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The Promise and Reality of Public Sector Reform – A Case Study of the Implementation of Trinidad and Tobagos Health Sector Reform

Jochelle Greaves Siew

Jochelle Greaves Siew 1

  1. The London School of Economics and Political Science, UK. 1

on Google Scholar
on PubMed

Pages: 94-111

DOI: 10.18488/journal.74.2020.72.94.111

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Article History:

Received: 15 October, 2020
Revised: 09 November, 2020
Accepted: 24 November, 2020
Published: 21 December, 2020


This research examines the relationship between control mechanisms selected for use by central governments during the implementation of public sector reform and the successful implementation of said reform. This investigation is carried out in light of a case study, namely Trinidad and Tobago’s health sector reform. Previous research either offers a descriptive account of what conditions are necessary for perfect implementation or focuses on the debate between top-down and bottom-up approach supporters in terms of controlling implementation. Drawing on both sets of literature, this study goes further by offering insights into the importance of government control over public sector reform implementation by contributing a fresh perspective to existing research – recognition that the actions of the central government can constitute more important explanations for the outcome of public sector reform than those of the implementers. This paper presents relevant interdependent elements needed for determining what type of control mechanisms should be used to control implementing bodies, which include central acceptance of delegated tasks, balance between control and discretion, clear roles and performance goals that accurately reflect policy intent, objective measurement and effective monitoring, and a simple implementation structure. It is found that control mechanisms need to be planned and performed in light of the intent and performance goals of the reform in order for said reform to be successful. These findings provide policymakers with knowledge on how control mechanisms can be better employed in order to improve the performance of the public sector under the reform.
Contribution/ Originality
This study provides an original investigation into how governments can better select and employ control mechanisms during policy implementation to improve the performance of public sectors under reform. It further demonstrates that central governments actions constitute more significant explanations for outcomes of public sector reform than those of its implementers.


Implementation theory, Public sector reform, Textual analysis, Framework design, Organisational control, Organisational change.


Bahall, M. (2012). Reform of the trinidad and tobago health service: The limits of decentralisation. Social and Economic Studies, 61(4), 105-129.

Barzelay, M. (2003). The process dynamics of public management policy change. International Public Management Journal, 6(3), 251-402.

Bauer, M., Süerdem, A., & Bicquelet, A. (2018). Textual analysis. London, UK: Sage.

Bissessar, A. (2008). External agencies and domestic reform: The case of the health sector in Trinidad and Tobago’ In AM Bissessar (ed) governance and institutional re-engineering (pp. 245-261). Newcastle Upon Tyne, UK: Cambridge Scholars Publishing.

Bossert, T. (1998). Analyzing the decentralization of health systems in developing countries: Decision space, innovation and performance. Social Science and Medicine, 47(10), 1513-1527.Available at:

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.Available at:

Brehm, J., & Gates, S. (1997). Working, shirking, and sabotage: Bureaucratic response to a democratic public. Ann Arbor, MI: Univ. of Michigan Press.

Caiden, G. (1978). Administrative reform: A prospectus. International Review of Administrative Sciences, 44(1), 106-120.Available at:

Cassels, A. (1993). Perspectives on health sector reform’ In WHO In Health sector reform, Report on a consultation, WHO.

Cassels, A. (1995). Health sector reform: Key issues in less developed countries. Journal of International Development, 7(3), 329-347.Available at:

Conteh, F. (2016). The promise and reality of decentralization: A critical appraisal of Sierra Leone’s primary health care system. Critical African Studies, 8(3), 350-369.Available at:

Elmore, R. (1978). Organizational models of social program implementation. Public Policy, 26(2), 185-228.

Elmore, R. (1979). Backward mapping: Implementation research and policy decisions. Political Science Quarterly, 94(4), 601-616.Available at:

Fayol, M. (1949). General and industrial management. London, UK: Pitman.

Finer, H. (1941). Administrative responsibility in democratic government. Public Administration Review, 1(4), 335-350.Available at:

Galbraith, J. (1977). Organization design. Reading, MA: Addison-Wesley Publishing.

Gilson, L. (2015). Michael Lipsky, street level bureaucracy: Dilemmas of the individual in public service’ In M Lodge et al (eds). The Oxford Handbook of Classics in Public Policy and Administration (pp. 383-404). Oxford, UK: OUP.

