Comparative Federal Health Care Policy: Evidence of Collaborative Federalism in Pakistan and Venezuela

Article excerpt


Federalist theory has provided an effective conceptual framework for researching public policy making and implementation in political systems where power is separated among levels of government. Federal systems of government encourage diversity and policy experimentation, but also tend to be fragmented and fairly complex with overlapping jurisdictions (Kincaid, 2002). Although there are numerous strains of federalist theory, one developing approach is collaborative federalism, which examines the practice of building cooperative relationships and partnerships across levels of government and sectors of society in order to implement complex policy areas (Cameron and Simeon, 2002). Applying the collaborative federalism approach provides an effective means for understanding intergovernmental and intersectoral linkages in the policy cycle, without supplanting other segments of federalist theory.

Collaborative federalism is a particularly useful analytical approach for examining health care policy and governmental responses to crisis situations, as exhibited by several recent studies where it has been applied to specific federal systems (Cameron and Simeon, 2002; Brock, 2008; Graefe and Bourns, 2009; Baracskay, 2012). As a theoretical strain of federalist theory, the literature on collaborative federalism is continuing to evolve with studies that apply it to specific federal systems marked by intergovernmental and intersectoral cooperation. The existence of collaborative practices in authoritarian federal systems has largely been ignored in the literature. As Adeney asserts, "a chequered democratic history" does not preclude the potential to analyze the ways that a nation's federal form has influenced its identity formation and articulation (Adeney, 2009). Accordingly, the collaborative federalism approach is used in this article to examine the public health policies and epidemiological surveillance and intervention functions of two nations: the Islamic Republic of Pakistan, and the Bolivarian Republic of Venezuela. This study is unique to the literature on federalism and public health policy, in that it utilizes a comparative perspective of two federal systems that have largely exhibited authoritarian forms of government. Given that Pakistan and Venezuela are both considered to be "high risk" nations for the spread of diseases (WHO, 2012a; WHO, 2012g), this article will also consider the prospects for further integrating collaborative approaches to federalism into the governance process.


The scholarship on collaborative federalism provides an effective framework for understanding the intricacies of shared roles and responsibilities in policy formation and implementation. Specifically, collaborative federalism (1) is defined by the core interrelated dimensions of intergovernmental relations and intergovernmental management, with the focus of the former being primarily on politics and macro-level policy considerations, and the latter on agencies, functions, and micro-level policy implementation (Wright, 1990).

The collaborative approach augments traditional federalist thought with considerable reflection on the partnerships and networks which arise due to the complexities of modern policy environments. These complexities necessitate the creation of intergovernmental and intersectoral arrangements to foster an atmosphere of shared decision-making and implementation rather than those that are unilateral and autonomous (Painter, 1998; Agranoff, 2001; Agranoff, 2005; McGuire, 2006). When practiced on a regular basis over time, collaborative federalism becomes an innate facet of the nation's federal structure. These systems tend to embrace democratic principles, rather than being authoritarian (Elazar, 1964; Lijphart, 1977; Lijphart, 1979; Elazar, 1987; Adeney, 2009).


With only a handful of states having federalized structures across the globe, much of the development of federalist theory has focused upon the American political system, using it as a point of reference for understanding the history, structure, and evolution of federalism (Hueglen, 2003). …