トップページ - 横浜国立大学学術情報リポジトリ

全文

(1)Culturaland lnterorganizational Relationshipsin Development Policy: Case. Studies. of Health. Care Programs. in Cear丘State. Kazumi. 1. Many. literature. Major and. scholars has. social. examined. organizations. giving foreign. several. along也e. method. the. argued. in this paper.. and. developed. by. because. social policy. has. been. Bossert. it is a top down. management. The policy. various. main. innovative. combined and. and. wi也a. care. effective keen. extent,. to. countries local agents. awareness. be need. care. of血e. to. take也e. this paper. policy. model. important. government,. policy. lead. and. any. analyzes. for. condition. Chile. and. has experienced. and. to. the. by Thomas. implementation. region. synergistic relationship. or. and. policies. entities. for defend. the. public. and. make. healthcare. service. delivery. out. its citizens.. Decision-making and. Central. should. be. policy. the three. more. making in. governments. assigned,. local govemment. of all policy. the. of. that decentralization,. of the locality, bo也in. central. that. model care. district will affect t shaping. also points. between. between. space. the authorityto. autonomy. affect the outcome. economic. the local officials have,. ¶1is paper. be. theory.. role in both. A decentralized. an. It also analyzes. policies.. government. the. as. bealtb. Bossert. of such. point whichwill. govemmental. has. disparities. a. this. regard. effect. fore. decision. The. between. cultural. of either. The. citizens.. came. of public. making･. regional and local decisions. concerned. of countries. of decentralized. social characteristics. in policy. govemment･. the. and. developed. the wider. for its citizens･. cultural. main. in particular. approach,. Bossert･. the performance. the political culture. effective in alleviating. of the national. regional inequalitybecause Furthermore,. health. emerged by Thomas. interorganizational. is, while. for their. access. into the vertical relationship. an. and. a. Brazil, Columbia,. number. by the principal-agent. theory. space. play. a. since. affect the implementation. of the central. system. care. is that the central. of this research. implementation,will. developing. that. perspectives:from. the control. effective the health an. the decision. that local governments. Under. care.. only. Brazil. decentralized. of adop血g. continued. Bolivia. policies･. examined. analyzed. of analyzing. looks. made. flSCal. administration,. decentralization. Argentina,. care. be. to. care. trend. social polices.. social policy.. health. agent. health. method. approaches. hypothesis. decisionsand. health. against. issue. principal. approacb也at. other. from. decentralized key. proper. to the. limited. a. ¶1is study also argues. validityof several. The. applied. is. of their health. has been. making. including. countries,. is the. have. public. has. countries,. the IMF. and. of various. including. ¶1e Current. in developed. Bank. some. the decentralization. managementl)･. even. and. the World. as. for providing. on. against. discussed. variousviewpoints,. public. to its present. path. decentralization. framework. new. decentralization. to. last resort. IntrodllCtion. previously. countries,. of decentralization. effect as. as. In I･atinAmerica,. aid･. phases. The. well. such. the transition. making. as. City, Brazil. Nogucbi. decentralizationfrom. in developing. policies. have. the world. over. social capital approaches,. international. are. all. and Maranguape. may. to. some. expand. implementation. levels. of government. and.

(2) (692). 76. social. 横浜国際社会科学研究. between. vertical relationship in delivering. and. domestic. including. organizations,. governance2'in. care. services. international. which. governments. is indispensable. necessary.. In this framework,. foreign. and. Political. it is important. the health. to. local. with. local governments3). to. the health. shape. policy. countries,global. relationships. collaborative. aid organizations. for local governments. care. the. is. be. thatwill. policies. that. socio-economic. that. the. management;. she. management.. has. further. by dividing. the political culture fomal. that. pivotal in且uence. factors. system's. care. increases血e. between. inequality. history,. economics ¶1e. of the health. Sample. care. system. of the. that she. research. out a. exhibit. care. districts･ care. management. care. Atkinson. locality will have. political culture. Brazil. health. in Cear丘, Brazil･. has. in Ceara,. believes. among血e. and也e. carried. argues. Atkinson. of health. areas. metropolitan. does. crucial role in health. a. play. he. Bossert. Sarah. the performance. and. the have-nots･. and. in decentralized. into consideration. management. local ofrlCials. when. performance.. factors in addition to political culture. management･. in performance. that variations. taken. districts into rural, urban. including. heal也care. on. be. the relationship. analyzed. the have. between. health. lower. abilityof local officials. However,. heal也care. informal. that various. states. decentralized. a. should. the decentralized. o也eⅣise she. district. of the. culture. on. aspects. will be. services. care. result in disparities. can. do affect the innovative. factors. political. concludes. Framework. of health. performance. abilities, and. the effect of cultural. not mention. Moreover,. the. that. notes. lack of professional. a. Cultural. Culture. AlthoughBossert. and. international. guidance血･om. in shaping. of the citizens. In developing have. than. synergistic,rather. and. indispensable. NGOs. and. aid organizations. because. are. the needs. meet. which. 2.. process. It is the horizontal. to all citizens'needs.. responsive. 2.1.. NGOs.. levels of governmentthat. upper. the health. 第10巻第6号(2006年2月). demonstrates. on. positive. a. relationship. with. decentralization (Atkinson, 2002). Moreover,. Atkinson. implementation autonomy. of health local. and. government,. of either the. found. out. potential. success. therural. areas.. their. resolve. compared heal也care. with. Atkinson. mral. indigenous. care. the. there. them. stems. two. are. reform. from. the. local factors.. with. the. and. political culture. contract. policy, especially. care. that at least three. strategies,. services･. care. important. the most. of Brazil･. Based. Furthermore,. areas. dimensions. of local politicalculture. relationship. she. affect the. the local government. with. can. determinants. in therural. of income,也e. sources. become. political culture. federal. the. with. local. localities. Throughthese. accountability, and the quality of their health and. that increase. strategies. formal. affect the. and. (Atkinson,2000). (2000). says. where. that her In her. problems.. areas. in Brazil, the patron. political culture. people. research. study,. depend. shows. districts. urban. greatly. that. on. the. and some. people. barely. patrons. client networks4). to. use. this kind. use. the. are. patron-client. solve their everyday. very. strong. of network. in to. relationship business. and. problems.. Indigenous while. contract. health. for autonomy:. of the traditional. health. of the. Brazil, it is evident. to local data. aspect. a. failure of any. or. and real space. Asone. One. involves. that. argues. social organizations. that in Northeast. attentiongiven. She. policy･. responsiveness,. of Atkinson,. the research. 2.2.. other. local social organizations. that both. argues. responsiveness･. the. while. care. their empowerment,. enhance on. (2000). Culture. Atkinson cultures. focuses. on. the. in the performance. political culture, of public. Nations. management･. and. Nuto. pay. attention. to. the. importance. of.

(3) Cultural and Interorganizational Relationships in Development. Table. l. Gri d. Four. Styles. of Public. Management. Organization:. High. Fatalist Way. ne. Example:. Atomized. ne. Individualist. Atomized. Source:. C. Hood,. UniversityPress,. In fact, it is not conducted. toothaches. popular. as. culture. cultural. from. practice. Researchers patterns. focus. of social. be. should. any. the local. 2.3.. Public. and. Management.. Nuto. cityof. This. (Nations. communities people. that. shows. and. the. help. the. 2002).. Nuto. and. discovered. that. treatment. of. of Catholicfo1klore. in Berberibe. people. Nuto,. They. of dental. understanding. flrStly seek. patients. Nations. services.. of Cear丘.. region. the. regarding. Beberibe,. care. believe. It is well illustrated. in both that this. in this district of Berberie. healers. is at the. core. of也e. problem. dental. regarding. (2002) mention:. and. vision. by. of the. historical/political/economic. a. adopting. panoramatic. involved. of all actors. view. context. in which. various. other. of their. the clinical. example. not. only. the local popular. on. that any. shows. ¶1is includes. health. care. the cultural,. but also. culture, program. tIY tO consider. must. economical,. on. historical. and. social aspects. all possible. societal. of也e before. options. practices. obseⅣed. in. area.. the. the. cultural. approach,. area. individual. Public. represents. and. Nuto. in localities do. that cultural aspects. policies.. Management Christopher "the. of life that is open choice. similar to Nations. argument. of decentralized. and. grid. an. present. Theory. that the. reducing. of. bureaucracy. (p.242).. placed. conclusions.. Cultural. explains. Rhetoric,. in the Beberie. care. belief in popular. patient's. impaired. affect the implementation. Using. which. a. greeⅢ'doctrines. to conventillal. alternatives. Culture,. patients. dentists.. for也e. interaction. Rondine11i and Cbeema indeed. and. In the. in也eir. and. is embedded. local district. This reaching. Nations. in which. up for grabs'.. of the localityaffects the health dental. on. dentists. one. correct也eir. encounter. The. healers. that. show. However,. treatment.. ■. is. `Dark. Example:. of. StateI. of the. consulting. important. an. Heal也s山dies. decision. (Goodin 1992). Art. cavities.5). as. Way. p.9.. the. before. well. is. every. market'(Self 1993). research. between. rezadeiras. or. The. ethnographical. conflict. doctrines. that the culture. overstated. resulting. healers6). 1998,. structure. military. High-participationstructures. to organization and bargaining.. by the. Oxford. Stereotype. 刀le Egalitarian. Chicago-school. approaches. (Dixon 1976). their antecedents. and. Way. cohesive,rule-bound. Example:. ill. sunk. Way. approaches. `government. a. Applied. to organization.. societies. stressiIlg negotiation Example:. Hierarchist. Socially. (Ban五eld1958). rigid routines IJOW. bound. to organization.. approaches. was. Theory. High. The. I,ow-co-operation,rule. (2002). Cultural. 77. Gro up Low. there. (693). (Kazumi Noguchi). Policy. is constrained. degree to. Hood to which. individual. by group. has. applied our. lives. negotiation.". choice,. by binding. cultural are. theory7). to. circumscribed. Fulthermore, the individual. public by. the group into. one. He. management.. coⅢventions shows. and. rules,. the "degree. collective. body.. ". to.

