• Several questions underlie the issue of the role of the state. What is the state? What does it do? How does it do it? The history of the first three-quarters of the Twentieth century can be seen as one where states held clear authority within theit holders, acquired growing functions and tended to perform thern on theit own. The lattet part of the twentieth century and early twenty-fitst century take a more porous view of the nation state, whete it has fewet ditectty performed functions and works more in partnership wirh orher actots.

  • The focus of this chapter is the process of restructuring within central government ministries. It explores the contextual factors underlying these changes - specifically the broad pressures driving organisational reform in government in general, of which ministries form only a part. The underlying assumption is that, for good or ill, many features of the restructuring process in central government ministries (whether the Ministry of Health or any other ministry) can be only fully understood by reference to this more generalised or ‘blanket’ reform process which is not tailor-made to any specific ministry.

  • Over the past two decades, governments around the world have been undertaking decentralisation in some form or other. The reasons vary. They include demands from local communities for a greater say in the government of their communiry; perceptions that bringing decision-making closer to rhose affected will produce better outcomes and greater accountability; and, less creditably, the desire of central governments to off-load some of their expenditure responsibilities.