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The COVID-19 outbreak and the municipal administration responses: resource munificence, social vulnerability, and the effectiveness of public actions

El brote de COVID-19 y las respuestas de la administración municipal: munificencia de recursos, vulnerabilidad social y efectividad de las acciones públicas

Abstract

Facing the unprecedented situation of the COVID-19 pandemic, public officials at the municipality-level have no clear benchmarks or tested policies. In this situation, decision-making becomes a controversial process. This article provides insights for public agents in the Brazilian municipalities to deal with the initial stages of the COVID-19 pandemic. We analyzed the actions taken by city halls of the 52 Brazilian municipalities at least thirty days since the first confirmed case of COVID-19. We used a fuzzy-set Qualitative Comparative Analysis (fsQCA) to identify the combinations of contextual factors and public actions that reduced COVID-19 transmission during the critical initial stage. The empirical results show three main paths to guide policy-making: (1) a plural collaboration path involving public and private sectors, operating in a fragile health system; (2) a public action path providing aid programs through intense collaboration inside public bureaucracy; and (3) a resource-based path relying on a well-structured health system.

Keywords:
COVID-19; municipality; public action

Resumen

Ante una situación sin precedentes de brote de la enfermedad por coronavirus 2019 (COVID-19), los funcionarios públicos a nivel municipal no tienen puntos de referencia claros ni políticas probadas. En esta situación, la toma de decisiones se convierte en un proceso controvertido. Este documento proporciona información para que los agentes municipales brasileños puedan hacer frente a las etapas iniciales del brote de COVID-19. Analizamos las acciones tomadas por los ayuntamientos de los 52 municipios brasileños que llevaban al menos treinta días desde el primer caso confirmado de COVID-19. Utilizamos un análisis cualitativo comparativo de conjunto difuso (fsQCA) para identificar las combinaciones de factores contextuales y acciones públicas que redujeron la transmisión de la COVID-19 durante la etapa inicial crítica. Los resultados empíricos muestran tres caminos principales para guiar la formulación de políticas: (1) un camino de colaboración plural que involucre a los sectores público y privado en presencia de un sistema de salud frágil; (2) una vía de acción pública que proporcione programas de ayuda a través de una intensa colaboración dentro de la burocracia pública; y (3) una ruta basada en los recursos de un sistema de salud bien estructurado.

Palabras clave:
COVID-19; municipios; acción pública

Resumo

Diante de uma situação sem precedentes do surto da doença do coronavírus 2019 (COVID-19), os agentes públicos no nível do município não têm referências claras ou políticas testadas. Nessa situação, a tomada de decisão pode se tornar um processo controverso. Este artigo fornece subsídios para gestores municipais lidarem com os estágios iniciais do surto de COVID-19. Analisamos as ações das prefeituras de todos os 52 municípios brasileiros com pelo menos trinta dias desde o primeiro caso confirmado da COVID-19. Utilizamos a fuzzy-set Comparative Qualitative (fsQCA) para identificar as combinações de fatores contextuais e ações públicas que reduziram a transmissão da COVID-19 durante o estágio inicial crítico. Os resultados empíricos mostram três caminhos principais para orientar a formulação de políticas: (1) um caminho de colaboração plural que envolve os setores público e privado na presença de um sistema de saúde frágil; (2) um caminho de ação pública que forneça programas de ajuda através de intensa colaboração dentro da burocracia pública; e (3) um caminho baseado nos recursos de um sistema de saúde bem estruturado.

Palavras-chave:
COVID-19; municípios; ação pública

1. INTRODUCTION

What is the best response from a local government in the early stages of a pandemic? The pandemic of the coronavirus disease 2019 (henceforth COVID-19) is an unprecedented situation in modern times. The serious threat to public health promotes the debate about actions taken by government officials. However, without consolidated and tested policies, decision-making becomes a controversial process. In this context, specific information or action can be considered either exaggerated, worrying, or insufficient, depending on the perspective of the analyst (Melo & Cabral, ForthcomingMelo, C., & Cabral, S. (Forthcoming). Pandemics and Communicaton: A Randomized Control Trial Assessment. Revista de Administração Pública, [in press - early view].). Despite the great number of studies regarding the epidemiological aspect of COVID-19, the evidence of the effectiveness of government acts is still scarce.

