A Temporal Analytical Approach to Decentralization: Lessons from Brazil’s Health Sector Eduardo Gómez Brown University Abstract This article introduces a new concept to the study of decentralization processes: policy dynamism. At its core is the notion that the sequential and temporal process of health decentralization affect the nature of intergovernmental relationships and municipal bureaucratic capacity. Examining the case of Brazil, I argue that the rush to decentralize health services to municipalities has, in the absence of sufficient financial and technical assistance from the federal and state governments, increased state-municipal conflict over the management of health policy, limiting municipalities’ ability to increase bureaucratic capacity. Consequently, some states have attempted to recentralize reforms, generating further conflict between both subnational levels of government. While some municipalities have tried to overcome these problems by creating associations and working with international organizations, several bureau- cratic obstacles remain. This article attributes these outcomes not to federal institu- tions and economic constraints (the traditional approach in the literature) but rather to the noninstitutional, temporal policy dynamics of decentralization. Introduction Developing nations are now seeking to improve the provision of social services by decentralizing those services to state and municipal govern- ments (Kaufman and Nelson 2004; Samuels and Montero 2003; Smoke, Gómez, and Peterson 2006; Haggard and Kaufman, forthcoming; Burki, Perry, and Dillinger 2000). The Federal Republic of Brazil is a perfect example of this. While the government decentralized fiscal and financial powers to the states shortly after independence in 1889, it only recently began devolving new welfare functions to states and municipalities. Journal of Health Politics, Policy and Law, Vol. 33, No. 1, February 2008 DOI 10.1215/03616878-2007-047 © 2008 by Duke University Press JHPPL331_05-Gomez.indd 53 9/27/07 1:12:18 PM