Latin American countries struggle with high levels of inequality, clientelism, and insecurity, partly because of weak institutions that are unable to provide basic services. Many academic and media outlets focus on these challenges for development. Against this backdrop, the two books reviewed here tell a success story. They examine the causes of successful state capacity building in Brazil. In When Democracies Deliver: Governance Reform in Latin America, Katherine Bersch accounts for effective public sector reform in Brazil (and failure in Argentina), and in Movement-Driven Development: The Politics of Health and Democracy in Brazil, Christopher Gibson explains the causes of health improvements. Both authors agree that developing institutional capacity takes time, so they trace policy development over more than two decades. They also both agree that successful institutional reform has to happen within the state. For Bersch, the agents of change are “insider” technocrats, whereas for Gibson they are activists in the state (“pragmatic publics”). Both books should be mandatory reading for anyone interested in the long-term process of building successful state capacity amidst adversity.

Bersch is interested in explaining when and how Latin American states develop strong, accountable, and transparent institutions. This is a crucial question because stronger institutions deliver better and more services to the population. Gibson’s focus is on the consequences of these strong, accountable institutions, asking how Brazil’s cities increased their residents’ access to health care and reduced infant mortality rates since the mid-1980s. The answer to both authors’ questions lies in long-term state capacity building. Bersch studies the effectiveness and durability of changes across 25 years in Argentina’s and Brazil’s health and transportation sectors and finds that incremental change strengthens institutions more than do structural overhauls. Civil servants in place for long periods of time are crucial for supporting slow (and successful) change. Similarly, for Gibson the answer lies in long-term subnational officeholding by pragmatic activists over a span of 30 years. Both time and actors inside the state are key for guaranteeing successful institutional reforms and a reduction in infant mortality.

Gibson’s Movement-Driven Development focuses on social movement activists in the state as the main motor of social development in Brazil. He argues that Brazil was able to increase health access and reduce infant mortality by 70% because the health care movement’s (Movimento Sanitário) activists held office atop the subnational state. These practically minded actors—“pragmatist publics”—mobilized ideologically diverse political parties to set up institutions that maintained the ideals of the constitutional reform with the goal of continuing to occupy those institutions in the future. More specifically, Gibson shows how members of this movement (“sanitaristas”) had a state-building project in mind: they leveraged public health directorships in cities to expand their capacity to provide basic public health. This is his main theoretical contribution: although previous studies have emphasized the role of the sanitaristas in the advancement of a universal, decentralized, and participatory health system in Brazil, this book systematically conceptualizes these civil society actors and state–society relations as pragmatic. In this way, these are different from Leonardo Avritzer’s “participatory publics” analyzed in Participatory Institutions in Democratic Brazil (2009). The goal of the “pragmatist publics” is not to involve the population in policy making but to create institutions that will favor their own members to hold positions within them. These actors seek social change, but achieve it through occupying important positions in the bureaucracy; they are also able to produce change by working with ideologically moderate politicians. Pragmatist publics leverage their privileged position and fluency in the language of political elites to the advantage of their cause (“social code-switching”).

Gibson’s goal is to explain subnational variation in health development across Brazil’s major cities. Social development is maximized under two conditions: a lack of monopolistic control over the subnational executive by far-right clientelist parties and pragmatist publics’ long-term occupation of democratic offices. The book identifies three trajectories of participation for civil society, or “health democratization.” First, in a “participatory programmatic” trajectory (in Belo Horizonte, Porto Alegre, and Recife), sanitaristas occupied the health secretariat from which they and their allied populist health activists in councils strengthened the state and made it accountable to civil society. Second, in a “programmatic trajectory” (in Curitiba and Fortaleza), sanitaristas also occupied positions of power but lacked the more deeply participatory monitoring of the previous pathway. Third, in a “minimalist” trajectory (in Salvador and Rio de Janeiro), sanitaristas did not have the opportunity to occupy directorships because of the context of consistent right-wing party rule and patronage. Whereas the first two paths produced “robust development,” the third generated “non-robust development” or a local state that was unable to effectively deliver health care.