(4) In. it is very. sense,. some. four. established. organizational. faithinherent. has. management. fabianism. among. these. are. of public. hierarchical. numerous. tO. theoIY. cultural. classification. Public management. of and. (1998). Furthermore,. egalitarian. management. Imperial. Government,. is the competition. Cameralism. and. common. expertise. Recently,. management.. of pubic. in Europe. (Hood, 1998).Tile. management. public. styles is professional. management. of individualism. the above. under. individualist and. the hierarchical. as. management. group. and. the Chinese. as. such. classi丘ed. three. of the characteristics via. applies. affect the results. may. public. the grid. fatalist, bierarchist,. categories;. and. been provided. public service. channels.. (1998) states:. Ⅲood And. much. into. separate. of today's. in the public. in. like health. seⅣices. Bentham. to have. seems. had. that the cultural. out. points. management. for disaggregation. management. market'for. what. in public management. theory. consideration. `internal. units,. to go well beyond. seems. cultural. in public. enthusiasm. corporate. government. This. Hood. of public. progressivism. One. classifythe Brazilian. by Hood.. broad. culture. Threetypes. 第10巻第6号(2006年2月). difficult to. developed. theory. cultural has. 横浜国際社会科学研究. (694). 78. care. public policies, especially in health. fragmentation. and. in mind. values. institutions. of monolithic. of. (p.111). be. should. into the. taken. greatly. is applicable. policy, which. for any. countries.. Inter-organizational. 2.4. A. care. developed. well. Both. policies.. As. In public horizontal. NGOs. noted. in the. previous. network. policy. in both. governments. (Brinkerhoff. and. most. Rondinelli. section,. has. paradigm. will have. organizations. relationshipsfor. and. private. Brinkerhoff,. important. between. Government. and. for the successful a. implementation. tremendous have. Cbeema(1983). and. of all social. impact also. on. health. any. policy implementation.. successful. shifted from. factor. organizations, Under. 2002).. hierarchical. a. bureaucratic. community. private丘rms, the. L. form. new. the. out. pointed. to. management. are becoming style. In fact, the collaborative and cross-sectional networks Networks developed and developing countries. role play an important. management. between. the. the. of NGOs is crucial. relationship. collaboration. administration,. in public. becomes. and. of the inter-organizational. importance. bridge. Theory-Collaboration. inter-organizational. cooperation. system.. focused. Relations. of governance,. in the field of public administration,. more. the. as. NPOs. organizations,. a. and. interdependence. mutual. the top-downmanagement. ratherthan. style. In. developing. the. of individual. interdependency organizations countries,. In order identical. governments,. policies to have. program. state-civil. a. strong. between. create. networks. prerequisite. for building. synergetic. and. have. Among也e. occu汀ed. Even. relations.. inthe. to reach. civil organizations. in which. effects. synergistic. roles of civil organizations. the sub-national government. the civil. developed. shared. goals. in. is necessaⅣ. it is important. effective synergetic relations･. objectives.. One. organizations. to. needs. accept. international. sub-national governments,. local non-govemmental. society. and也e. responsibilities. states, trust is. interdependency. social wel血･e. and. and. the. world,. as. well. as. o也er. the. donors,. to have. for the stakeholders fact. that. various. international. civil organizations. both. including. parties. non-governmental. in the international. shared. policy. national. organizations,. development,. world. all have different obJ'ectives respectively. Managing. is necessary. interdependencies. collaboration. Three. objectives of the. inter-related. participation. are. factors. are. to promote. not. only. for policy management. of significance:. participation,. the responsiveness. but. also. decentralization,. of policy. implementers. for state-civil society. and incentives. to. the needs. The of its.

(5) Cultural and Interorganizational Relationships in Development. citizens. build. to. and. policy. is significant. participation. and. empowement. of the civil organization. empowerment. of the civil societycontributes. and. as. civil society, and. problem. There. are. emergence. isthe. (Brinkerhoffand. solving. forms. various. of networks. prerequisite To. the. extent. autonomy. and. crossISeCtional. situations, where. particular. forms. conditions, or. nonexistent. should. key. a. play. implementation. interrelated. the. partners. administrative. administrative. HⅣ/AIDS Health. preventive. Secretary. In the. as. shown. as. case. a. 2002, p.. and. 171). Decentralization the. a. best. work. in. local. are. networks. forms. local level. the. state:. effectively. In. and operate. which. for the. condition. promote. cases. way. under it is. where. depending. synergistic network. incentives.. network. of network. the local. on. partners. that. and enhances. provide. transforms. of the local network. and. of Cear孟,. a. two. These. United. have. may. States. cases. reveal. a. incentives to. top-down. a. incentives. policy. country. these. various. Moreover,. in也e. state. all. to enter. bottom-up. outcomes. government. has. and and. different. private. political,. supports. of Maranguape,也e. is necessary. civil. informlngany. aspects. healers'programimplemented governance. are. arefeasible. non-governmentalorganization丘nancially. that global. of the. and. positive. in bo也血e. Each. to consider. traditional. supportsthe. property. each level of government. countries.. by the local NGOs.. planned. (WHO)financially. one. systems. goals. incentive. to policy. necessary. differs among. in developing. shared. and. ¶1erefore,. the level of capacities. roles and. settings; therefore,. from. government. are. band,. other. trust.. civil societywiththe. the. the emergence. questionable. intellectual. the. that incentive. the. decentralization. participation,. empowerment. and. to note. accomplishing. including. argue. On. partnerships.. It is important. relationshipsfor. of the health are. important. care. system. in Brazil, these. for establishing the network. other private entities both in policyformulation. that. entities. capacity for social. the World. by the Municipal for. health. policy. n.. incentives well. program. of Health.. implementatio. and. In the state. Organization. This. government. enabling. centralized,. for stimulating. tools. In fact, the level of capacities. becomes. economic,. network.. at. objectives legitimacy, creditability, and public. netⅥ℃rk, the. issues.. which. specific. an. support. emergence. for policy lmPlementation. structure. the policy. become. all network. and promotes. organizations, and. between. and Brinkerhoff(2002). demonstrating. promotesthe. of the. some. decentralization. network. societyarefundamental. both. remain. capacity. to. network. (2002). participation. relationship. In establishing. operational. the. share. Brinkerboff. Similarly,. for implementing. and implementation.. buildingthe. easilyform. stmctures. affected by negative. and related. Increased. network.. are. in strengthening. role. and. of. In fact,. levels of government.. adversely. successes. Brinkerhoff. more. be. that. exist. can. networks. decentralization. incentives. are. Network. partners.. at lower. positive. partnerships. already. of decentralization,. enablethe. In addition,. especially,. Moreover,. means. (p.171).. weak. situation.. capacityand their capacity,. of the. one. this. of social policies.. B.rinkerhoff,. In fact, Brinkerhoff. seⅣice-deliveⅣ. /or providing. and. of decentralization. Varioustypes. network. collaboration,. different. of experiencingwith. (Brinkerhoff &. them". relationships. and. "can. Decentralization. the networks.. administrative. it is. formulation. and. 79. Furthermore,. since. differentials. of power. (695). 2002).. to establish. decentralized. that. in policy. the synergeticforces. of decentralization. a means. and. governance. of the implementation. to the reduction. informing. implementers.. and. good. by participating. Brinkerhoff,. for the establishing. and. responsiveness. emerges. result, will help. a. beneficiaries. of democratic. in the aspects. the accountability, transparency. achieving. both. among. ownership. (Kazumi Noguchi). Policy. synergistic. collaboration. among. the. three among and. government,. factors,. including. government,. implementation. international. decentralization,. participation,. non-governmentalorganizations, At the municipal organizations. level, it has been. and. NGOs. has.

