This professional report is a case study of three municipal administrations in Sao Paulo, Brazil, during the period 1988-98. It examines the challenges and limitations of the decentralization of the national health care system from a local perspective. The report examines demographic trends in the districts and subdistricts of the municipality of Sao Paulo, levels of decentralization among Brazilian regions and states, general characteristics of state and municipal government, and state-society relations. The report concludes that the process of good governance is a complex one that relies on political negotiation, innovative public policies, financial support, and clear national and state policy directives.
--Author's foreword.
