2000; Ribot, 2002; Faguet, 2004, 2012; Diamond &
Received: 23 April 2020 Revised: 18 January 2021 Accepted: 18 January 2021
DOI: 10.1111/padm.12722
832 © 2021 John Wiley & Sons Ltd Public Admin. 2021;99:832–858.wileyonlinelibrary.com/journal/padm
Tsalik, 1999; Stepan, 2001). Incentive-based governance reforms, such as performance-based financing and results-
based aid, have also emerged as popular policies to encourage improved administrative capacity in the public sector
(Brinkerhoff & Brinkerhoff, 2015; El Bcheraoui et al., 2017; Hood, 1991; Loevinsohn & Harding, 2005; Manning,
2001). While accountability and incentive mechanisms are clearly important, a large body of social science research
demonstrates that programs intended to operate through these rational-choice mechanisms often have additional
social and psychological effects on target populations (Bowles, 2008; Deci et al., 1999; Frey, 1994; Gneezy &
Rustichini, 2000; Heyman & Ariely, 2004).
Ultimately, street-level bureaucrats are the targets of these governance reforms as they reside at the end of the
service delivery chain (May & Winter, 2009). Frontlineservice providers and local public officials play a crucial role in
the implementationof government policy and public servicesdelivery (Brodkin, 1990; Lipsky, 1980), andthey exercise
a great degree of influenceover how they carry out their daily activities (Brodkin,2008; Hupe & Hill, 2007; Le Grand,
2010; May & Winter,2009; Scholz et al., 1991). In the developingcountry context, where weak statecapacity and lim-
ited resources constrain the extent of directaccountability, bureaucrats can have evengreater discretion (Jiang, 2018)
and play a more importantrole in directly shaping local outcomes (Andersson, 2004; Ang, 2017; Geddes, 1994; Larbi,
2001; Tankha, 2009).
Governance reforms affect not only material incentives faced by public service providers but also the choice
architecture within which they make decisions (Brodkin, 2008; Brodkin, 2011; Moynihan, 2010; Moynihan & Soss,
2014). The growing literature on behavioral public administration emphasizes micro-level foundations of individual
behavior (Battaglio Jr et al., 2019; Grimmelikhuijsen et al., 2016; Moynihan, 2010). However, much of this work has
focused on small-scale 'nudges,' rather than the behavioral impact of broad-scale policy interventions. Recent
reviews of this literature urge us to move beyond nudges toward “behavioral science research that focuses on meso-
and macro-level understandings of policies and institutions”(Bhanot & Linos, 2020, p. 169) and to engage more with
outcomes of interest to public management (Hassan & Wright, 2019).
We examine the impact of meso-level governance reform on teamwork, namely, the ability of public service pro-
viders to coordinate their activities effectively during the implementation of public policies and delivery of social ser-
vices. We use an incentivized behavioral game to measure and compare successful teamwork in both decentralized
and centrally administered municipal health systems in Honduras. We find that decentralization reduces the effec-
tiveness of teamwork and attribute this negative net effect to the how existing staff members, hired before the
reform, have experienced and reacted to the reform.
1|THE IMPORTANCE OF TEAMWORK FOR HEALTH SERVICES
Social service delivery is enhanced when bureaucrats, civil servants, and frontline service providers are able to work
together effectively and coordinate their joint activities. For example, teamwork is critical to develop an annual oper-
ating plan, design and carry out targeted interventions, or come together as a team to solve a difficult problem faced
by a client. The study of teamwork is critically important for effective service delivery but has been underemphasized
in work on governance reform (Baker et al., 2006; Rigoli & Dussault, 2003). Although there is a large and diverse liter-
ature on collaboration (Ansell & Gash, 2018; Emerson et al., 2012), that scholarship focuses on interactions among
organizations, while teamwork, as defined below in the context of public administration, is about micro-level interac-
tions between individual public servants within and across levels of government, working to implement policy
directives.
Teamwork refers to “groups of two or more individuals working interdependently toward a shared goal”(Salas
et al., 1992; Weaver et al., 2012). Multidisciplinary teamwork is especially important in primary health care, which is
characterized by complex problems that require different types of expertise (Solheim et al., 2007). A “complex task”
is one in which there is no single path to the solution (Campbell, 1988), and so, coordinating strategies across
GRILLOS ET AL. 833
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