(6) 横浜国際社会科学研究. (696). 80. the implementation. reinforced. In the network relationships.. formation. From. Theory. space. theories. one. may. of血e. argued. is basically. founded. for other. work. is the. how. key. aspects. is acquired. power. element. which. Of collaborative. is characterized. this collaboration. role. governments. play leading. to. the health. administer. touch. and. as. power in the. challenged. inhibits. either. a. This. strong. facilitates. or. successful. health. of the. federal. government. parts in delivering. focuses. trust between A. policy･. care. care. in various. relationships. & Freedheim,. in. 1994). to. civil seⅣants'dedication and the social network. of Tendler's. is that. argument. Although. policy.. policy. Bossert,. state. and. she. municipal is. in Cear丘, the role of the federal government. services. of social policies. a. from. stand. the govemment. drawback. the political context,. in the analysis. on. health. analyzing. Crendler. to work. approach. in health. health. Moreover,. policy.. care. care. takes. paper. on. different. a. ′托e. perspectives.. various. argument. commitment. space. from. come. the proper. provides. decision. to也e. inter-organizational. upon. including. any. is excluded. governor. rarely. incentives.. upon. factors. of development. Judi也Tendler argues也at也e. study,. the. Bossert. is contrary. implementing. to. underestimates. not. Power. that theories. show. for by. In也is. his/her work.. the state. involves. Important. Studies. approaches也at. is crucial. (1989) that. of collaboration. (2002).. cited above. approach. agents. which. Case. to. its argument. since. cite Gray. is very. actors. actions.. ′nle different decision. services.. the different. (2002). efforts.". of collaborative. collaborative. 2.5.. McGuire. and. care. sharingamong. state that, "¶le exercise. They. sharing.. setting, power. Agranoff. health. of responsive. 第10巻第6号(2006年2月). the position. as. such. of Cear丘.. in the state. involved. organizations. of politicalparties. Furthermore, in the. Tendler. and does. health. Ceara. care. prOgram･. Robert. Putnam(1993). implementation. wi也a. depends. the. on. the. continuing. from. care. local and. regarding has. Hood styles. Nations. the. of public. management. on也e. the. experienced. period. collaboration between egalitarian. type. have. since. is one. 1985.. the government. of public. explored. between. continuation. management.. inherited. of the. a. strong. have. cavities.. types. In its present. have. localityhas. a. research. and yields. a. civil societyhas. North. clear. such. of "democratic". an. has. for仙e. and patients Christopher. categorized four. offour. cases. of public. public management. authoritarian in Brazil,. it is difficult to state. In. policy.. dentists. and. in. health. on. and argue. care. Brazilian. governance. care. management,. cut image. as. forces. strong. of health. cultural血eoⅣ a. as. between. of all of them.. intensified,. by. up. the. pivotal influence. dental. on. the gap. of centralization. form. long. of parliamentarianism. emerged. In the fleld of public. in the middle. ended. America,. nation a. of civil society.. analyzed. public management. of several. and. They. placed. and. itself affects the performance. ¶1is categorization case. of. have. they. to Latin. a. have. countries. Spain,. of power. will work. that the fate of. noted. American. from. higher visibilityand. ethnographical. from. has. Contrary. tradition. for the. is that decentralization. Latin. separation. that the political culture. for toothaches. there. control. the local culture. organization.. however,. Since. gained. heal也policy.. relationship. management. forms,. decentralization. an. treatment. dental. focused. Nuto. in implementing. of culture. inherited. argues. of study, and. followed.. principles. have. cultures. Atkinson. In this丘eld. to Atkinson,. the. (1990). North. indispensable. are. participation. subordinations.. vertical. have. they. indigenous. previously. and. benefltedfrom. Sarah. management.. impoぬnce. of clientalism. ¶lerefore,. Douglass. authoritarian. and. citizen. and. of the social capital approach. weakness. that it has. path. have. management.. contrast. has. tradition. reciprocity. of social capital.. bureaucratic. England.. Recently,. public. historical. countries. derived. tradition. strong. of centralized. American. The. of social policies.. in countries. history. that. argues. era. and. although. that Brazil. a. the. exhibits.

(7) Policy (Kazumi Noguchi). cultural and Interorganizational Relationships in Development. Furthermore, government. and. foremost. in the bottom-up. networks argument. is very. that global. means. of government. government. the. performance. agents bo杖om. the. decentralized. up. and. bring. approach. the. made. factors.Among. particular. Prud'homme. (1995). sectors;. in Brazil. indigenous. local. sustainable. 地at indigenous the developed. the. culture. His. world.. role of interargument in developing structure. but also to all social. examines. highly. Therefore,. feasible. than. any. culture. health and. 也e implementation. of health. all developing. effective implementation. note. policies, especially aid institution countries,. that. a. care. of all social policies.. rather. to. policy.. international. in developing. diverse,. make血e and. The and. a. cultural. of the. aware. towards care. making. policy. proves Even. policy･. to empirically gready. to health. heal也care. cultural. basis will be. governance血at. local NGOs,. is very. in. policies･ prove. municipal. global. as. decentralized. of all social welfare. contributes. inter10rganizational. an. of health. is anxious. policy. fail and and. keenly. health. theory. when. social policies･. roles in implementing. organizations. services.. factors. might. contribution. the inter10rganizational. locality in public. been. decentralized. affect the implementation. non-governmental. to. tremendous. indispensable. local government,. collaboration among也e. to. study. and values. of血e. a. analysis including. public. implementing. has. policy,. management.. policy. when. policy･. approach. implementing. government. of Brazilian. care. political, economic. when. cautious. and. of various. aware. decentralized. issues. very. made. policy play. in the analysis. interorg･anizational. Althoughthe. case. be. citizens. top-down. in local. of culture to. institutional,. municipal has. policy by. care. it is important. international. the. culture. in heal也care. be. up. to public. approach. the. include. should. to all. A. cultural characteristics. other血･amework. of the. the. in health. beyond. bottom. reinforces. between. participants. goes. s山dy. roles. be paid to cultural. that. noted. available. government. various. The. crucial. identity. trust. as. in. is necessary. approach,. in relation to health. among. Otherwise, factors. should. the indigenous. The. applied. cross-sectional. especially. cultural. such. importance. the. measures.. indigenous. the state. that. performance. actors.. the. the top-down. and. inter-sectional. an. the government. and values. countries,. paper. This. development. implementation.. be. are. of也e. securityissues. aspects. relationship. out. points. attention. be. Informal. to. refers. Various. outcomes.. it should. collaboration between. applicable. approach. the hierarchical. rather也an. it is critical for the government. that. argues血at. culture.. health. and. than. policy. productive. horizontal. decentralized. policy. these,. a more. research. point. result lead to harmful. This. the. Brinkerho#'s. of social policies. ra血er. health. policy.. collaboration and. implementing. and. approach. role of the various. theory. of my. argument has. care. the. of each. agent. and. up. about. analyzes. non-govemmental. main. Prud'bomme. public. Moreover,. national. between. developing. the importance. countries･. only toward. not. in the. also. recently. the horizontal,. on. decentralized. a. health. consequently. principal. government. designing. this approach. of. bene丘ts the analysis. then. The. in various. focuses. that the bottom. argues. of any. effectiveness. as. since. but. in the implementation. approach. for applying. paper. to analyze. such. important. of government. argues. of heal也policy. of government. whole. that collaborative and. in developed. only. Widely recognized. is very. and. Brinkerhoffargues. not. case. theory. relationship. 81. policies.. ′me present. The. become. governance. and. and welfare. which. has. ′nle Whole. countries.. in the. horizontal. the. consider. relations. Brinkerhoffand management,. applicable. relations. not. Inter-organizational. in public. much. does. approach. approach.. important. organizational. space. civil organizations.. are. order. decision. the. (697). that policy policy more. includes critical to. countries. carry. than. a. out. a. universal. universal. policy. development should. be. policy, which emphasized. can. in the.

