Transnational Social Learning As a Driver of Health Policy Reform in Turkey

Since the 1990s health sector has witnessed much reform effort, and similar policy choices seem to emerge in industrialized countries as well as many industrializing countries. Although scholars have long debated the relative importance of domestic versus international factors that drive policy change, this recent ‘epidemic of reforms’ in health care systems brought to the fore the issues of policy learning and diffusion above and beyond national boundaries. This paper focuses on a reform initiative in Turkey – Health Transformation Project (HTP) - which was recently praised by the World Bank and the OECD for its “success” in expanding health insurance coverage, improving access and building institutional capacity. The paper identifies two types of social learning as drivers of reform in the Turkish context: First, social learning took place before and during the reform and thus was important in the framing of the need to reform. Second, social learning took place through a more long-term process of embeddedness in and regular engagement with global policy circles.  The paper demonstrates that, especially since the 1990s, various mechanisms of policy learning and diffusion, such as training initiatives, project funding, career movement of key individuals, international meetings, comparative analyses that defined policy problems and disseminated best practices, and other collaborative work  have facilitated the integration of Turkish policymakers into global ‘epistemic communities’ which contributed to the formation of shared set of normative and causal beliefs as well as a common technical rationality to deal with the major problems.