Until April 16th, 2020, when we started the data collection process for this study, Brazil had almost 29,000 confirmed cases of COVID-19 and more than 1,700 reported deaths. The first case appeared in the city of São Paulo on February 25th. Since then, 1,152 municipalities have been dealing with at least one confirmed case of COVID-19. It took 51 days for coronavirus spread to more than 20% of the municipalities in a country of continental size. Brazil is large and heterogeneous, and the municipal governments face the COVID-19 outbreak in quite different contexts and possess a diverse set of resources and capabilities. This article is an attempt to identify which public administration actions, at the municipality level, have reduced the spread of COVID-19 more successfully.

To do this, we collected data from 52 Brazilian municipalities where at least thirty days had passed since the first COVID-19 case was confirmed on April 16th. We focused on the first 30-day period because we understand that acts taken during this initial phase would have a lasting impact, given the exponential spread of the disease. In the data collection process, we developed measurements to capture two broad conditions in each municipality, namely: (i) the contextual features of the municipality; and (ii) the governance structures and actions taken by the city halls in the fight against the disease. As one could imagine, there is not a silver-bullet to succeed in the fight against COVID-19. Therefore, it would be naïve to search for a unique solution for public administration efforts. Thus, instead of relying on econometric techniques, we used the fuzzy-set Qualitative Comparative Analysis (fsQCA), which identifies the different possible paths leading to success. In other words, fsQCA enables us to arrive at different combinations of conditions (aka. solutions) that simultaneously lead to a successful outcome, in our case, a reduction in the spread of COVID-19.

The empirical evidence identifies three main paths consistent with the reduction in transmission of COVID-19 during the initial stages of the outbreak. The first path taken to avoid the spread of the virus was developing plural collaboration across public units and involving private sector partners to compensate for the lack of specialized resources. We call this path the plural collaboration path. The second path is the implementation of government aid programs through collaboration within the public sector to overcome the lack of health resources and the social vulnerability of the local population. We call this path the public action path. Finally, the third path is the reliance on the well-structured public-health system and coordination settings within a single public unit. We call this the resource-based path.

2. PUBLIC ADMINISTRATION AND THE RESPONSES TO COVID-19 OUTBREAK

Although COVID-19 is a still new disease of little-known parameters, the medical and scientific communities quickly reached consensus on practical measures to reduce transmission and react to the outbreak1 1 World Health Organization: all technical guidance documents regarding COVID-19 can be found here https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance. . Until now, some principles are guiding government officials, including: (i) isolation of confirmed and suspected cases as well as tracing who had contact with a potential virus carrier (Hellewell et al., 2020Hellewell, J., Abbott, S., Gimma, A., Bosse, N. I., Jarvis, C. I., Russell, T. W., … van Zandvoort, K. (2020). Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts. The Lancet Global Health, 8(4), e488-e496. Retrieved from https://doi.org/10.1016/S2214-109X(20)30074-7
https://doi.org/10.1016/S2214-109X(20)30...
); (ii) mobilization of human and material health resources, given that the quick proliferation of the disease leads to an overwhelming number of hospitalizations, and the possible subsequent collapse of the health system (Remuzzi & Remuzzi, 2020Remuzzi, A., & Remuzzi, G. (2020). COVID-19 and Italy: what next? The Lancet, 395(10231), 1225-1228. Retrieved from https://doi.org/10.1016/S0140-6736(20)30627-9
https://doi.org/10.1016/S0140-6736(20)30...
); and (iii) generalized social distancing or quarantine, to prevent the proliferation of the disease and to alleviate the burden on the health system, i.e. flattening the spread over time (Lazzerini & Putoto, 2020Lazzerini, M., & Putoto, G. (2020). COVID-19 in Italy: momentous decisions and many uncertainties. The Lancet Global Health, 8(5), e641-e642. Retrieved from https://doi.org/10.1016/S2214-109X(20)30110-8
https://doi.org/10.1016/S2214-109X(20)30...
). From the public administration standpoint, these principles are converted into practical actions, under locational specific conditions.

