The quality of the relationship State-Social enterprise under the framework of governance and delegation: a case study about the program Hora Certa Móvel, São Paulo Municipality, from the perspective of CIES (Center of Integration for Education and Health

The fiscal crisis and new demands for public management after 1988 Constitution in Brazil made the State resorted increasingly to civil society organizations for the implementation of public policies. In Latin America and... [ view full abstract ]

The fiscal crisis and new demands for public management after 1988 Constitution in Brazil made the State resorted increasingly to civil society organizations for the implementation of public policies.
In Latin America and Brazil, the democratization showed political and social demands before repressed. Three major forces aligned themselves or countered: the need to optimize the use of public resources, the demand for the expansion of public service provision and the pressure for more transparency and social participation (VAZ , 2006).
Given this scenario, the objective of this paper is to investigate the environment that favors the existence of complex institutional arrangements in State-social enterprise partnerships from the perspective of governance structures and logistical challenges. Thus , it is proposed to answer the following research question in this article:
"How governance structures and logistical factors influence the dynamics of complex new institutional arrangements between the state and social enterprises?
For this, we analyzed the program Hora Certa Móvel, between the Municipality of São Paulo and the CSO CIES (Center for Integration of Education and Health), which works under a hybrid model with a social enterprise (Fleximedical).
This is an exploratory research, in the form of a case study conducted between June 2013 and June 2014. In order to deepen the understanding of the case, an analysis was made under two approaches, from a detailed description of the different phases in the public policy cycle:
1) the factors that determine the choice of a governance model by the government (GOLDSMITH and EGGERS, 2006);
2 ) the delegation in the logistics context ( VAZ and LOTTA , 2011) .
Generally speaking, it is noted that due to the intrinsic characteristics of the analyzed organization there is a strong attraction for partnering with the public agent in health sector: under the model proposed by Goldsmith and Eggers (2006), all factors analyzed favors the network model.
Taking into account the criteria that can guide decisions in the field of delegation of services, there is a strong trend for a delegation as well. Much of the challenges related to complex arrangements also are present in Hora Certa Móvel, as bureaucratic barriers and lack of public commitment server.
In methodological terms, for purposes of future studies, it is suggested to apply other standards such as the analysis of implementation capacity and innovation proposed by Pires and Gomide (2013). Conducting an independent quantitative research with patients is another suggestion. Finally, research on complex arrangements in the health field, such as on the Hora Certa program (regardless of the mobile mode) certainly contribute to the deepening of discussions raised here.

Keywords: Institutional arrangements, relationship State–social enterprise, public health policies, delegation, logistics, governance