Government of Trinidad, & Tobago Ministry of Finance. (2019). Trinidad & Tobago 2019/2020 Budget Highlights.

Guardian. (2016). Hospitals at crisis point’. July 17. Retrieved from: .

Hood, C. (1976). The limits of administration. London, UK: Wiley.

Hupe, P. (2008). Implementation. In H.K. Colebatch & R. Hoppe (eds). Handbook on Policy, Process and Governing (pp. 169-185). Chelthenham, UK: Edward Elgar.

Kelman, S. (2007). Improving service delivery performance in the United Kingdom: Organization theory perspectives on central intervention strategies. Journal of Comparative Policy Analysis: Research and Practice, 38(4), 93-419.

Kingdon, J. (1995). Agendas, alternatives and public policies (2nd ed.). NY: HarperCollins.

Lipsky, M. (1980). Street-level bureaucracy: Dilemmas of the individual in public services. NY: Russell Sage.

Liwanag, H., & Wyss, K. (2018). What conditions enable decentralization to improve the health system? Qualitative analysis of perspectives on decision space after 25 years of devolution in the philippines. PLOS One, 13(11), 1-20.Available at:

May, P. (2014). Implementation failures revisited: Policy regime perspectives. Public Policy and Administration, 30(3/4), 277-299.Available at:

Mintzberg, H. (1978). The structuring of organizations. Pearson.

Nadler, D., & Tushman, M. (1988). Strategic organization design: Concepts tools and processes. Foresman and Company.

Nilsen, P., Ståhl, C., Roback, K., & Cairney, P. (2013). Never the twain shall meet? - a comparison of implementation science and policy implementation research. Implementation Science, 8(1), 63–75.Available at:

Niskanen, W. (1971). Bureaucracy and representative government. Chicago, IL: Aldine-Atherton.

Pan American Health Organisation. (2017). Trinidad and Tobago. Retrieved from: . [Accessed December 15, 2020].

Pan American Health Organisation. (2018). No direct maternal deaths reported in Trinidad and Tobago in 2018. Retrieved from: . [Accessed December 15, 2020].

Pierre, J., & Peters, B. (2017). The shirking bureaucrat: A theory in search of evidence? Policy & Politics, 45(2), 157-172.Available at:

Rafeeq, H., & Paul, R. (2000). Health sector reform in the republic of trinidad and tobago. Pan American Journal of Public Health, 8(1/2), 45-54.

Trinidad, & Tobago Parliament. (2014). Review of the regional health authority system in Trinidad and Tobago. Retrieved from: . [Accessed December 15, 2020].

Trinidad, & Tobago Parliament. (2015a). Review of the regional health authority system in Trinidad and Tobago. Retrieved from: . [Accessed December 15, 2020].

Trinidad, & Tobago Parliament. (2015b). Review of the regional health authority system in Trinidad and Tobago. Retrieved from: . [Accessed December 15, 2020].

Trinidad, & Tobago Parliament. (2015c). Review of the regional health authority system in Trinidad and Tobago. Retrieved from: . [Accessed December 15, 2020].

Trinidad, & Tobago Parliament. (2015d). Review of the regional health authority system in Trinidad and Tobago. Retrieved from: . [Accessed December 15, 2020].

Trinidad and Tobago Ministry of The Attorney General and Legal Affairs. (2011). Regional health authorities act (1994, 2011). (Chap. 29:05). Retrieved from: [Accessed December, 15, 2020].

Trinidad and Tobago Parliament. (2017). Establish joint select committee to review levels of health care delivery. Retrieved from: . [Accessed December 15, 2020].

Trinidad and Tobago Registers Nurses Association. (2019). Acute staff shortage at NCRHA. Retrieved from: [Accessed December 15, 2020].

Wegrich, K. (2015). Jeffrey L. Pressman and Aaron B. Wildavsky, Implementation. In M Lodge et al (eds): The Oxford Handbook of Classics in Public Policy and Administration (pp. 342-358). Oxford, UK: OUP.


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This study received no specific financial support.

Competing Interests:

The author declares that there are no conflicts of interests regarding the publication of this paper.


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