These questions are the subject of prolonged and often divisive debate in countries ranging from the former communist and developing states to advanced industrial nations. Proponents of increased private sector involvement in realms previously reserved for public institutions cite efficiency and the reduction of fiscal burden as the primary benefits.
Opponents cite concerns about equity.
And there is little agreement on how to reform public institutions or what the role of the state versus the private sector should be. Many emerging market countries have already launched full-fledged experiments with private sector delivery of public services. In these nations, the question is no longer whether the approach is acceptable, but what is the best way to incorporate new market incentives in a manner that improves the performance of public institutions and at the same time guarantees widespread access and minimum standards. Graham looks at social service reform initiatives in Chile, Peru, Bolivia, the Czech Republic, and Zambia, and offers analyses of salient equity, performance, and political issues. A common element among the reforms she examines is their reliance on exit and voice strategies to improve institutional performance and to create new stakeholders in the reform process.