Contextual conditions. In the public administration literature, the context interacts with the management practices to impact the performance (O’Toole & Meier, 2015O’Toole, L. J., & Meier, K. J. (2015). Public Management, Context, and Performance: In Quest of a More General Theory. Journal of Public Administration Research and Theory, 25(1), 237-256. Retrieved from https://doi.org/10.1093/jopart/muu011
https://doi.org/10.1093/jopart/muu011...
). The availability of resources in the surroundings is called environmental resource munificence. When resources are abundantly found, a larger number of opportunities are in place, and this increases the organization’s performance (Andrews, 2009Andrews, R. (2009). Organizational Task Environments and Performance: An Empirical Analysis. International Public Management Journal, 12(1), 1-23. Retrieved from https://doi.org/10.1080/10967490802646813
https://doi.org/10.1080/1096749080264681...
). In the COVID-19 outbreak, more specifically, the availability of health resources is critical not only to identify and monitor the suspected cases but also to care for critically ill patients (Armocida et al., 2020Armocida, B., Formenti, B., Ussai, S., Palestra, F., & Missoni, E. (2020). The Italian health system and the COVID-19 challenge. The Lancet Public Health, 5(5), e253. Retrieved from https://doi.org/10.1016/S2468-2667(20)30074-8
https://doi.org/10.1016/S2468-2667(20)30...
; Ji et al., 2020Ji, Y., Ma, Z., Peppelenbosch, M. P., & Pan, Q. (2020). Potential association between COVID-19 mortality and healthcare resource availability. The Lancet Global Health, 8(4), e480. Retrieved from https://doi.org/10.1016/S2214-109X(20)30068-1
https://doi.org/10.1016/S2214-109X(20)30...
).

Another relevant contextual condition in the COVID-19 outbreak is the social vulnerability of the local population. Public health problems are frequently more severe in locations where high percentages of citizens live in socially vulnerable conditions (Ahmed, Ahmed, Pissarides, & Stiglitz, 2020Ahmed, F., Ahmed, N., Pissarides, C., & Stiglitz, J. (2020, April 02). Why inequality could spread COVID-19. The Lancet Public Health, 5(5), e240. Retrieved from https://doi.org/10.1016/S2468-2667(20)30085-2
https://doi.org/10.1016/S2468-2667(20)30...
). For instance, there is a current debate in England and in the USA investigating if ethnic minorities are dying of COVID-19 in disproportionately higher numbers than white people2 2 Retrieved from https://www.theguardian.com/world/2020/apr/22/racial-inequality-in-britain-found-a-risk-factor-for-covid-19. . Furthermore, the vulnerable population is living in densely populated areas with poor infrastructure, which hinders disease prevention (Snyder, Marlow, Phuphanich, Riley, & Maciel, 2016Snyder, R. E., Marlow, M. A., Phuphanich, M. E., Riley, L. W., & Maciel, E. L. N. (2016). Risk factors for differential outcome following directly observed treatment (DOT) of slum and non-slum tuberculosis patients: a retrospective cohort study. BMC Infectious Diseases, 16(1), 1-7. Retrieved from https://doi.org/10.1186/s12879-016-1835-1
https://doi.org/10.1186/s12879-016-1835-...
). Thus, social vulnerability should also affect the results of policies to contain the spread of COVID-19.

Public administration actions. The first governmental responses to the COVID-19 outbreak are restrictions on the movement of the population in order to decrease virus transmission (Chen, Yang, Yang, Wang, & Bärnighausen, 2020Chen, S., Yang, J., Yang, W., Wang, C., & Bärnighausen, T. (2020). COVID-19 control in China during mass population movements at New Year. The Lancet, 395(10226), 764-766. Retrieved from https://doi.org/10.1016/S0140-6736(20)30421-9
https://doi.org/10.1016/S0140-6736(20)30...
). Subsequently, public administrations have to address a second-order impact of massive social distancing. As mentioned, social vulnerability can play an essential role during the outbreak. However, the informal economy is significant in Brazil, and suddenly poor people have their income flow interrupted by staying at home for a few days. Thus, it can be harder to keep a social distance in the presence of social vulnerability3 3 Retrieved from https://valor.globo.com/mundo/blog-do-fmi/post/2020/04/a-politica-economica-na-al-e-caribe-em-tempos-de-covid-19.ghtml. , hindering the prevention of the disease dissemination. During the COVID-19 outbreak, the provision of government aid programs to meet the basic needs of the vulnerable population4 4 Retrieved from https://www.gov.br/casacivil/pt-br/assuntos/noticias/2020/abril/solicitar-auxilio-emergencial-de-r-600-coronavirus-covid-19. .

