Social policy expansion amidst limited policy capacities: The case of subnational comprehensive care systems in Latin America

Vollständiger Abstract

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Limited policy capacity is commonly expected to constrain the expansion of social policy. Yet, across Latin America, several subnational governments have expanded Comprehensive Care Systems despite persistent fiscal, organizational, and institutional constraints. How do implementing agencies expand social policy under such conditions? This paper argues that policy capacity shapes implementation through the organizational coping strategies agencies adopt when implementation demands exceed available capacities. I examine this mechanism through a comparative analysis of three subnational Comprehensive Care Systems in Bogotá (Colombia), San Pedro Garza García (Mexico), and Iztapalapa (Mexico). Drawing on more than 55 semi-structured interviews with policymakers, mid-level managers, and frontline workers, complemented by documentary evidence and field observations, the study compares how implementing agencies addressed capacity deficits while carrying out two core implementation tasks: targeting and integrated service delivery. The findings show that agencies expanded social policy through different combinations of organizational coping strategies—developing internal capacities, borrowing external capacities, and thinning-out policy mandates—which produced systematically different outcomes in terms of access, generosity and quality, and equity. Implementing agencies that primarily developed missing capacities achieved more sustainable and equitable forms of policy expansion, whereas those relying more heavily on borrowing or thinning-out were able to implement Comprehensive Care Systems under severe constraints but often at the expense of service quality, equity, or long-term sustainability. By identifying organizational coping strategies as the organizational mechanism linking policy capacity to implementation outcomes, the paper contributes to the literature on policy capacity, policy implementation, and comparative social policy.