Bersch’s When Democracies Deliver is also interested in institutional development, but at the national level. Contrary to earlier understandings, Bersch shows that radical reform (the “powering” view) is less effective than piecemeal reform. Its demonstration of the cognitive-psychological microfoundations for the superiority of incremental reform is the book’s first contribution to the rational choice and historical institutionalism literatures. Wholesale reform increases the chances of making mistakes and producing more enemies. Those in charge of carrying out these reforms tend to be “outsiders” (to the public sector)—elected officials and their technocrats with less expertise; they also tend to have shorter time horizons and are thus reliant on problematic cognitive shortcuts. Conversely, gradual problem-solving reform processes tend to be conducted by experienced (“insider”) technocrats with less bounded rationality; the process allows for learning and adjustment and thus making fewer mistakes along the way. Small changes within institutions are also more sustainable and protect bureaucratic autonomy.

The second central theoretical contribution of this book is to embed these microfoundations for reform success into broader macrofoundations. Bersch finds that wholesale reform is adopted more frequently in the health and transportation sectors of Argentina than in Brazil. Along the lines of Arend Lijphart’s consensus and majoritarian Patterns of Democracy (1999), coalition multiparty governments in Brazil promote gradual change, whereas single-party cabinets in Argentina encourage radical reform. Power concentration produces informational shortcuts and rapid reform because election cycles are short, high-level appointees leave with the executive, and reform is easy due to like-minded and cohesive groups of appointees. These powering reforms generate crisis and, consequently, a new round of wholesale reform. Conversely, power sharing in coalitional presidentialism slows down reform processes, produces less extreme proposals, includes permanent technocrats, and allows for deliberation and loosening the bounds of rationality

Both works are excellent examples of the importance of extensive field research in political science. Over a span of four years, Bersch conducted more than 200 interviews with ministers, policy makers, politicians, and members of civil society, among others. She analyzed these qualitative data through a controlled comparison of Argentina’s and Brazil’s health and transport sectors and process-tracing within cases across a span of 25 years. The process-tracing is particularly powerful: it shows, for example, that the rare instances in which Argentina engaged in gradual reform and Brazil in wholesale reform produced positive and negative repercussions, respectively. Gibson conducted more than two years of fieldwork during which he collected original quantitative and qualitative data on sanitarista officeholding across time in Brazil’s major cities. He analyzed these data following a mixed-methods strategy, combining pooled time-series regressions, fuzzy sets, and subnational comparative historical analysis. All three methodological approaches aim to answer the same research question: the role of sanitaristas’ holding office in increasing access to public health and reducing infant mortality. The regression identified associations, the fuzzy sets specified conditions, and the case studies explained the mechanisms by which holding office leads to social development.

These two books nicely complement and challenge each other in a number of ways that merit further research. On the one hand, Bersch shows that overhaul reforms are decidedly inferior to gradual change. In Gibson’s case, however, sanitaristas’ influence emerges in the context of a complete overhaul of the system: a transition to democracy, a constitutional reform, and a sweeping health reform (as Lindsay Mayka convincingly shows in Building Participatory Institutions in Latin America, 2019). One may wonder whether the sanitaristas’ type of influence was uniquely successful because of this window of opportunity that entirely reformed the system. Although it took years for the institutions discussed in Gibson’s book to be consolidated, the structural reform of federal legislation is partly what started this process and what, arguably, made it successful. In other words, is it possible that a wholesale reform succeeds in the long term in the presence of “pragmatic publics”? On the other hand, whereas Bersch’s focus is on the national level, Gibson studies the local level. This difference opens up questions regarding the unit of analysis of each of these books. Does Movement-Driven Development travel to the national level? In scaling up the unit of analysis, it is plausible to argue that having pragmatist activists occupy top offices at the national level also strengthens state institutions. Santiago Anria’s findings in When Movements Become Parties (2018) seem to point in that direction. In the case of When Democracies Deliver, scaling down the unit of analysis would mean incorporating the possibility that slow institutional change emerges from the subnational level, especially in the case of the large two federations included in this book.