Governance for public administration actions. More recently, the perspective of a unilateral policymaking process is increasingly being replaced by collective decision-making involving public and private sectors (Ansell & Gash, 2007Ansell, C., & Gash, A. (2007). Collaborative Governance in Theory and Practice. Journal of Public Administration Research and Theory, 18(4), 543-571. Retrieved from https://doi.org/10.1093/jopart/mum032
https://doi.org/10.1093/jopart/mum032...
). In this scenario, public administration has to find ways to achieve collaboration across multiple public units through collaboration within the public sector (Cabral & Krane, 2018Cabral, S., & Krane, D. (2018). Civic festivals and collaborative governance. International Review of Administrative Sciences, 84(1), 185-205. Retrieved from https://doi.org/10.1177/0020852315615196
https://doi.org/10.1177/0020852315615196...
; Sedgwick, 2017Sedgwick, D. (2017). Building collaboration: Examining the relationship between collaborative processes and activities. Journal of Public Administration Research and Theory, 27(2), 236-252. Retrieved from https://doi.org/10.1093/jopart/muw057
https://doi.org/10.1093/jopart/muw057...
). Notwithstanding, the solutions are not only concentrated within public bureaucracies. Collaboration with the private sector is critical to deal with the complexity of the COVID-19 outbreak (LazzariniLazzarini, S. G., Pongeluppe, L. S., Ito, N. C., Oliveira, F. de M., & Ovanessoff, A. (Forthcoming). Public Capacity, Plural Forms of Collaboration, and the Performance of Public Initiatives: A Configurational Approach. Journal of Public Administration Research and Theory, muaa007. & Musacchio, Forthcoming). Inter-sector collaborations work effectively under a myriad of possible configurations (LazzariniLazzarini, S. G., & Musacchio, A. (Forthcoming). Leviathan as a partial cure? opportunities and pitfalls of using the state-owned apparatus to respond to the Covid-19 crisis. Revista de Administração Pública, [in press - early view]., Pongeluppe, Ito, Oliveira, & Ovanessoff, Forthcoming). On the one hand, inter-sectorial collaborations are efficient under conditions of resource munificence and a stable environment (Provan & Milward, 1995Provan, K. G., & Milward, H. B. (1995). A Preliminary Theory of Interorganizational Network Effectiveness: A Comparative Study of Four Community Mental Health Systems. Administrative Science Quarterly, 40(1), 1-33. Retrieved from https://doi.org/10.2307/2393698
https://doi.org/10.2307/2393698...
; Raab, Mannak, & Cambre, 2013Raab, J., Mannak, R. S., & Cambre, B. (2013). Combining Structure, Governance, and Context: A Configurational Approach to Network Effectiveness Jorg Raab. Journal of Public Administration Research and Theory, 25(2), 479-511. Retrieved from https://doi.org/10.1093/jopart/mut039
https://doi.org/10.1093/jopart/mut039...
). On the other hand, while the COVID-19 outbreak does not create a stable environment, network-based organizations can also respond efficiently to situations of crisis and disasters (Kapucu & Garayev, 2011Kapucu, N., & Garayev, V. (2011). Collaborative Decision-Making in Emergency and Disaster Management. International Journal of Public Administration, 34(6), 366-375. Retrieved from https://doi.org/10.1080/01900692.2011.561477
https://doi.org/10.1080/01900692.2011.56...
).

