Skip to main content

Advertisement

SpringerLink
Log in

Implementing policy integration: policy regimes for care policy in Chile and Uruguay

  • Research Article
  • Published:
Policy Sciences Aims and scope Submit manuscript

Abstract

How are integrated policies implemented? In this paper we analyze two policies in Latin America aimed at securing integral care to children to show how the process of integration takes place over time. We study the process through which an ‘idea’ framed both the problem definition and the design features of the integrated policy over time; how the institutional arrangement continuously shaped the operation of the information flows, budget allocation and the relations among the organizations involved, and the role interests of different coalitions had on launching the strategy and, later, in keeping it integrated. We explain the design of care policies in Chile and Uruguay as integrated strategies, as they aligned several instruments from different sectors (health, education, and social development) to target children according to their specific, evolving needs. Based on official records, recent research and first-hand accounts of specialists and public officials, we conduct a comparative analysis of their implementation processes. We argue that their contrasting trajectories are not explained by differences in the policies’ design, but by variations in their policy regimes: how institutional arrangements, ideas and interests interacted with the policy to keep it integrated during the implementation. By doing so, we offer a more nuanced understanding of the forces that integrate or disintegrate a policy during their implementation. We employ a comparative case study approach for analyzing two integrated care policies for children in Chile and Uruguay, both testing existing theoretical conjectures about policy regimes and developing new ones about their role in implementing integrated policies and their adaptation over time.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. As it has been argued in the literature on comparative social policy, policy legacies are key for understanding why political processes play out the way they do (Arza et al., 2022) and thus account for the characterization of the governing arrangement where new policies are created. In this research we do not seek to problematize how previous policies shape the expansion of social policies in Chile and Uruguay, but take it as the point of departure for the analysis of their implementation.

References

  • Amarante, V., Colacce, M., & Tenenbaum, V. (2019). The national care system in Uruguay: Who benefits and who pays? Population and Development Review, 45, 97–122.

    Article  Google Scholar 

  • Beach, D., & Pedersen, R. (2019). Process-tracing methods: Foundations and guidelines. University of Michigan Press.

    Book  Google Scholar 

  • Biesbroek, R., & Candel, J. (2020). Mechanisms for policy (dis)integration: Explaining food policy and climate change adaptation policy in the Netherlands. Policy Sciences, 53(1), 61–84.

    Article  Google Scholar 

  • Candel, J. (2019). The expediency of policy integration. Policy Studies, 42(4), 346–361.

    Article  Google Scholar 

  • Candel, J., & Biesbroek, R. (2016). Toward a processual understanding of policy integration. Policy Sciences, 49(3), 211–231.

    Article  Google Scholar 

  • Carter, D., & May, P. J. (2020). Making sense of the US COVID-19 pandemic response: A policy regime perspective. Administrative Theory & Praxis, 42(2), 265–277.

    Article  Google Scholar 

  • Cejudo, G., & Michel, C. (2017). Addressing fragmented government action: Coordination, coherence, and integration. Policy Sciences, 50(4), 745–767.

    Article  Google Scholar 

  • Cejudo, G., & Michel, C. (2021). Instruments for policy integration: How policy mixes work together. SAGE Open, 11(3), 21582440211032160.

    Article  Google Scholar 

  • Cejudo, G., & Trein, P. (2023). Pathways to policy integration: A subsystem approach. Policy Sciences, 56(1), 9–27.

    Article  Google Scholar 

  • Clarke, D., Méndez, G., & Sepúlveda, D. (2019). Creciendo Juntos: Evaluando la Equidad y Eficiencia de Chile Crece Contigo. London: Universidad de Santiago de Chile.

    Google Scholar 

  • Cunill, N. (2014). La intersectorialidad en las nuevas políticas sociales: Un acercamiento analítico-conceptual. Gestión y Política Pública, 23(1), 5–46.

    Google Scholar 

  • Esquivel, V. (2017). The rights-based approach to care policies: Latin American experience. International Social Security Review, 70, 87–103.

    Article  Google Scholar 

  • Farías, A. M. (2008). Formación de políticas públicas y Los Consejos Asesores presidenciales. Revista MAD, 3, 47–63.

    Google Scholar 

  • Givoni, M. (2014). Addressing transport policy challenges through Policy-Packaging. Transportation Research Part a: Policy and Practice, 60, 1–8.

    Google Scholar 

  • Howlett, M. (2019). Procedural policy tools and the temporal dimensions of policy design. Resilience, robustness, and the sequencing of policy mixes. International Review of Public Policy, 1(1), 27–45.

    Article  Google Scholar 

  • Howlett, M., Vince, J., & Del Rio, P. (2017). Policy integration and multi-level governance: Dealing with the vertical dimension of policy mix designs. Politics and Governance, 5(2), 69–78.

    Article  Google Scholar 

  • Hupe, P. (2011). The Thesis of Incongruent Implementation: Revisiting Pressman and Wildavsky. Public Policy and Administration, 26(1), 63–80.

