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This qualitative study aims to examine key stakeholders' perspectives of primary care group/trust prescribing strategies. Within the context of general practice prescribing, the paper also debates the wider issue of whether GPs' prescribing autonomy is under threat from managerial expansion following recent organisational changes in primary care.

Data were obtained from focus groups and a series of individual semi‐structured interviews with GPs and key primary care organisation stakeholders.

The data underlie a tension between the managerial objective of cost‐restraint and GPs' commitment to quality improvement and individual clinical patient management. In presenting both managerial and medical narratives, two divergent and often conflicting discourses emerge, which leads to speculation that managerial attempts to constrain prescribing autonomy will achieve only limited success. The contention is that GPs' discourse features as a challenge to a managerial discourse that reflects attempts to regulate, standardise and curtail clinical discretion. This is due not only to GPs' expressed hegemonic ideals that clinical practice centres on the interests of the individual patient, but also to the fact that the managerial discourse of evidence‐based medicine encapsulates only a limited share of the knowledge that GPs draw on in decision making. However, while managers' discourse presented them as unwilling to impose change or directly challenge clinical practice, evidence also emerged to suggest that is not yet possible to be sufficiently convinced of the future retention of prescribing autonomy. On the other hand, the use of peer scrutiny posed an indirect managerial influence on prescribing, whilst the emergence of prescribing advisors as analysts of cost‐effectiveness may threaten doctors' dominance of medical knowledge.

There is a continuing need to analyse the impact of the new managerial reforms on primary care prescribing.

This study provides a snapshot of managerial and GP relations at a time of primary care transition.

Informed by the literature on regional security and fragile states, ‘new regionalisms’, and natural resources and violent conflict, this essay investigates the challenges of state-building in West Africa. These range from the influence of diasporas and subregional strongmen to flows of small arms and light weapons (SALWs) and lootable natural resources. The analytical framework that links patron–client networks and lootable natural resources is applied to the cases of Sierra Leone and Côte d’Ivoire. In recent years, strategies by African leaders to co-opt subregional strongmen as part of patronage networks have failed. The essay finds that an ossified state presence and the erosion of a leader's influence enables subregional strongmen to gain control over valuable natural resources, such as diamonds. The essay then assesses the impact of the Kimberley Process Certification Scheme (KPCS) on state-building, concluding that although international regimes like the KPCS can increase state capacity and thereby counter the deleterious effects of state failure, they are not sufficient state-building tools. Hence, the KPCS must be supplemented through a combination of more explicit state-building initiatives under the auspices of bilateral government donors, aid agencies, diasporas and transnational and local NGOs.

It is commonly recognized that the transition to democracy in Korea was associated with economic progress. However, not many scholars have given attention to the role of bureaucracy during the process of democratization, due to the fact that bureaucracy is usually thought of as belonging to politics, not democracy. As a refutation of this general view, first, this chapter argues that bureaucracy has been an important contributor to political modernization. Since the post-1945 period, the ‘ceiling’ strategy, which limits the total number of civil servants, was introduced into the personnel management method and system of checks and balances to limit undue political influence over staffing and to control bureaucratic expansion. Second, through this strategy as policy, the bureaucracy legitimately tried to avoid undemocratic political power by standardized process and allow coordination. The ceiling policy is originally the product of historical context during colonial and authoritarian period, but the bureaucracy utilizes it as the instrument to reduce corruption. The contribution of this chapter is provoking the new insights about democratization from bureaucrat’s perspective which is rarely highlighted.

Korea is a highly centralized country where most administrative functions are carried out by the central government in Seoul. Increasingly, however, local governments have been given greater autonomy in their operations. This chapter examines how the ideal values of political decentralization have interacted with the country’s local bureaucracy, which inherently has dark side in itself. The focus is on how local government employees have contributed, or responded, to the democratic change of their communities, particularly since the 1980s. At the outset, the experiences of Korea’s decentralization and local autonomy are briefly reviewed. It is then examined how the bureaucrats have played in the process of democratization in terms of three features: bureaucratic power, scope, and culture. Institutionalizing competitive local bureaucracy contributed to reduce the disparity between capital regions (Seoul and its surrounded area) and noncapital regions (locals). Empowering local bureaucracy to allow own localized decision-making process was the first move of Korean governance.