3. DATA AND METHOD

This is a multiple case study of Brazilian municipalities facing COVID-19. The benefit of a multiple case study analysis relies on two main factors. First, it allows us to find common patterns amid different observations considering them deterministically, not probabilistically. In other words, every single case contributes to improve our understanding of the phenomena (Bansal, Smith, & Vaara, 2018Bansal, P., Smith, W. K., & Vaara, E. (2018). From the Editors: New Ways of Seeing through Qualitative Research. Academy of Management Journal, 61(4), 1189-1195. Retrieved from https://doi.org/10.1016/B978-0-444-56336-1.50013-8
https://doi.org/10.1016/B978-0-444-56336...
; Kahwati et al., 2016Kahwati, L., Jacobs, S., Kane, H., Lewis, M., Viswanathan, M., & Golin, C. E. (2016). Using qualitative comparative analysis in a systematic review of a complex intervention. Systematic Reviews, 5, 82. Retrieved from https://doi.org/10.1186/s13643-016-0256-y
https://doi.org/10.1186/s13643-016-0256-...
). Second, the validity of multiple case studies relies on the selection of cases that share similar a set of characteristics that are anchored on theoretical constructs. Moreover, the possibility of replication of the analysis using similar occurrences validates the empirical effort (Eisenhardt, 1989Eisenhardt, K. M. (1989). Building Theories from Case Study Research. Academy of Management Review, 14(4), 532-550. Retrieved from https://doi.org/10.5465/AMR.1989.4308385
https://doi.org/10.5465/AMR.1989.4308385...
; Pratt, Kaplan, & Whittington, 2020Pratt, M. G., Kaplan, S., & Whittington, R. (2020). Editorial Essay: The Tumult over Transparency: Decoupling Transparency from Replication in Establishing Trustworthy Qualitative Research. Administrative Science Quarterly, 65(1), 1-19. Retrieved from https://doi.org/10.1177/0001839219887663
https://doi.org/10.1177/0001839219887663...
).

Given that different alternative successful paths are possible, and the interactive nature of public actions, governance mechanisms, and contextual factors, we used a fsQCA method (Rihoux & Lobe, 2009Rihoux, B., & Lobe, B. (2009). The Case for Qualitative Comparative Analysis (QCA): Adding Leverage for Thick Cross-Case Comparison. In D. Byrne & C. C. Ragin (Eds.), The SAGE Handbook of Case-Based Methods (pp. 222-242). London, UK: SAGE. Retrieved from https://doi.org/10.4135/9781446249413.n13
https://doi.org/10.4135/9781446249413.n1...
). The fsQCA applies fuzzy set algebra to construct multiple combinations of conditions consistent with a certain outcome (Crilly, Zollo, & Hansen, 2012Crilly, D., Zollo, M., & Hansen, M. T. (2012). Faking It or Muddling Through? Understanding Decoupling in Response to Stakeholder Pressures. Academy of Management Journal, 55(6), 1429-1448. Retrieved from https://doi.org/10.5465/amj.2010.0697
https://doi.org/10.5465/amj.2010.0697...
; Fiss, 2007Fiss, P. C. (2007). A Set-Theoretic Approach To Organizational Configurations. Academy of Management Review, 32(4), 1180-1198.). In other words, fsQCA maps the different possible paths leading to a similar outcome.

Case selection process and dataset. We identify all Brazilian municipalities with at least 30 days since the first confirmed COVID-19 case until April 16th, 2020. This cutoff date constructed a dataset of 52 municipalities. As municipalities were at different stages of coping with the outbreak on the cutoff date, only statistics and actions that occurred within the first thirty days in each municipality were considered. Box 1 provides a list of selected municipalities. It is important to note that a thirty-day threshold delimits the initial stages of the outbreak. Below, we describe the outcome and conditions we used in the model specification.

BOX 1
LIST OF MUNICIPALITIES IN THE DATASET

Outcome: The low spread of COVID-19. The outcome is the number of confirmed COVID-19 cases per 100 thousand inhabitants in the municipality by the thirtieth day after the first confirmed COVID-19 case. We used the negated form of the outcome, which means that more successful municipalities are those with lower levels of confirmed cases. The source is the “brasil.io” website, which is an independent initiative, and it consolidates daily data from the state-level health departments.

Resource munificence. The first contextual condition measures the availability of resources to respond to the outbreak. We used the number of physicians per 100 thousand inhabitants in the municipality in January of 2020 to capture the size of the health system in place. We also measured the number of hospital beds in the specialty of pulmonology per 100 thousand inhabitants in the municipality to evaluate the specialized resources. The data is available from the DATASUS website, which is a data repository of the Federal Health Department.

Social vulnerability. Another contextual condition has to do with the social structure in the municipality. We collected the social vulnerability index for each municipality, which is available from the “Atlas da Vulnerabilidade Social,” elaborated by Instituto de Pesquisa Econômica Aplicada (IPEA).

Government aid programs. We identified public action related to the provision of emergency aid programs for the population. By reading municipal laws and newspaper articles, we have identified three types of programs: (i) provision of meals for public school students at home; (ii) distribution of basic food baskets; (iii) other programs to reduce taxes, subsidized credit for small businesses, or offering financial assistance directly. In addition to official sources from municipalities, we used Google to search for evidence of aid programs in newspapers.5 5 In this search we used Google with the following description in: “coronavírus + <<city name>> + prefeitura + auxílio OR bolsa OR cesta básica”.

