From Eldis:

This article, in the journal Human Resources for Health, argues that the two most important World Bank health reform policies in Latin America - decentralisation and privatisation - have had a negative impact on workers' conditions of employment, and have prompted opposition from organised professionals and unions. In several countries of the region, the workforce became the most important obstacle to successful reform. The article is based on fieldwork and a review of the literature. It discusses the reasons that led health workers to oppose reform; the institutional and legal constraints to implementing reform as originally designed; the mismatch between the types of personnel needed for reform and the availability of professionals; the deficiencies of the reform implementation process; and the regulatory weaknesses of the region.

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