Centralizing Decentralized Governance in Brazil

Contrary to the once-popular notion of the central bureaucracy withering away as an outcome of decentralization, scholars have shown that in cases of local policy success, national bureaucrats have instead redefined their roles, strengthening their focus on monitoring and accountability.Yet building national capacity for effective oversight presents a challenge within a context of strong subnational autonomy such as Brazil. Comparing the dynamics of decentralization across two areas of health policy, AIDS and tuberculosis, this article presents one strategy utilized by federal bureaucrats to increase their regulatory capacity: seeking resources located outside the formal political arena. Specifically, national bureaucrats utilize international resources to mobilize local civic groups as policy watchdogs, thus increasing the accountability of subnational politicians both to the center and to the public. Fiscal and administrative decentralization, while initially promoted as advancing democracy and social welfare, has more recently become associated with new governance challenges. This is especially the case in the public health sector, where governments in Western Europe have recentralized key aspects of healthcare financing and management in response to local governance challenges. In Lati