(8) 横浜国際社会科学研究. (698). 82. Table. 2. Population. Year. Table. in Cear畠. Population. 3. Estimate. Under1. 2002. 7,654,540. Estimate. 2001. 7,547,684. 2000. 7,430,661 7,106,612 7,013,382. 1997. 6,920,307. 1996. 6,809,290. Groups. Female. as. of 2003 Total. 78,361. 160,446. 1-4. 344,871. 333,550. 678,421. Estimate. 5-9. 436,623. 421,945. 858,568. Census2000■. 10-14. 455,790. 448,328. 904,118. Estimate. 15-19. 428,654. 428,919. ■857,573. Estimate. 20-29. 636,363. 668,142. 1,304,505. Estimate. 30-39. 507,796. 550,740. 1,058,536. 40-49. 341,735. 387,727. 729,462. 50-59. 242,707 163,816. L278,311 197,123. 521,018. 60-69 70-79. 103,948. 122,709. 226,657. 43,522. 54,672. 98,194. 3,787,910. 3,970,527. 7,758,437. 2003.. Resl'den te poL･ Ano,. Age. 82,085. Estimadvas-Popu)ac貞o. e. in Cear畠by Male. 7,758,437. Censos. Population. Method. 2003. .1999 1998. Source:. 第10巻第6号(2006年2月). 0Ver80. Source:. Censos. EstimativasrPopulacaoResidente. e. 地Etbn'a Table. Cear畠Basic. 4. Care. Health. HealthUnits. e. sexo,. por. 2003.. Units. NumberofUnits. %. HealthStation. 736. 20.4. HealthCenter. 429. ll.9. GeneralClinicforOutpatients GeneralHospitalUnits. 78. 2.2. 244. 6.8. SpecializedHospitalUnits. 67. 1.9. MiXedUnits. 53. 1.5. 6. 0.2. SpecializedEmergencyUnits Consultation. 348. 9.6. SpecializedClinic. 216. 6.0. CenterforPbysic-SocialCare. 22. 0.6. 5. 0.1. CenterfbrRebabilitation OtherMedicalServicesand′merapy. 164. 4.5. MobileUnitswithDoctorsandDentists. 15. 0.4. MobileUnitsforEmergencyandTrauma. 8. 0.2. Pharmacy. 1. 0.0. 111.7. 30.9. UnitsforPublicHealthSun′eillance. 77. 2.1. NonSpecialUnits. 25. 0.7. 3611. 100. UnitsofFamilyⅢea1也. 360,939. OtherCategories Total Source: 3.1.. Health. 3.I.1.. Care. Programs. Population. the population ′me percentage. 3.1.2.. Basic. Health. In Cear丘, health and. 1117. family. in Ceara. in Cearえ. ¶1e population 2000,. Datasus.. of the state stood. of Cear孟has. at 7,430,661. of the population Units care. and. exhibited. as. increasing. trend from. it has population. since then. by gender,. an. shown. 1996. increased血･om. in the graph,. to 2003.. 6,809,290. is concentrated. from. At the. census. of. to 7,758,437.. the ages. of lO119.. in Cearえ units consist. health units.. Moreover,. of both health stations and various. specialized. family. hospitals. health. units.. There. and clinics have. are. been. 736 health units established.. ′me.

(9) cultural and Interorganizational Relationships in Development. of Cear孟is playing. state. that have. 3.1.3.. Emergence NGO. of. projects and ISDS. of the. activity. competitive. is veⅣ. relationship. ¶1ere. does. NGOs. among. relationship. thousands. are. In Fortaleza,. is. there. not. one. in Fortaleza, that. case. X AIDSwith. adolescent. international the. as. the. of Health. increase. bealtb. top. and. other. for AIDS. 100. of Cear丘.. of HIV,. the. on. aid agencies of the. one. the Secretary. in combating. lnstitute. problems,也e. Cear丘, mostlyfocuses. in Fortaleza,. in these. in Ceara. Although horizontal. the. Unfortunately,. programs.. the. time. Cear丘which. that. shows. and. of Cear丘, ranked. state. for cooperating. exist. hospitals. it possesses. since. Programs. cooperateswith. important. clear at the present. of NGOs. (ISDS). and. of Artes. more. prevention. Development. programs. the program. is becoming. HⅣ. to. the capital of the. established NGOs. Social. and. system. for HIV/AIDS. Organizations. for various. planning. entities. Fortaleza､. in 2000.8). the. in Health. care. 83. and tertiary patients.. the secondary. actively commi仕ed. most. Investigation. governmental cases. been. health. regionalizationof. of the Non-Governmental that has. Projects and. formation. role in the. for both. the capabilityof caring. The of. important. an. (699). (Khzumi Noguchi). Policy. a. focus. mainly. HⅣ/AIDS. on. interorganiztional. global. programs.. prevention been. relationship. has. fight against. AIDS.. recently. developing.. 3.2.. Case. 3.2.1.. Study. Arte. The. feature. way,. plays that make The former. technical. program. support. since. 1999,. Tne by. ways. results. and. disease.. public. highest. of democratization. effective. northeastern. X AIDS. those. of diseases. control. involved. with. theater. AIDS. of information. This. festival located. such. and. as. mobilization. Projects and. programfocused. positive. is the. leader. and. are. not. AIDS. of. of the different. groups. to. arenas,. produce. It. various daily seen. requires. of the. he. includes. now. has. problems. social mobilization. obtained. His. multi-. including. just as. are. has. broadcasting. a. of knowledge,. but rather. through. Investigations on. the. in the municipalityof. art.. in Health. directors. and. Guramiranga,. Street. The. as. and. and actors. Social that. 100knfrom. Theater. a. through. AIDS.. against. areas. Jr.. National. education. which,. experiences as. Cardoso. of this initiative and. &om. in scope.. Ranulfo. and. of artistic expression. wisdom. number. the. relevant. as. the solution a. desire. (ISDS, 2002; InteⅣiew). alld cultural reality of the country down is to break the "fatality"stigma of HIV and to overcome. economic. by the Institute of in 1997.. HIV. and. relationship. unheard. Unit. of communication. other. name. accessible. and也e. an. private. Prevention. organizations,. with. an. the. I. He. to expand. along. and. inspector. sanitary. experience. meeting. 38 theater. public. of the. in Brasl'1ia.. of. As. InteⅣiew). and. advisor. continued. national. are. 2002;. doctor. unique. to health. who. (ISDS,. an. and. Project, popular. people. streets,. by. diseases. production. less than. to the. non-governmental. has a. linked. themes. The. and. Program. policies that suit血e challenge. of也is. No. in. wider audiences,. for仙e. scene.. time. same. of Health. governmental. In the Art. Project,coordinated became. symbolic. overseen. of sexual. theater. in Cear丘,. Ministry. has. and. to. transmissible. is responsible. wasformulated. of the. and. prevention. idea of taking. at也e. of ISDS. of both. uses. approach. this dreaded. think. and. the Art X AIDS. scientific information,. implement. and. AIDS. biomedical丘eld.. the. bring. to. to. theater. street. of drama. power. in 1997. embraced. laugh. the practical. disciplinary. to. have. coordinator. against. in Ceara. is using. of Ceara's. much. start this program. the. Program. started. subject via. of STD/AlDS. presented. funding. messages. someone. chance. Coordination. art. With. the. to. AIDS. linked to也e. program. of Ceara. municipalities. for HIV/AIDS. utilizes the symbolic. This. on. Program. of the AれⅩ. valuable. behavior. texts. Care. Program. this program. humorous. dramatic. Health. on. AIDS. main. suggests,. to social. X. against. to. it. AIDS. Development(ISDS) were. involved Fortaleza,the. ,first in the HIV capital. of.