    Article  Google Scholar 

  • Jochim, A., & May, P. (2010). Beyond subsystems: Policy regimes and governance. Policy Studies Journal, 38(2), 303–327.

    Article  Google Scholar 

  • Kefeli, D., Siegel, K. M., Pittaluga, L., & Dietz, T. (2023). Environmental policy integration in a newly established natural resource-based sector: The role of advocacy coalitions and contrasting conceptions of sustainability. Policy Sciences, 56(1), 69–93.

    Article  Google Scholar 

  • Kern, F., & Howlett, M. (2009). Implementing transition management as policy reforms: A case study of the Dutch energy sector. Policy Sciences, 42(4), 391–408.

    Article  Google Scholar 

  • Lambelet, S. (2023). Unintended policy integration through entrepreneurship at the implementation stage. Policy Sciences, 56(1), 161–189.

    Article  Google Scholar 

  • May, P. (2015). Implementation failures revisited: Policy regime perspectives. Public Policy and Administration, 30(3–4), 277–299.

    Article  Google Scholar 

  • May, P., & Jochim, A. (2013). Policy regime perspectives: Policies, politics, and governing: policy regime perspectives. Policy Studies Journal, 41(3), 426–452.

    Article  Google Scholar 

  • Pressman, J. L., & Wildavsky, A. (1984). Implementation. University of California Press.

    Google Scholar 

  • Quinquenal, M. (2021). Memoria quinquenal del sistema Nacional de Cuidados. Montevideo.

    Google Scholar 

  • Ranci, C., & Arlotti, M. (2019). Resistance to change. The problem of high non-take up in implementing policy innovations in the Italian long-term care system. Policy & Society, 38, 572–588.

    Article  Google Scholar 

  • Rayner, J., & Howlett, M. (2009). Conclusion: Governance arrangements and policy capacity for policy integration. Policy and Society, 28(2), 165–172.

    Article  Google Scholar 

  • Sager, F., & Gofen, A. (2022). The polity of implementation: Organizational and institutional arrangements in policy implementation. Governance, 35, 347–364.

    Article  Google Scholar 

  • Salvador, S. (2019). The national integrated care system in Uruguay: An opportunity for the economic empowerment of women. UN-Women.

    Google Scholar 

  • Torres, A., Lopez Boo, F., Parra, V., Vazquez, C., Segura-Pérez, S., Cetin, Z., & Pérez-Escamilla, R. (2018). ‘Chile Crece Contigo: Implementation, results, and scaling-up lessons: Chile Crece Contigo: Lessons learned. Child: Care Health and Development, 44(1), 4–11.

    Article  Google Scholar 

  • Tosun, J., & Lang, A. (2017). Policy integration: Mapping the different concepts. Policy Studies, 38(6), 553–570.

    Article  Google Scholar 

  • Trein, P., & Maggetti, M. (2019). Patterns of policy integration and administrative coordination reforms: A comparative empirical analysis. Public Administration Review, 80, 198–208.

    Article  Google Scholar 

  • Trein, P., Biesbroek, R., Bolognesi, T., Cejudo, G., Duffy, R., Hustedt, T., & Meyer, I. (2021). Policy coordination and integration: A research agenda. Public Administration Review, 81(5), 973–977.

    Article  Google Scholar 

  • Vince, J. (2015). Integrated policy approaches and policy failure: The case of Australia’s Oceans Policy. Policy Sciences, 48(2), 159–180.

    Article  Google Scholar 

  • World Bank. (2018). 10 years of chile grows with you (Chile Crece Contigo): Key components and lessons learned for the setting up of comprehensive child development support systems. World Bank Group.

    Google Scholar 

  • Bachelet, M. (2017). “Chile Crece Contigo a 10 años de su inicio”. Retrieved from: https://bernardvanleer.org/es/epi/2017/chile-crece-contigo-10-years/.

  • Consejo Nacional de Políticas Sociales [CNPS] (2009) De la Emergencia a la Equidad Social: Las políticas sociales del Gobierno Nacional (2005–2009).

  • Economic Commission for Latin America and the Caribbean [ECLAC] (2011). El desafío de un sistema nacional de cuidados para el Uruguay. https://repositorio.cepal.org/bitstream/handle/11362/7022/1/S1100468_es.pdf.

  • En Perspectiva. (2020). Julio Bango: Fusionar la Secretaría de Cuidados con el Pronadis es “ineficiente”. YouTube. https://www.youtube.com/watch?v=gY1XQtzA_Ao.

  • Food and Agriculture Organization (FAO). (2002). Integrated Food Security Strategy for South Africa. Retrieved from: https://www.fao.org/faolex/results/details/en/c/LEX-FAOC149624/.

  • Grupo de Trabajo Interinstitucional. (2012). Hacia un Modelo Solidario de Cuidados. Propuesta para la Construcción de un Sistema Nacional de Cuidados. Ministerio de Desarrollo Social de Uruguay. http://dspace.mides.gub.uy:8080/xmlui/bitstream/handle/123456789/434/465_2012_Hacia%20un%20modelo%20solidarios%20de%20cuidados.%20Sistema%20Nacional%20de%20Cuidados.pdf?sequence=1&isAllowed=y.