Bureaucratic power – the power derived from the formal authority of the bureaucratic organization – has become a central organizing mechanism in modern societies. In this study, we develop theoretical arguments to identify institutional sources as well as limitations of bureaucratic power. We argue that the very institutional sources of bureaucratic power also cultivate the countervailing forces that set limit to the exercise of bureaucratic power in formal organizations. These arguments and considerations are illustrated in two case studies of the “inspection and appraisal” processes in the Chinese bureaucracy. Our study raises issues about organizational isomorphism and calls for a closer look at the behavioral patterns in organizational processes.

Public private partnerships (PPPs) centralize decision making into a hybrid type of firm, consisting of a government entity with a private firm, that is either a profit‐seeking or non‐profit entity, that initiates, constructs, maintains, or provides a service. The PPP model recognizes that both the public and the private sectors have certain comparative advantages in the performance of specific tasks. PPPs, grounded in cost/benefit analysis, have been used in Australia for decades and are presently being introduced in the USA as a form of innovate contracting. This paper aims to evaluate PPPs as a potentially transferable model for the delivery of public services. PPP firms are evaluated in terms of capital asset management, productive and allocative efficiency, transfer of risk between the public and private sectors, rights to the residual, and the public interest. A case study comparison of Fremantle Ports (Australia) and the Indiana Toll Road (USA) is employed to demonstrate PPP design and function.

A description and evaluation of public private partnerships (PPP) is presented and two original and primary case studies are reviewed.

A PPP functioning as a monopoly provider of a common pool public asset approximates economic efficiency when user fees cover virtually full cost. Identifying optimal output and quality assessment is more challenging in the case of social goods in which the public goal is subsidy minimization and clients cannot assess quality. Best practices are helpful; they guarantee the PPP process, but not the outcome. All PPPs, in whatever country or industry, are vulnerable to bureaucratic expansion whenever they are given access to subsidized loans underwritten by taxpayers.

The two case studies in this paper are 100 percent original; they were examined in person by the authors, and the managers of the two entities were interviewed in Indiana (USA) and Fremantle, Western Australia.

This chapter provides an assessment of how the late Portuguese colonial state (especially in Angola and Mozambique) responded to widespread conflict and anticolonial pressures. Focusing on its structures, idioms, and strategies of social transformation and control-especially as they relate to the domains of development and security-my assessment of state response emphasizes the coming together of: coercive repertoires of rule; planned developmental strategies of political, economic and social change; and processes of engineering sociocultural difference. The late colonial state’s developmental and repressive facets are critically assessed through mobilizing theoretical perspectives and empirical analysis.

The article shows that the concept of patrimonialism is useful for the analysis not only of nation-states, but also of local and imperial power structures. Highlighting the limits of empires, we consider how local conditions shaped the strategies of colonial states in the process of empire building. We argue that the strength of local patrimonial networks before colonization, coupled with the sequencing of colonial conquests, either facilitated or hindered the French colonial and imperial project. Using a comparative-historical approach based on the analysis of two cases, Algeria and Tunisia, we find that the French colonial state employed markedly differing strategies of domination in each case. In Algeria, the French initially attempted and failed to destroy local patrimonial networks and the social practices associated with them through extensive military action. The failed attempt to destroy local practices resulted in over a century of resistance and bloodshed. When military rule became too costly, the French opted instead to rely on decentralized control that used the very structures they originally sought to eradicate. With constant reminders of the misguided colonial strategy in Algeria, the French used a different form of rule in Tunisia. They incorporated the existing Tunisian bureaucracy into their own political project, using it to limit the power of local patrimonial networks and transforming them instead through the development of capitalistic agriculture. The article illustrates the importance of paying close attention to local patrimonial networks in the analysis of colonial and imperial strategies.