(10) (700). 84. Cearま.. 横浜国際社会科学研究. Recently,. Camisinha".. 18. By. theater. virtue. the play in也eir. Quixad丘, Iguatd, Aracoiaba, Russas,. Eus6bio. beginning. a. of. synergisticeffect.. initial presentations ¶1is SESA. 3.2.2.. This current. Ceara. than. The. event.. against. present. the "Auto. Culture. project not. widelyfrom. while. simultaneous. and. a. other. da. had. the. Maranguape,. Juazeiro do. play, which. public. Norte, the. marked Many. venues.. collaborations to choose. commission. 800. 2002;. InteⅣiew). Snowball. an. reaching. of the. with. ISDS,. the six best plays. of. "Auto. da. Camisinha"for. The. MacArthur. the communication. network.. Stage. the collaboration. Project with. Communication. registered. Culture. and. and. br. of 150,000. theater had. the whole book. of the tackling. da Camisinha"I. Street. called. Company. in Sao. groups. space. of Drag豆o. Theater. in Fortaleza. and. Art ¶1is. place.. but also triggered the sufficient. AIDS. against. gave. in Brazil. areas. other. join this. do Mar. took. did not have. groups. to. trained. were. of AIDS,. an. the Street. to establish. X AIDS. in. groups. opportunityto. Theater. theater. company. the. the problem. The. people. de ′meatro. halls helped. also. occupied. theater. a. similar to the. way. all of也e也eater. of amateur. since these. especially. together. a. more. (ISDS,. Effect. TYle adaptation. families. groups. instance,. the Taipa. in Fortaleza. vehicle. of "Auto. For. municipal. 18 groups. the publication. and. audience. and. of this show. of Ceara,. for the presentation. presentations,. in which. communication. scene. SUS.. to bring. SECULT. theater. other. sessions. legitimized. a. SESA,. cities in Brazil, in. major. Furthermore,. arranged. presentation. debate. where. tour. on. go. a. of the theatrical. than. combating. in pubic. The. other. throughart. and. The. a project of Projects and. the Institute. Project. of the. focused. on. Communication. state. targeting and. new. phase. the ISDS. of Cear丘:. and. Enxame. the. NCO. the On. ProjectlO)and low-income. focused. on. newspaper. school. expanded. launched. adolescents血･om. Culture. It also coordinated. areas.. other. into. this. moved. organizations. Enxame. in Fortaleza. schools. Foundation,. of two. NCO.. violence. the cinema. juveniles by. edited. students. These. leading. three. organizations. were. by. participants. project and only. the. been. Communication. drop. school. of the. at schools,. theater. in discussions out. rate.. dangers. public squares. against. their. as. Culture. and. formed. integration. seeking. in the Street ′meater. you也s. awareness. held. a. subsequently. involving. reducing greater. have. roles in the utilization of the street. Prqject,coordinated. were. ltapipoca,. the. see. "Auto. 15 of 18 theaters. strengthening. formed. system,也e. was. in 1998,. meeting. Camisinha". became. to. not. By. other. da Camisinha"･. between. collaboration state. da. care. ¶1is presentation. show.. Center, only. the "Auto. presented. close. funds. the. they. entitled,. InteⅣiew).. 2002;. Cear畠to. bealtb. of the universal. AIDS. the revitalization. who. to. chance. anticipated.. Cear丘(SECUIJ),. Project has spread. In Fortaleza,. meeting,. those. over. anyone. play. Jaguaribe, Banabuid,. at local schools. (ISDS,. well. of Brazil. on也is. Theater. 3.2.3.. as. Regions. de Teatro". also put. and. Other. to. Art X AIDS. Cheia. annual. also shown. video. Secretary,. Ilational program. Paulo. was. a. including. towns. Branca, the. on. Cear丘(SESA),. of maIly. had. put. da Camisinha."9) From. "Lua. Fortaleza,. play. on. further. gone. the State Culture. and. of "Auto. recorded. were. project has. This. of Health,. Icapul', Pedra. besides. to. opportunity. cities. Residents. Aracati,. Pompeu,. the. State Secretary. home. Pindoretama,. Senador. e. Cear丘had. the. offundingfrom. to present. oppor山nity. from. groups. 第10巻第6号(2006年2月). own. theater. and bus. by the. vehicle.. took part. groups.. and. Students. in也eater. health. schools. generation.. health. students on. public. and. NGOs. Most. (ISDS, 2002; InteⅣiew).. of the. has. been. to. participate schools. in. aimed. the intention. contributing. discussions. Equal. by instructors. could. issues, but also with. by playing. Equal. taught. workshops many. issues. tied to the. Presentationsfocused. reproductive. between. younger. terminals. art education. Project. In this way,. and. cooperation. of AIDS. socializing. NCO,. AIDS. of sexuality. This. a. between. of to. and seminars. a.

(11) Policy (hzumi. Cultural and Interorganizational Relationships in Development. The the. are. meetings. collaborating. in collaborating. Moreover,. provided,. are. become. to. able. NGOs. will be. involved. It is possible for them. the government.. with. in the. trust. popular. NGOs. is that flnanCial. the government. with. in health. health. care. and. places. for. with. the. by cooperating. enhanced. in large-scale. to engage. support. programs. by. that provide. better. care. programs. 85. to citizens.. services. Health. Care. Programs. Demographic. 3.3.1.. is munlClpal. It is surrounded. by Guaiuba, As. in Maranguape. lmformation. Maranguape km2.. NGOs. Furthermore,. government.. 3.3.. for the. advantage. (701). Noguchi). Pacatuba. is 66,471 while. 3.3.2.. that of也e. Population. The. ≠e. 3.3.3.. Economic the. agriculture.. The. agricultural. development. has. system. in 2000. Aspects. During. a. of Cear畠.. and. Guaiuba. an. city is 89,742,. The. density. the population. has. of 654,80. area. to the South,. to the West.. of the. population. and. Palmacia. Caridade. and. of the state. Moreover,. of the urban. population. is 138,20. in 2000. and. its area. per km2.. residents. been. cultivation. is. age. range. of. to. in 2000.. 89,742. to nine. one. in. mainly. concentrated. the. of Maranguape. economy. of打し1its and. do. and. clear since. agricultural. years. Additionally,. old, and. the. highest. in 2003,. it increased. primary. industry. to. areas.. urban. 60 percent. has. from. the. of its soil is. the volume. of water. other. now. based. mostly. most. important. parts. of the. on. in this. state. sufficient to meet. not. of Cear丘. a. and. Obstacles. area.. ′nle neCeSSityof. semi-dried. was. saved. been are. production. differ significantly. not. drought. very. in the. was. in 1996. 82,064. of Maranguape. last 60 years,. severe. from. grew. of Maranguape. population. experienced. the. of Brazil. by Caridade,. by Pentecoste. of the total population. of Maranguape. of the population. 93,196.. Nor也east. North,. characteristics,. is 23,271.. in也e. of Maranguape. population. percentage. to the East, and. area. rural. to the. Caucaia. demographic. 1.18 percent. comprised. of Maranguape located. which. and. and Maracanau. for its particular. population. govemment. by Maracanau. City. the. about. to. Maranguape irrigation. proper. the growing. demands. of. economy. of. its inhabitants. The. Therefore,. sectors.. As. present. time, The. park. benefit. this agricultural. vulnerabilityof. Maraguape.. for the. the development. Maranguape. future. seeks. all of the localities around. has. there. economic. of Maranguapewill. greatly. of Maranguape. sector,. commercial. has. sector. the urban. on. been. its. on. in. is also. a. the. industrial. and. in the urban. commerce. its industrial tendency. strong. of the. growth. of Cear丘, which. state. abilityto expand. There. areas.. with. the rise of both. increase. an. along with the. growth. depend. interfered. depends. has. sector,. a. commercial. areas.. the. industrial. modern. which. At. will ultimately. to promoterural. tourism. in. Maranguape.. Basic. 3.3.4.. Care. 8 shows,. AsTable for people. Health. to receive. nurse,. and. dependeds ¶1e. community on. there. are. advanced. In fact, the family. health health. of Health. thirteen. medical. care. health. agents. from. The. of Maranguape. such are. table shows. the family. and six health. stations. in places. units in Maranguape. the basic services. Secretary. in Maranguape. lnformation. health. (SMS). as. the larger. all equipped that each. centers.. cityof. with. a. In Maranguape,. it is necessary. Fortaleza.. medical. doctor,. districtof the family health. a nurse,. team. an. assistant. in Maranguape. units. is responsible. for the. implehlentation. of all of the health.

(12) (702). 86. 横浜国際社会科学研究. Table. 5. Population. 第10巻第6号(2006年2月). of Maranguape. by Age. Male. Female. Age. Groups. in 2003 Total. Under1. 1,038. 928. 1,966. 1-4. 4,398. 4,150. 8,548. 5-9. 5,631. 5,423. ll,054. 10-14. 5,602. 5,594. ll,196. 15-19. 5,144. 5,061. 10,205. 20-29. 8,094. 8,206-. 16,300. 30-39. 6,230. 6,702. 12,932. 40-49. 3,793. 4,135. 7,928. 50-59. 2,548. 2,928. 5,476. 60-69. 1,817. 2,212. 4,029. 70-79. 1,165. 1,295. 2,460. 0Ver80. 479. 623. 1,102. 45,939. 47,257. 93,196. Total Source:. Censos Sexo,. Estimativas-PopuLac孟o. e. Resl'dente por Fbixa. Etati'ae. 2003.. Table. 6. Population. of Maranguape. by. Region. in 2003. Female. Male. Total. UrbanArea. 32,737. RuralArea. ll,464. ll,807. 23,271. Total. 44,201. 45,541. 89,742. Source:. Table. Prefeitura. 7. Proportion. 33,734. de Maranguape.. of the. 66,471. (2004).. Popu一ation. in Maranguape. Age. by. Age. 199 1. 43.3. 15-19. 8 ー5. 9. 20-49. 68 7. 8. 42 5. 4. Over. 50. 92. 59 6. Source:. DatasusINtimero. PropoLTCa-o. e. de Um'dades. 9.7. 70 7. 3.〇. 10-14. To tal. (%). 2000. 23. 5-9. Group. 9 7 8 4. por. T)'po de UnL'date, 2002.. seⅣices Health. in也e. city. ′mere. Assistance;. Planning. Family. Control. and. In Maranguape, in Maranguape. information. nine. health. ga血ering. agents. on也e. Division;. and Auditing. families. Basic. is covered. and 74,186. received. health. including. a. Public Care. Health. Ⅲealtb Division; DivisioⅢ;. Sanitary. Division; Division;. Pharmaceutical. Division.. of the population. assist 16,602. divisions. administrative Assistance. Health. Division 98 percent. which. Community. are. condition. 60. reais of也e. people as. an. by the SUS.. -. are. approximately. incentive. residents where. ′mere. to. 123 communityhealth 83 percent. fulfill various. the community. agents. of the population.. requirements. heal也agents. work.. such One. as. of.

