Making Reform Work: Institutions, Dispositions, and the Improving Health of Bangladesh

SummaryWe examine whether local governance can improve social development empirically, using good and bad cases of public health outcomes in Bangladesh. We explore the institutional underpinnings of service provision, digging down beneath the “rules of the game” to analyze the beliefs, understandings, and dispositions that drive social behavior. Changes in deep social attitudes led to improvements in social indicators. Regional variation in health outcomes is explained by the presence or absence of a dense web of relationships that enmeshed reformers in local systems of authority and legitimacy, strengthening their actions and making local society more susceptible to change.