Comparative Dynamics of State-Society Relations for Health Provision in Argentina, Pakistan and Singapore

We study how the political organization of society changes the provision of basic health in Argentina, Pakistan and Singapore. Our approach implies combining the analysis of social movements and the state bureaucracy to understand how a grievance (lack of good provision of health) is translated into specific state health responses when the degrees of political organization of society are different. Through this study we hope to examine how social inequality in the Global South is shaped by diverse patterns of state-society relations, bureaucratic capability, and the associational capacity of the society.

The specific dynamics between the elements of grievance, type of bureaucratic organization and degree of societal political organization change the state’s provision of health services. The countries represent three distinct types of state-society relations, illustrating interesting diverse societal dynamics and outcomes. Singapore is a case of a society whose needs are anticipated by the state bureaucracy in the provision of services, while Pakistan is the extreme opposite – an atomized society which rarely sustains the articulation of collective grievances and a bureaucracy that is more responsive to patronage. In neither country do we find effective citizenship-based claims for service delivery, although a key difference is that those services are nonetheless provided in Singapore but not in Pakistan. Lastly, Argentina represents a case in between, where the society is organized to claim for their rights, and – even though patronage is used many times – the bureaucracy responds to some of these claims in relatively successful terms. Based on this comparison we elaborate a possible explanation to one important dimension of the persistence and reduction of social inequality in health provision in the Global South.