(13) Policy (Kazumi Noguchi). Cultural and Interorganizational Relationships in Development. Table. 8. Numberofthe. Hea一th. Maranguape Health. Station. Health. Center. General. Units. Medical. 2002) 13. 27.1%. 6. 12.5%. Hospital. Clinic. Specialized. Clinic. Medical. medical. seⅣices. for dignoses. 87. in. Hospital. Specialized General. Other. (As. Care. of Dec.. (703). and. 3. 6.3%. 1. 2.1%. 2. 4.2%. 1. 2.1%. 2. 4.2%. therapy Units. of Famil. H. e. alth. Total Source:. l. Prefeitura. services ¶1e doctors,. and. agent. of the crucial roles played. of the. Secretary. of Health. of Maranguape. (2004).. is to visit the homes by communityhealth. of residents agents,. and. they. record. any. as. bridge. serve. a. births. that have. between. health. taken care. citizens.. City of Maranguape and. Structure. de Maranguape.. the roles of the communityhealth. place.Asone. 41.7% 100.2%. Datasus.. Figure. Source:. 20 48. nurses. are. is divided into 17 administrative. all equipped. a占a. team. to serve. districts where. the residents.. ′mere. communityhealth are. 9 PSF. teams. agents,. medical. in the urban. areas.

(14) 横浜国際社会科学研究. (704). 88. Table. 9. Number. 第10巻第6号(2006年2月). of Community. Health. Agents. in Maranguape. 2000. NumberoftheCommunity. 123. HealthAgents AssistedFamilies. 16.602. AssistedPopula也on. 74.186. Source:. Prefeitura. Table. 10. de Maranguape.. Health. Administrative. District. 10 PSF. nurses. assistant. dutyat. the health. that they group need. and. were. at the. veIY. Amanari. 1938.. DecreeIAW448. Itapebgu. 1938. Decreebw448. Sapupara. 1938. DecreeI.aw448. Tanques. 1938. DecreeI_aw448. Jubaia. 1961. Law998. AntonioMarques. 1964. I.aw7148. VertentesDohgedo. 1964. I,aw7148. Umarizeiras. 1988. Resolution14. I_agoaDoJuvena1. 1990. I.aw1045. Cachoeira. 1991. I_aw1074. I.ages. 1991. I,aw1074. ManoelGuedes. 1991. I,aw1074. Papara. 1991. IJaW1074. Penedo. 1991. LIW1074. SaoJoaodoAmanari. 1991. IJaW1074. hdeiraGrande. 1991. I_,aw1074. are. capitalcity, Fortaleza care. seⅣices. interviewed. has in S豆o. (Prefeiturade. areas. agents. At the Sao. centers.. for. not. de Maranguape.. Prefeitura. Satisfiedwith. to丘11 in forms. I_aw I.aw553. local church. S包o JoaoAmanari. YearofCreation. communityhealth. care. in Maranguape. 1851. in therural. teams. District. Maranguape. Source:. and. (2004).. car･e. play music. bom. and. deeply. committed. to practice. greatly. to. Jo豆oAmanari1ives. to. however,. and. happy. were. in o也er. engage. an. service;. increase. in Fortaleza. team,. however,. school,. a. in the number. and only goes. back. most. of them. of doctors home. alongwith. hospitals.. internship in也e. for the weekend. for. rural. on. stated. the youth the agents. ≠e. doctors. like to stay. would. and are. interviewed. In the community, to. nurses. nurses. only. agents. women. three-month. doctors,. of thetime,. to participate. activities.. also assist in taking pregnant medical. most. PSF. of the communityhealth. activities and. In the medical. medicine,. contributed. two. In each. 2001).. equipped;. Amanari,. Joao. their health. babies. Maranguape,. arefully. wbere也ey new. (2004).. in. in the. regional health. area.. Ⅶe. (Interview).. doctor.

(15) Policy (Kazumi Noguchi). Cultural and Interorganizational Relationships in Development. Table Urban. Popu一ar. Healers. Area Pau. Serradeo. Area verde/Coni.P.. of Popular. Rezadores:. ll. Raizeiros:. 3. 3. Novo. Maranguape-CAIC. Rezadores:. 4. Outra. Banda. Rezadores:. 16. Rezadores:. 8. Rezadores:. 10. Rezadores:. 3. Rezadores:. 10. Rezadores:. 10. 5. Centro 6. Parque. Santa. 7. Stenio 8. Parque 9. Novo. F6. Comes Sao Joao Par. lracema. ue. Rural Area. Number. 3. of Popular. Rezadores:. 10. Sapup. ara/Tab atinga. 2. ll.Generad. Rezadores:. 12.Penedo 13.Umarizeiras/I,ages 14.Jubaia. Rezadores:. 10. Rezadores:. 5. Rezadores:. 9. 15.Itapebussu. Rezadores:. 9. 5. Rezadores:. 24. Raizeiros: Rezadores:. 10. 18. S孟o Jo畠o doAmanari. Rezadores:. 24. Source:. Health. Care. ¶1ere. have. health. speciflC. supported. by也e. prevention. of domestic. 3.4.1.. Projecto. This. science.. As. program. was. a. launched. experienced. approximately. medical. However, were. at. to combat. infant mortality on. general,focus. 90,000. doctors. increase. an. people.. expanded. worked. The. e. government. municipal. Rezas,. In addition,. is well. which. some. aimed known. at solving has. and. prワjectsare. of也e. its Family. in infant. Health. closely in harmony. Secretary. continued. of Health,. in the cityof Maranguape.. the. important infant. reduced. of those. At this time,. the infant mortalityrate. due to diarrhea.. the. related. been to也e. children and adolescents.. the infant mortalityrate. to reduce. the. Rezas. e. communityin. 1999, the municipality ′mese. directed. 2003.. since. result, this project has significantly. Maranguape seⅣe. Foundationll). Soro12), Raizes. andthe. interviewwith. projects established by is Projecto Soro, Raizes. care. of them. Vargas. violence. project was. local healers. bealtb. One. Getulio. ll. (2004) and. in MaraⅡguape. several. problems.. Rezadores: de Maranguape.. staff in Maranguape.. ministry. Projects been. Guedes. Prefeitura. health. 3.4.. 2. 17. Papara 19. Manoel. Healers. 9. Raizeiros:. 16. Amanari. Healers. 6. Rezadores:. Camara. 89. in Maranguape. Number. 1. Area seca/ 2.. Numberof. ll. (705). babies. under. mortalityin. the rural. areas. Program wi也tbe to increase. Maranguape,. and. 1998 had. one. due year. and 40 percent organized. a. only. team. The. two. respect. to. objective of. this. doctors. to. seⅣices.. In. medical. to medical. access. the number. health. with. of age.. limited. increased. community. diarrhea.. it had. when only. to. of PSF,. professionals. of the local culture. values. deaths. The. of medical. doctors. to. 19.. agents. of the deaths consisting. underthe of. an. age. of. one. epidemiologist, a.

