Political analysis of health reform in the Dominican Republic

This article examines the major political challenges associated with the ad option of health reform proposals, through the experience of one country, t he Dominican Republic. The article briefly presents the problems of the hea lth sector in the Dominican Republic, and the health reform efforts that we re initiated in 1995. The PolicyMaker method of applied political analysis is described, and the results of its application in the Dominican Republic are presented, including analysis of the policy content of the health refor m, and assessment of five key groups of players (public sector, private sec tor, unions, political parties, and other non-governmental organizations). The PolicyMaker exercise was conducted in collaboration with the national O ffice of Technical Coordination (OCT) for health reform, and produced a set of 11 political strategies to promote the health reform effort in the Domi nican Republic. These strategies were partially implemented by the OCT, but were insufficient to overcome political obstacles to the reform by late 19 97. The conclusion presents six factors that affect the pace and political feasibility of health reform proposals, with examples from the case of the Dominican Republic.