In 2017, Cape Town, South Africa, was on a countdown to disaster. An unprecedented and wholly unforeseen third consecutive year of drought threatened to cut off water to the city’s four million citizens. Faced with the prospect of running dangerously low on potable water, local officials raced against time to avert “Day Zero”—the date on which they would have to shut off drinking water to most businesses and homes in the city. Cape Town’s government responded effectively to the fast-worsening and potentially cataclysmic situation. Key to the effort was a broad, multipronged information campaign that overcame skepticism and enlisted the support of a socially and economically diverse citizenry as well as private companies. Combined with other measures such as improving data management and upgrading technology, the strategy averted disaster. By the time the drought eased in 2018, Capetonians had cut their water usage by nearly 60% from 2015 levels. With each resident using little more than 50 liters per day, Cape Town achieved one of the lowest per capita water consumption rates of any major city in the world. The success set a benchmark for cities around the world that confront the uncertainties of a shifting global climate.

Leon Schreiber drafted this case study based on interviews conducted in Cape Town, South Africa, in November 2018. Case published February 2019.

In 2003, after 14 years of civil war and as many failed treaties, representatives of Liberia’s government, rebel groups, and civil society came together in Accra, Ghana, to negotiate a peace agreement. They chose Gyude Bryant, a businessman unaffiliated with any of the factions, to head a transitional government made up of ministers from the incumbent political party, the two main rebel groups, and independents, including opposition politicians and civil society leaders. Bryant’s primary goals were to maintain peace and pave the way for elections by the end of 2005—an assignment that entailed disarming and demobilizing more than 100,000 combatants, creating the means to deal with crucial issues ranging from truth and reconciliation to governance reform, and addressing a long list of other tasks—all of it under the scrutiny of Liberia’s legislature as well as regional and international organizations. Although successful democratic elections in late 2005 marked the achievement of Bryant’s primary aims, his fractious government failed to reach many other objectives, including building capacity and ensuring that resources earmarked for development served their intended purposes. The difficulties led to a novel, temporary system of governance—shared with international partners—that targeted procurement, spending, and other aspects of financial management. This case offers insights useful for planning transitions in low-income, divided societies where prolonged conflict has gutted institutional capacity.

Tyler McBrien drafted this case study based on interviews conducted in Monrovia, Liberia in November 2019. Case published in January 2020.

This series highlights the governance challenges inherent in power sharing arrangements, profiles adaptations that eased those challenges, and offers ideas about adaptations. 

The United States Institute of Peace funded the development of this case study.

During the first decade and a half after Nigeria returned to democracy in 1999, the country struggled to adequately fund its primary health care system. Despite a nearly 10-fold increase in the size of the economy, Nigeria in 2014 was still spending only US$11 per capita on health care—equal to only 6% of total government expenditure and far below regional norms and the nation’s own stated aspiration. As a result, Nigerian citizens were paying 69% of their medical expenses out of pocket, and the cost discouraged many from seeking treatment. A new National Health Act, adopted in 2014 after a decade of delay, raised hopes for a solution by stipulating that at least 1% of the government budget go into a new fund to improve basic services provided at the thousands of primary health care clinics located throughout the country. However, owing to Nigeria’s longstanding neglect of primary health care, there was a real risk that the fund might never become reality. To demonstrate the viability of the program and press for its implementation, the federal health ministry, led by Minister Isaac Adewole, developed operational procedures that spelled out crucial steps to ensure financial accountability and transparency, won international backing for a pilot project that would validate the system, and built a support coalition that spanned the government and civil society. The effort took three years, but in 2018 the Nigerian legislature passed an appropriations bill that for the first time included the 1% allocation for the fund—significantly boosting the resources available to improve the quality and accessibility of primary health care services across Nigeria. Even more significantly, in September 2019, the government declared the fund a statutory allocation that it would automatically renew every year, and clinics in three states began receiving the new resources in November 2019.

Leon Schreiber drafted this case study based on interviews conducted in Abuja, Nigeria, in July and August 2019 with the help of Bunmi Otegbade. Case published November 2019.

Narrowing the gap between rich and poor was a top priority for Teresa Surita, five-time mayor of Boa Vista, Brazil. Surita had long viewed early childhood development services as crucial for improving life chances and attaining that goal, and she had partnered with several programs to expand parent coaching and other opportunities. As her fifth term began in 2017, she turned to a program called Urban95, which called for making a top priority the needs of young children and their families in all of the city’s planning and programs. Building on work the city had already done, Surita and her department heads undertook projects that included adapting a neighborhood to the needs of young children and their caregivers and building a cutting-edge data dashboard and alert system designed to ensure citizens would get help when they needed it. The city sought to keep those efforts on track while also extending assistance to families among the refugees fleeing deprivation and violence in neighboring Venezuela. As the term of the initial phase drew to a close in September 2019, municipal officials began to take stock of progress and results. Despite some philosophical disagreements and some uncertainties about the future of vital federal funding, the city was on track to achieve its project goals. 

Bill Steiden drafted this case study based on interviews conducted in Boa Vista and Sao Paulo, Brazil, in July and August 2019. Case published October 2019. The Bernard van Leer Foundation supported this case study to foster early-stage policy learning.