(16) (706). 90. social worker. and. The. to. task. was. a. It was. care. most. PSF. This. Tne. to be仕er. how. was. of infant death. necessary.. Maranguape.. for medical 也erefore. health. consultation with也e. centers. care. inclusion and. public. has focused. infant mortality. the 100. sought. healers. participation. 3.5.. The. governments.. care e. a. healers. On血e to exhibit. an. in. hand,. o也er. of their curing. significance. openess on. the. reduce. the. role. include. register. local healers. in the program･. identi丘ed也e existence Secretary. the. with. is. (ORT). therapy. rehydration. It was. au也orities.. thus. of diarrhea and. cases. of. to officially. healers. take. of也e. of Health. in. beaters. signi丘cant也at也ese. families. of those. care. At the Cantinho. de Fe,. that. come. religiousobjectiveshave. is也at healers. in Maranguape. total of 197. programs. individual. of these. have. regularly. present. Rezas. was. stayed. at. heal也care. at也e. did not. between itself was. has. the very. participated. patients. who. consult. with. did. in 2002.. to. It is evident. not. trust. effective in implementing. program. conventional. the health. as. of infants who which. that both. one. a. high A.om. one. of. of ill. were. caused. the age. under. government. and. in Maranguape. as. citizens. medical. care. in the rate of. Foundation. doctors,. medical. care. decrease. a. mothers. of the infant mortalityrate in the health. ¶1e City of Maranguape. and. served. doctors.. as. Citizen. programs.. Relationship a. the health. federal government. healers. Previously,. between. correlation. Vargas. the rate of infant mortality. decrease. to this remarkable. by the Getulio. in 2003,. 5.33 percent. to. strong. of Brazil.. the northeast. recognized. Awards They. a. that has greatly contributed. program. healers.. in. is. that there. shows. especially. Section. in 1999. that popular. trust. government. implemented The. were. center. health. percent. of lnter-Organizational. federal. government. prayers. contributed. in the program. Analysis. a. of. from. to note. priority and. of the. position. needed. beal也agents. da Fe "where. remarkable. only. for building. catalyst. is very. Service. 40. their丘rst. as. local community.. objective,oral. community. With the introduction of this program,. have. It is important. the. 2004).. in its Public. from. the. consider. oppoれunityto. seⅣices. there. This Projecto Soro, Raizes. decreased. popular. a. policy, which. of infant death.. diarrhea. diarrhea caused. of ORT.. of 2003,. Maranguape,. this. for the sick children.. of healers into the health. semi-finalists. diarrhea. the. launched.. was. wi也proper. of the beal血care as. to丘rst. achieve. them. is "cantinho. preparation. the development. on. community,and. administration.. say prayers. and. local healers,. tmsted. the number. excellent. registered. there. center,. an. asked. and. 155 healers. and. (Prefeiturade. Tne. rate. was. of the characteristics. 也e health. from. care. to. In order. initially launched,. part of the public. as. merged. One. time,. Rezas13). e. well.While. beal也professionals. to reduce. became. communities. At也is. At each. culture. and. was. feeling. not. to try to understandthe. Soro, Raizes,. diarrhea.. from. program. own. recognized. deaths.. of all of these. causes. the relationshipwith. se仕ing of也e. it clear也at也e. healers. these. for the ORT. wben也is. in their. centers. roles in也e. made. the Program. Prescriptions. In 1999. into the. priority.. for them. necessary. understand也eir. learnfrom. were. to well. their second. as. it was. principle objective of the program. healers. of the family,. going. considered. Maranguape. percentage. were. parents. concluded也at. to. investigate. their children. when. for dehydration. of Heal也of. awillingness. population.. time,. of也e. in order. 也e Secretary. further. to. conditions. to pray. of families. team. Maranguape. socio-economic. treatment. medical. The. decided. and. service.. the custom. regarded. and. project assistant. identi& the. a仕itudes to bealtb. dehydration,. 第10巻第6号(2006年2月). 横浜国際社会科学研究. national care. agenda program.. in Brazil. plays. for decreasing This a. shows. the. infant mortalityrate,. differing. role in establishing. roles. of the. national. goals. while. the. local. and. the. local. national in health. care. policy..

(17) Culturaland. For. The. state. policies, including state. care. health. has. a. It is global. ′nle Culture. to. contributed Health. with. municipal. and. in. has. Soro,. healers. Raizes. of the. it has. healers. case. to have. is. agent. in health. the. indigenous. kind. AsBrinkerhoff developing. of the. out. countries,. The. inclusion. local healers. program. have. explain. of也is. reflects been. Halligan. to. has. into. healers. popular. A. helped. has. established. (WHO). has. and great. the. desperately. and. case. success.. has. main. and. to. that. of. program.. is crucial. participation. is indispensable. has. the trust for the. establishing. citizen. and. of healthcare. of this. success. public. Secretary. kind. this particular. citizens. role. Althoughtheformer. contributes mention. important. an. played. of various. in. for implementation. Conclusion. both. local government As the. approach.. of heal也seⅣice. between. cultures. in Maranguape needs for. affects. has of the a. the. local. among. local government, health. of the. effectiveness. that it is important. policy. of implementing. lmplementation.. development. governmental. its. and. is. agencies. this governmental. in. policies a. pivotal. intersectoral. city of Maranaguape.. popular. reduced. healers. in health of any. the infant. citizens.Althoughmost method. NGOs,也e. govemment,. intensi丘ed.. demonstrates. to successful. of top-down. the sub-national. has recently. of Ceara. jointcollaboration. in the implementation. effectively. universal. greatly. the effectiveness. and. above show,. in Brazil. local, international. In Brazil, the beginning. of concerning. s山dies. in the state. contributed. in the smallrural. even. case. autonomy. delivery. program. states that the. study. looking. flnanCial. great. such. the implementation. for the great. reason. the government. has been. indigenous. speci五c. promoted. the needed. provided to achieve. to implement. Putnam. and. prevention. policies.. developed. of this. traditional. combining. while. the. synergistic relationship. pubic. collaboration has been. popular. can. HIV/AIDS. the. relates,. has. WHO. and. in Maranguape. Tendler. between. of global governance. in implementing. aspect. healers. ofBcials. Organization. culture. hesitated. be. to. programs. As. the municipalization. study. This. citizens.. government. Maranguape. of the infant mortalityrate.. global inter-organizational relationship. a. other. in Maranguape.. approach. limitation. one. regarding. The. program,. On也e. in this district.. rate. mortality. has led this program. of policyformation. that first, he. turned. of residents.. out. reduction. interview. at our. healers,. in heal血policy. principal. especially. social. Resas. e. Resas,. e. social policies, the trust. analysis, wbicb. agent. popular. compensation. this program,. cul山re也at. 4. The. municipal. municipal. health. including. and. pays. Health project, the World In Projecto Soro, programs.. been carved. Raizes. success. government. of popular. In implementing. indigenous. Soro,. Project. region. the huge. of popular. implementing. users. now. government. infant. of this. aspects. governance. Project. popular. Participation. care. 91. policy. as. such. in the. of health. ¶1e Maranguape. Soros.. care. to. in the nation.. programs. health. decrease. members. for their services.. Cear孟mentioned. policy. dramatic. its community. health. Maranguape,. cityof. for state and. makers. launched. lead in making. the. a. of equal. promotion. of this. In the. policies.. by. led to. in its health. of Culture. Role. has. and. the丘nancial. medicine. support.. the policy. as. role. in relation. government. central. (707). its internal workings.. over. Regarding traditional. a. roles in implementing. making. consisting. them. contractwith. autonomy. 3.6.. is broad. Projecto. greater. been. taking也e. play lmpOrtant. council. the. establish. have. decision. policy. policy,. municipal. care. governments. municipal. a. plays. like. policy. After the state of Cear丘flrSt. in Brazil. Autonomous health. government. health. governments. hand,. to. in Brazilfunction. their part, state governments. governments.. Policy (Kazumi Noguchi). Interorganizational Relationships in Development. of development. policy. health. care. mortalityrate of the policy,. policy. since. international this. the. shows. case. importance. of. ¶1e utilization of this type. of health. aid organizations which. respects. the.

(18) (708). 92. 横浜国際社会科学研究. Table. 12. The. 第10巻第6号(2006年2月) Cases. NumberoftheA[DS. during. 1980. 2003. and. Numberqfthe. Municipalities(State). Cases. (1980-2003). E). sAopAULO(SP). 59773. 2. RIODEJANEIRO(RJ). 29352. 3. PORrOALEGRE(RS). 11190. 4. CURITIBA(PR). 5785. 6. SANTOS(SP). 4561. 7. RⅠBEⅠRAOPRETO(SP). 4298. 8■. CAMPⅠNAS(SP). 4166. 9. BRASiuA(DF). 3672. 10. SALVADOR(BA). 3307. ll. on. 3089. sÅoJOS丘DORⅠOPRFrO(SP). 14. NOVAIGUACU(RJ). 2952. 15. GUARULHOS(SP). 2771. Source:. emphasis. 3202. FORTAEZA(CE). 13. characteristics. 3297. RECⅠFE(PE). 12. cultural. 8458. BEI-OHORIZONTE(MG). 5. http://ww.. aids.gov.br/.. locality clearly demonstrates. of也e. societal and cultural. any. aspects血an. development. that any. other. various. policy. should. place. more. of. an. factors.. Notes. 1). New. (NPM). public management. and the other. the "marriage. from. comes. including. business-type managerialism detailed discussion, see Hood, C. (1991). was. 2) International institutions including the United Fund. (IMF) and the World. UNDP,也e. concept a. manage. includes. otber. economies.. Good. governance. rule of law and 也e voices. means ensures. of governance. (UNDP). ,. the International. political and administrative. participatory,. which. and the most. emphasized. that developlng. to the. au也ority to Economic. political and administrative.. The. are. vulnerable. the institution of governance democratic. critical. Moreover, capacities. and. au也or. is transparent,. accountability. state,. institutions. to emerging. on. a. on. administrative. and. in society and that. consensus. allocation of development. over也e andthe. See. sector.. private. political parties,free. and civil organizations. prlOrities.. governance.. equitable. It also promotesthe. broad. civil society. including. private top. are. based. are. in decision-making. consistof. and accountable. the support. effective. accountable, priorities. beard. focuses. of this paper. UNDP. trade unions. and. particularly to develop. UNDP. web. document;. b仕p://magnet.undp. org/policy/cbapterl.htm; b仕p://magnet.undp. org/policy/cbapter2.htm; http://magnet.undp.org/policy/chapters.htm. Tbe. IMF. has. a. Monetary. According. governance.. and good. as也e exercise of ecollOmic, has three legs: economic,. that political,social and economic. Moreover,. management. seen. of policy implementation.. resources.. are. different concepts be. Programme. For. of the public sectors.. that affect a country's processes economic activities and its relationship with Political governance is the process to formulate of decision-making policy. Administrative. of the poorest. tbe media). privatization and deregulations. Development. institutional economics. was. partner. decision-making. is the system. governance. have can. affairs at all levels. Governance. country's. governance. Bank,. of governance. Nations. one. of opposites".. different. concepts. of governance. from. the. UNDP. and. the World. Bank.. In. July, 1997, Michael.