Collaboration within the public sector. This variable identifies the creation of multi-departmental entities within the public bureaucracy set up to deal with the disease outbreak, according to official sources from municipalities and searches in the newspapers.6 6 Similarly: coronavírus + <<city name>> + prefeitura + comitê OR comissão OR gabinete OR centro de operações OR campanha OR convênio.

Collaboration with the private sector. This refers to the presence of a relevant initiative with the joint participation of the city hall and organizations outside the public sector. The sources are also municipal laws and searches in the newspapers.7 7 Similarly: coronavírus + <<city name>> + prefeitura + parceria OR colaboração OR campanha OR convênio OR empresários OR empresas OU ONG OR força-tarefa.

The measurements of variables concerning government aid and collaborations are influenced by the judgment about the content of law and newspaper articles. We selected policies initiated at municipality-level, not federal or state-level programs distributed by the city halls. We also excluded specific public initiatives or private sector initiatives without the participation of the city halls or only recognized by city halls8 8 The tables and boxes from A2 to A6 in the appendix detail the content of public action and governance measurements, as well as its sources, in order to make the results and limitation more transparent. .

Analytical procedures. The critical initial step of fsQCA is to calibrate whether the outcome or a condition is present or not in a case. Box A7 in the appendix describes the calibration criteria for each variable. Then, following the established criteria in the fsQCA literature, after analyzing the truth table, we adopted a 0.8 consistency threshold (Ragin, 2006Ragin, C. C. (2006). Set Relations in Social Research: Evaluating Their Consistency and Coverage. Political Analysis, 14(3), 291-310. Retrieved from https://doi.org/10.1093/pan/mpj019
https://doi.org/10.1093/pan/mpj019...
; Schneider & Wagemann, 2012Schneider, C. Q., & Wagemann, C. (2012). Set-Theoretic Methods for the Social Science. A Guide to Qualitative Comparative Analysis. New York, NY: Cambridge University Press. Retrieved from https://doi.org/10.1017/CBO9781107415324.004
https://doi.org/10.1017/CBO9781107415324...
). We also considered a frequency threshold of at least one case in the solution, given the small sample (Rhioux & Ragin, 2009Rhioux, B., & Ragin, C. C. (2009). Configurational Comparative Methods Qualitative Comparative Analysis (QCA) and Related Techniques. Thousand Oaks, CA: Sage.). Finally, we reported the intermediate solutions provided by the fsQCA software (Fiss, 2011Fiss, P. C. (2011). Building better causal theories: A fuzzy set approach to typologies in organization research. Academy of Management Journal, 54(2), 393-420.; Misangyi & Acharya, 2014Misangyi, V. F., & Acharya, A. G. (2014). Substitutes or Complements? A Configurational Examination of Corporate Governance Mechanisms. Academy of Management Journal, 57(6), 1681-1705. Retrieved from https://doi.org/10.5465/amj.2012.0728
https://doi.org/10.5465/amj.2012.0728...
).

Analyzing the sample regarding public action, 26.9% of the municipalities did not offer any government aid to the population. The percentages of those that provided one, two, and three aid programs, respectively, are 51.9%, 19.2%, and 1.9%. Looking at governance mechanisms, in turn, we found that 50% of the city halls used only collaboration within the public sector, 7.7% established collaboration with the private sector only, and 25% created collaboration both within the public sector and with the private sector. Thus, 17.3% of city halls had no collaboration. Table A8 in the appendix presents the descriptive statistics for the contextual factors.

4. RESULTS

Box2presents the results of fuzzy-set qualitative comparative analysis, showing three solutions consistent with preventing COVID-19 transmission in the initial stages of the outbreak. We interpret the results considering that “●” indicates the presence of a condition and “?” indicates the absence of a condition. The blank spaces, in fsQCA jargon, mean “don’t care” situation; i.e. the condition can be either present or absent for the solution. For instance, solution 1a is characterized by the presence of both collaboration within the public sector and collaboration with the private sector, as well as by the absence of hospital beds. In the first solution, resource munificence in terms of physicians and social vulnerability is a “don’t care” condition, which means that these characteristics may be present or not to prevent COVID-19 transmission in this solution.

