Norms in tension: democracy and efficiency in Bangladeshi health and population sector reform

Spurred on by donors, a number of developing countries are in the midst of fundamental health and population sector reform. Focused on the performance-oriented norms of efficiency and effectiveness, reformers have paid insufficient attention to the process-oriented norms of sovereignty and democracy. As a result, citizens of sovereign states have been largely excluded from the deliberative process. This paper draws on political science and public administration theory to evaluate the Bangladeshi reform experience. It does so with reference to the norms of efficiency, effectiveness, sovereignty and democracy as a means of making explicit the values that need to be considered in order to make health and population sector reform a fair process.