(19) Policy (Kazumi Noguchi). Cultural and Interorganizational Relationships in Development. Camdessus,. IMF. an. development". our. our. public. resource. private. sector. World. deflneS. and. MonetaⅣ. social. the. aS. governance for. resources. Fund.. transparency. of government. Good. at all stages of closely related to. most. the effectiveness. regulatory. is central. in the. of. for. environment. management. is synonymous. to both. creating. and equitable development, and an essential complement key role in也e provision of public goods. World Bank (1992). a. and. is exercises. power. governance. fosters strong play. are. accounts,. of the economic. in which. manner. governance. that. 93. (1997).. development.. good. for countries. governance. of good. transparency. the stabilityand. and. In this context,. managemenL. aspects. on也ose. is important. governance. policies including血e. macroeconomic. management,. "Good. states,. is to concentrate. activities. International. Bank. economic. Director,. approach. over. suⅣeillance. Tbe. Managlng. (709). and. with. sustaining. to sound. economic. a. of. sound. an. country's. development. environment. which. Governments. policies.. ,. stated here. 3) IJOCal governments as. roles. Rocha. Magalh豆es,. clientalism continues health. 5)Another. study next. 6) Popular. care. state. to munlClpal. central government. 4)Antonio. include. a. and will. officer of the World. end. in Cear畠.. in therural. program. state. take their. governments. govemment.. principal country never. For example,. government.. and municipal. Bank,. at the Word. in the cityof Maranguape. community. that this kind of. at the interview. mentioned. (Interview on June 2004. office in Brasilia.. Bank. in Cear丘wii11 be discussed. the. as. case. paper.. healers. are. well respected. roles in reproductive. heal也programs. in nlral communities,. especially in也e. Northeast. of Brazil. They. play important. in Brazil.. 7) Grid and group theoIγ Was Originally developed in Fortaleza,the 8) The number of AIDS patients. by Douglas,. M. (1978) and Wildavsky, 1980. capital city of Cear丘during. and. A, (1987). 2003. was. 3202.. data is from. This. 1980to2003.. 9) This show as. other. "Street. Theater. workshops. was. and Salvador.. Moreover,. it was. published. are. aspects. by也e. Equal. to. and specializes in research. and consist of water. medicine. sponsored. Equal. and. in Fortaleza. area. has established. and. project. in which. a. partnership. with in. participate. adolescents. and social interaction.. in 1944. established. homemade. means. AIDS". against. related to issues of violence. ll) ¶1is foundation 13) Some. located at the central metropolitan. Projectis. projects,. 12) Soro. the state of Pernambuco. pela Ⅵda".. Enxame. 10) ′me. at several other cities including. played. "Cuidados. World. on. public administration.. pinch of salt and sugar.. wi也a. Heal也Organization. References. Agranoff,. R,. (Ed).,. &. Management. Atkinson,. M.. McGuire,. Getting. (2002). After the Network. Results. Quorum. S. T.. Bossert,. (1998). Analyzing D.. Talesfrom. Countries.. ∫.M.. In M.. & Medicine,. of Brazil.. P. Mandell. for. In M.. Public. In P. Lloyd-Sherlock. Estimativas-Populaga-o. Residente. por. Censos. e. Estimativas-Populaga-o. Residente. por. Faixa. Policy. Development:. dos Municl'pios. e. Proporga-o. Results. Rio 【Datafi1e】.. Etdria. e. Sexo,. November. de Unidades. in Developlng 20, 2004,from por. Policy. and. (Ed). Health. M. (1978). Cultural Bias. RoyalAnthropological. Gray,. (1989). Collabwating:. Common. Countries:. 113-124.. Decision. Space,. Lessons. Collaboration:. Quorum. from. Developing. Networks. and. Books.. de Janeiro, RJ: IBGE.. 2003 and. Beverly. 2002. and. Network. tDatafi1e].Rio de Janeiro, RJ: IBGE. DevelopmentI Hills: Sage. Policy. Implementation. Publications.. http://ww.aids.gov.br/.. Tl'po de Unidade,. Douglas,. Finding. Countries.. Networks:. through. Westport:. A.(Eds.).(1983). Decentralization. Implementation Retrieved. 2003. in Developing. Policy. bp. 167-188).. Censos. D.. P. Mandell. 47, 1513-1527.. (Ed.), Getting. Policy and Management.. G. S., & Rondinelli,. System. (2001). Cross-Sectoral. Ano. B.. North-East. the. of Health. e. Datasus-Ndmero. Structure. Network. and. and Performance.. America. Social Science. Brinkerboo,. Wリ&. StructuresforPublic. Dados. Networks. Power,. Books.. the Decentralization. and Performance.. Transitioning. Cheema,. Process,. Studies. bp. 78-93). London: Institute of IJatinAmerican and Povertyin (2002). Political Cultures, HealthSystems and Health Policy. Social Science & Medicine, 55,. Innovation Brinkerhoff,. in Practice:. Latin. Reform. Atkinson,. Collaboration:. through. bp.ll-29).Wesport:. S. (2000). Decentralization. Care. is Formed:. Brasl'1ia,Minist6rio [Data flle】.. da Sadde.. Institute of Great Britain and Ireland: London.. G710undfor MultipartyPy10blems.. San Francisco:. Jossey-Base.. in.

(20) (708). 94. Hood,. C.. Hood,. Management. (1991). A Public. C.. IBGE. 横浜国際社会科学研究. (1998).. tua,. e. Cooydenacao. M,. Sadde. em. Fortaleza: Sonia Paranagua. K". &. Social Science. Administytztion,. 69: Spring, 3119.. Management.. and Public. de Populacao. Oxford:. Sociais, Pesquisa. Indicadwes. e. Press.. Clarendon. de. Informagoes. Desenvolvimento. e. Social-ISDS. (2002).. Arte. XAids:. 0 Ceard. Desajio. no. de Santana,. (1997). Good. Fund.. Nuto,. Governance:. S. S. (2002). "ToothWorms",. The IMF's. Role.. PovertyTattoos. Washington, and. Dental. D, C. Care. Conflicts in Northeast. Brazil.. 54, 229-244.. and Medicine,. D. C. (1990). Institutions,. North.. Culture, Rhetoric,. de Pesquisas,. Investigacao. International Monetary Nations,. Public. Municipais.. Instituto de Projetos pela. for All Seasons?.. StateI of the. Diretoria. (2001), Basicas. The Art. 第10巻第6号(2006年2月). Institutional Change. and. Economic. Pe4ormance:. Cambridge:. Cambridge. University. Press.. Prefeitura de Maranguape, Prud'homme,. R. (2004) Plano ,. (1995).ne. Danger. Municipal. de Salide 2001 -2004. Maranguape. of Decentralization [Electronic version]. The Vt(orld Bank. Research. Obse7WeT;. 10(2). 201-220. Putnum,. R. Tendler.. J. (1997). Good. Tendler,. J.,& Freedheim,. Brazil. World UNDP. (1997) Development. UNDP. (1997) Development. UNDP. (1997) Development. Wildavsky,. Work:. S. (1994).Trust. Development, Governance. Retrieved Governance Retrieved. for. a. Rent-Seeking. ,177111791. Human Sustainable 23, 2005,from. March. for. Italy. Princeton:. John Hopkins. World:. Healthand. Princeton. University. Press.. UniversityPress. Government. Transformed. in Northeast. for March. 23, 2005,血om. Preferences Review,. Governance-and. Sustainable. Human. Development-Good. Governance-and. Sustainable. Human. h也p://www.magnet.undp.org/policy/chpater2.htm. Human. Sustainable. Development-Good. h仕p://ww.magnet.undp.org/policy/chpaterl.htm. Human. Sustainable 23, 2005,from. March. Political Science. Bank. (1992). Governance. in. in Modern. Baltimore:. 22 (12). Governance. Retrieved. Civic Traditions. in the Ty10Pics.. Government. A. (1987). Choosing. American World. Democracy. (1993).Making. Development-Good. Governance-and. Sustainable. Human. http://www.magnet.undp.org/policy/chpater3.htm.. by Constructing. Institutions: A Cultural ′nleOry Of Preference. Formation.. 81(1), 3121.. and Development.. [のぐち. かずみ. Washington,. D.C.. 横浜国立大学大学院国際社会科学研究科博士課程後期修了]. ,.

(21)