BOX 2
QCA RESULTS ON THE COMBINATIONS OF CONDITIONS TO AVOID THE TRANSMISSION OF COVID-19 IN ITS INITIAL STAGES

Solution 1b has an absence of all conditions of resource munificence, and the presence of social vulnerability. These contextual factors interact with the presence of government aid and collaboration within the public sector, and collaboration with the private sector is a don’t care condition. Finally, solution 2 has both dimensions of resource munificence present in it, whereas all public action and governance conditions are absent.

Before the discussion, it is worthwhile commenting on the social distancing procedures taken in the municipalities. First of all, despite its importance, social distancing laws were not explored in the model, because this was mainly a decision taken at the state-level rather than at the level of municipality. Second, all municipalities adopted social distancing laws, and it seems reasonable to assume that social distancing is a ubiquitous practice in the sample. However, it is possible to track how many days it took from the first case to the closure of shops and schools in each municipality. In general, comparing the number of days per solution, only municipalities in solution 1b seems to take longer to close the schools than the sample’s average behavior. Box A9in the appendix summarizes the analysis9 9 In the appendix, Box A10, Table A11 and Figure A12 analyze the association between solutions and other case characteristics. Solution 1b presents association with Southern region and small cities. .

5. DISCUSSION

Insights for municipality-level government officials. The results demonstrate that public action options are limited by contingent conditions in the municipality’s environment, and there are three possible paths for policymaking. Figure 1 presents a visual representation of the decision-making process based on the results10 10 During the reviewing process we took the opportunity to perform a robustness check. In the figure A13 of the appendix, it is possible to see that municipalities outside our solutions presented a faster spread of COVID-19 compared to municipalities participating in our solutions. . This can serve as a reference for public officials coping with the initial stage of COVID-19 outbreaks in their locations.

The first path (solution 1a) is limited by the lack of specialized resources, therefore, to avoid the spread of COVID-19, the local government has to develop plural collaboration across the public and private sectors. An example is a public-private partnership between the city hall of Mauá, in the state of São Paulo, and a private hospital to increase the number of hospital beds available in the public universal healthcare system. This path shows that in the absence of resources, collaborations might be the best strategy for local government. Additionally, the Mauá’s city hall created the called “Specialized Coronavirus Combat Center”, integrating different departments. Therefore, we call this the plural collaboration path. The second path (solution 1b) is constrained by the lack of available resources and threats from social vulnerability. The best strategy for local government is to design public actions such as the provision of aid and coordination with other public units to attenuate the spread of COVID-19. For example, the city hall of Pinhais, in the state of Paraná, provided financial aid to informal workers of recyclable garbage collection. Therefore, we call this the public action path. Finally, the third path (solution 2) relies on the well-structured health system. In this case, the presence of healthcare resources guarantees a successful fight against the spread of COVID-19. Therefore, we call it the resource-based path.

FIGURE 1
PATHS TO AVOID TRANSMISSION OF COVID-19 AT MUNICIPALITY-LEVEL DURING THE INITIAL STAGES OF THE OUTBREAK

Contributions to the current public administration literature. Comparing the solutions 1 (1a + 1b) and 2, there is an interplay between resource munificence and network-based governance. Resource munificence interacts with the lack of network-based organizations, which contradicts a current public administration framework (e.g., Provan & Milward, 1995Provan, K. G., & Milward, H. B. (1995). A Preliminary Theory of Interorganizational Network Effectiveness: A Comparative Study of Four Community Mental Health Systems. Administrative Science Quarterly, 40(1), 1-33. Retrieved from https://doi.org/10.2307/2393698
https://doi.org/10.2307/2393698...
), but supports findings of collaborative decision-making in emergency management (e.g., Kapucu & Garayev, 2011Kapucu, N., & Garayev, V. (2011). Collaborative Decision-Making in Emergency and Disaster Management. International Journal of Public Administration, 34(6), 366-375. Retrieved from https://doi.org/10.1080/01900692.2011.561477
https://doi.org/10.1080/01900692.2011.56...
). Thus, these findings contribute to a still understudied topic of crisis and disaster management in the field of Public Administration. The role of social vulnerability in the explanations for strategies to cope with public health emergencies can provide new insights into this debate.

