the interactions between development thought, policy formation and real world developments
at a general level, to be followed, in Section IV, by a more detailed analysis of actual changes
in the macro-environment over the past fifty years. Stages in the changing macro-
environment will be described and the implications for group behaviour explored, illustrated
by specific examples from the organisation of medical services.
II. THE MACRO-CONTEXT AND GROUP BEHAVIOUR: DOES IT MATTER?
The theory of social capital has emphasised how the extent of people’s membership of
groups and the nature of the groups to which they belong influences the economy and the
functioning of government. Thus Putnam argues - in a hypothesis that has received wide
support - that extensive ‘horizontal’ group membership, involving reciprocal ties of trust (i.e.
broadly COOP groups and networks) is likely to support efficient government (Putnam,
1993). Others have taken this further and argued that such a situation (described as ‘high’
levels of social capital) is also likely to be conducive to economic efficiency. This has been
supported by a variety of empirical studies, some predating the widespread acceptance of the
‘social capital’ concept. For example, a study by Uphoff of sixteen countries in Asia found
that those countries with the best network of local institutions linking rural communities and
the central government had the best agricultural performance and also the largest
improvements in social indicators. He suggests this arose as the strength of the ‘third’ sector
complemented the state or market, and put pressure on both to maintain efficiency (Uphoff,
1993; see also e.g. World Bank, 1997a). From this perspective then, group behaviour is a
significant input into both government and private sector efficiency with more COOP group
behaviour supporting more efficiency.
This paper is not, however, primarily concerned with this direction of causation - from group
behaviour to the wider economy - although we will return to it briefly at the end of the paper
- but with the reverse connection, from development paradigms, policy and events to group
behaviour.
There are several reasons for expecting some connections in this direction. First, the norms of
a society influence people’s expectations and behaviour. For example, where the dominant