  • International Decade for Action “Water for Life”-United Nations (UN-Water). (2022). Retrieved from: https://www.un.org/waterforlifedecade/iwrm.shtml.

  • Junta Nacional de Cuidados. (2015). Plan Nacional de Cuidados 2016–2020. Uruguay. Retrieved from: https://siteal.iiep.unesco.org/sites/default/files/sit_accion_files/siteal_uruguay_0492.pdf.

  • La Cuarta. (2019). Chile a tres años de la muerte de Lissette Villa. Retrieved from: https://www.lacuarta.com/cronica/noticia/chile-tres-anos-la-muerte-lissette-villa/368879/.

  • La Diaria. (2021). “Alerta social” sobre la situación del Sistema de Cuidados: organizaciones denuncian un debilitamiento y critican al gobierno. Retrieved from: https://ladiaria.com.uy/politica/articulo/2021/11/alerta-social-sobre-la-situacion-del-sistema-de-cuidados-organizaciones-denuncian-un-debilitamiento-y-critican-al-gobierno/.

  • La Tercera. (2018). Más de 12 mil menores han sufrido abusos sexuales o violación en Chile desde el 2012. Retrieved from: https://www.latercera.com/noticia/mas-12-mil-menores-sufrido-abusos-sexuales-violacion-chile-desde-2012/.

  • Maor, M., & Howlett, M. (2021). Policy instrument interactions in policy mixes: Surveying the conceptual and methodological landscape. Available at SSRN 3790007.

  • Marzonetto, G. (2019). La política de los programas de cuidado infantil en América Latina: Un análisis comparado de Argentina, Chile y Uruguay (2005–2015).

  • Milman, H., Castillo, C., Sansotta, A., Delpiano, P., and Murray, J. (2018). Scaling up an early childhood development programme through a national multisectoral approach to social protection: Lessons from Chile Crece Contigo. BMJ k4513

  • Ministry of Social Affairs and Employment of the Netherlands (EUNL). (2016). Integrated approaches to combating poverty and social exclusion. Best practices from EU Member States. Retrieved from: https://ec.europa.eu/social/BlobServlet?docId=15732&langId=en.

  • Molina H., Castillo, C., Sansotta, A., Delpiano, P. & Murray, J. (2018). Scaling up an early childhood development programme through a national multisectoral approach to social protection: lessons from Chile Crece Contigo, BMJ, 363.

  • National Health Service England [NHS]. (2022). “What are integrated care systems?” Retrieved from: https://www.england.nhs.uk/integratedcare/what-is-integrated-care/.

  • Raczynski, R. (2008). Sistema Chile Solidario y la política de protección social de Chile. Lecciones del pasado y agenda para el futuro. https://socialprotection.org/sites/default/files/publications_files/438.pdf.

  • Red Pro Cuidados. (2021). Carta abierta de la Red Pro Cuidados a Martín Lema. Retrieved from: http://www.redprocuidados.org.uy/carta-abierta-de-la-red-pro-cuidados-a-martin-lema/.

  • Salvador, S. (2010). “Hacia un Sistema Nacional de Cuidados”. Retrieved from: https://uruguay.unfpa.org/sites/default/files/pub-pdf/6_file1.pdf.

  • Sustainable Development Goals-United Nations [SDGS-UN]. (2022). Retrieved from: https://sdgs.un.org/topics/poverty-eradication.

  • United Nations. (2020). Inquiry concerning Chile under article 13 of the Optional Protocol to the Convention on the Rights of the Child on a communications procedure. Retrieved from: https://opic.childrightsconnect.org/wp-content/uploads/2022/01/G2011017.pdf.

Download references

Acknowledgements

We thank Philipp Trein for his helpful comments on an earlier version of this manuscript presented at the 5th International Conference on Public Policy (ICPP5) in 2021 as well as other participants in the panel on policy integration. We would also like to thank current and former public officials in Chile and Uruguay who agreed to be interviewed. Gabriela Marzonetto provided crucial insights and ideas about relevant actors in both countries. Three anonymous reviewers offered insightful and constructive feedback. Cejudo thanks Columbia University’s Institute for Latin American Studies, where he was a visiting scholar while writing this article. He is also grateful to the New York Public Library’s Center for Research in the Humanities, where part of this research was carried out.

Author information

Authors and Affiliations

  1. Center for Research and Teaching in Economics (CIDE), Carretera México-Toluca 3655, 01210, Mexico City, Mexico

    Guillermo M. Cejudo

  2. Hertie School, Friedrichstraße 180, 10117, Berlin, Germany

    Cynthia L. Michel

Authors
  1. Guillermo M. Cejudo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cynthia L. Michel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guillermo M. Cejudo.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cejudo, G.M., Michel, C.L. Implementing policy integration: policy regimes for care policy in Chile and Uruguay. Policy Sci 56, 733–753 (2023). https://doi.org/10.1007/s11077-023-09507-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11077-023-09507-4

Keywords

Search

Navigation