Limitations. Taking into account the characteristics of the dataset and the methodological choices, the results are not generalizable. Instead of generalization, the results enable the elaboration of a mid-range theory applied to Brazilian municipality-level during the initial stages of the outbreak in the country. Furthermore, solution 1b highlights the interaction between social vulnerability and government aid programs. However, this solution is also characterized by its location in the Southern Brazilian region and the small population size. Thus, it is important to note that arguing that aid programs are a response to social vulnerability is rather fragile, as the solution 1a shows a don’t care situation to social vulnerability in the absence of government aid.

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  • 1
    World Health Organization: all technical guidance documents regarding COVID-19 can be found here https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance.
  • 2
    Retrieved from https://www.theguardian.com/world/2020/apr/22/racial-inequality-in-britain-found-a-risk-factor-for-covid-19.
  • 3
    Retrieved from https://valor.globo.com/mundo/blog-do-fmi/post/2020/04/a-politica-economica-na-al-e-caribe-em-tempos-de-covid-19.ghtml.
  • 4
    Retrieved from https://www.gov.br/casacivil/pt-br/assuntos/noticias/2020/abril/solicitar-auxilio-emergencial-de-r-600-coronavirus-covid-19.
  • 5
    In this search we used Google with the following description in: “coronavírus + <<city name>> + prefeitura + auxílio OR bolsa OR cesta básica”.
  • 6
    Similarly: coronavírus + <<city name>> + prefeitura + comitê OR comissão OR gabinete OR centro de operações OR campanha OR convênio.
  • 7
    Similarly: coronavírus + <<city name>> + prefeitura + parceria OR colaboração OR campanha OR convênio OR empresários OR empresas OU ONG OR força-tarefa.
  • 8
    The tables and boxes from A2 to A6 in the appendix detail the content of public action and governance measurements, as well as its sources, in order to make the results and limitation more transparent.
  • 9
    In the appendix, Box A10, Table A11 and Figure A12 analyze the association between solutions and other case characteristics. Solution 1b presents association with Southern region and small cities.
  • 10
    During the reviewing process we took the opportunity to perform a robustness check. In the figure A13 of the appendix, it is possible to see that municipalities outside our solutions presented a faster spread of COVID-19 compared to municipalities participating in our solutions.
  • [Original version]

APPENDIX

BOX A1
LIST OF MUNICIPALITIES IN THE DATASET AND OTHER RELEVANT INFORMATION
BOX A2
SOURCE OF QUALITATIVE DATA
BOX A3
PRESENCE OF SCHOOL LUNCH DISTRIBUTION BY MUNICIPALITY
BOX A4
PRESENCE OF OTHER GOVERNMENTAL AID PROGRAMS BY MUNICIPALITY
BOX A5
PRESENCE OF COLLABORATION WITHIN PUBLIC SECTOR
BOX A6
PRESENCE OF COLLABORATION BETWEEN PUBLIC AND PRIVATE SECTORS
BOX A7
BRIEF DESCRIPTION OF CALIBRATION PROCESS
BOX A8
DESCRIPTIVE STATISTICS OF CONTEXTUAL FACTORS
BOX A9
COMPARISON BETWEEN SOLUTIONS AND NUMBER OF DAYS BETWEEN TO FIRST CASE AND LAWS CLOSING SHOPS AND SCHOOLS
BOX A10
SOLUTIONS VERSUS DATE OF THE FIRST CASE
TABLE A11
SOLUTIONS VERSUS CITY SIZE

FIGURE A12
SOLUTIONS VERSUS NUMBER OF CONFIRMED CASES PER 100,000 INHABITANTS

FIGURE A13
ROBUSTNESS CHECK. COMPARING THE OUTCOMES OF CITIES WITHIN OUR SOLUTIONS AND CITIES OUT OF OUR SOLUTIONS, IT IS POSSIBLE TO SEE A FASTER SPREAD RATE IN CITIES OUT OF OUR SOLUTIONS

Publication Dates

  • Publication in this collection
    28 Aug 2020
  • Date of issue
    Jul-Aug 2020

History

  • Received
    29 Apr 2020
  • Accepted
    27 May 2020
Fundação Getulio Vargas Fundaçãoo Getulio Vargas, Rua Jornalista Orlando Dantas, 30, CEP: 22231-010 / Rio de Janeiro-RJ Brasil, Tel.: +55 (21) 3083-2731 - Rio de Janeiro - RJ - Brazil
E-mail: rap@fgv.br