In the early 2010s in Tel Aviv, parents with children under four years of age were mostly on their own when it came to finding the child care services and support they needed. Although the city was an economic and technology powerhouse, the government showed little interest in providing for the youngest residents. Public concern about the cost and quality of day care and a shortage of opportunities to ensure infants and toddlers thrived drew parents into the streets. In 2016, the city began to respond. Municipal departments expanded services, launched a digital platform for parents, and renovated public spaces to suit children three years old and younger. By 2019, early childhood development had become a government priority and part of the mayor’s reelection campaign platform, although scaling services to some of the poorest neighborhoods remained a challenge.

Gordon LaForge drafted this case study based on interviews conducted in Tel Aviv in May 2019. The Bernard van Leer Foundation sponsored this case study to support learning in its Urban95 initiative. Savvas Verdis and Philipp Rode of the London School of Economics served as independent reviewers. Case published August 2019. 

In 2017, Geraldo Julio, the mayor of Recife, Brazil, heard scientific evidence that ensuring children from birth to age six years got a better start in life resulted in long-term benefits such as improved health, more-effective learning, less likelihood of criminal involvement, and increased employability. Julio, a technically-oriented leader in his second and final term, saw investment in early childhood development as an innovative strategy for addressing chronic crime and economic inequality in some of the city’s toughest neighborhoods. To enable parents and young children to move more safely and more quickly to locations where they could find efficiently clustered resources would require the city to align efforts in several city departments, including parks, public works, health, and education. Julio set up a management team and a steering committee to guide that work and won passage of legislation that authorized him to devote municipal resources and grant funding from private groups to the new strategy. The city engaged an existing public–private urban planning partnership to launch and manage pilot projects in two poor but contrasting neighborhoods: one where homes clung to steep, slide-prone hillsides and another where many residents lived in stilt houses on flood-prone riverbanks. It collaborated with a community peace center that could reach target neighborhoods effectively. Further, the mayor’s teams helped municipal departments start projects that would support the new agenda. In mid 2019, nearly two years after the program began, the pilot projects yielded key lessons about how to improve access to services for families with young children. 

Bill Steiden drafted this case study with the help of Sam Dearden based on interviews conducted in Recife, Brazil, in March and May 2019. Case published June 2019. The Bernard van Leer Foundation sponsored this case study, which is part of a series, to support learning in the early stages of its Urban95 program. Savvas Verdis and Philipp Rodeof the London School of Economics served as independent reviewers. 

In 2009, South Africa's health-funding system teetered on the verge of collapse. Despite the adoption of a transparent and credible budget framework in 1994, large parts of the public health system suffered from chronic overspending and poor financial control. As wage hikes and supply costs ate into the health budget and as government revenues plummeted in the wake of the 2008 global financial crisis, the national health department had to find ways to preserve priorities, linking them more effectively to the budget. The department won agreement on a list of non-negotiable expenditure items to protect in provincial budgets, used earmarked conditional grants to channel funds to key programs, cut medicine costs by improving central procurement, rolled out a new information technology system, and improved its monitoring of provincial finances. Although the country's nine provincial health departments had important roles to play, most of them struggled. However, the Western Cape was able to set a model by controlling personnel costs, improving monitoring, and creating incentives for health facilities to collect fees. Nationally, total per-capita government revenues dropped by 5% in the immediate aftermath of the financial crisis and grew only slowly thereafter, but the health sector's strategy helped ensure progress on its key priorities even as resources fluctuated.

Leon Schreiber drafted this case study based on interviews conducted in Pretoria and Cape Town, South Africa, in August 2018. Case published October 2018.

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Rwanda’s public health system was among the many casualties of the country’s 1994 genocide. In the aftermath of the violence, health workers were in short supply, maternal and child mortality rates spiked, and infectious diseases such as HIV/AIDs and tuberculosis often went untreated. By 2011, Rwanda had made enormous progress in remedying the situation, but much more remained to be done. From 2011 to 2016, officials in the finance ministry and health ministry worked together to develop five-year plans for public health, translate their new priorities into annual budgets, and monitor spending so as to ensure progress toward national goals. They revised the budget calendar to improve the planning process, helped local authorities build medium-term public-health strategies, and refined the tools used for tracking spending in the health sector. They met or surpassed more than half of the top targets they set for 2015, cementing the gains Rwanda had made since 1994.

Simon Engler drafted this case study with the assistance of Louise Umutoni Bower, based on interviews conducted in Kigali, Rwanda in March, April and August 2018. Case published September 2018.

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When Pete Buttigieg became mayor of South Bend, Indiana, in 2012, the city was struggling to overcome its image as a dying community. More than a thousand abandoned homes blighted urban neighborhoods, and the unemployment rate was more than 10%. Although these problems had their roots in the changing structure of the US economy, Buttigieg said he believed that more-efficient and more-effective government could help the city attract new businesses and residents, charting a path forward. In 2013, he hired Santiago Garces, a 2011 graduate of nearby University of Notre Dame, to create a new office that would identify opportunities for improving city operations and saving money. On a tight budget, Garces assembled a small team of business analysts, who used new technologies to help streamline and modernize the city’s code enforcement department, greatly accelerating the process of dealing with abandoned homes. Garces’s team then took on dozens of other projects to improve service delivery while also consolidating the city’s information technology resources, including outsourcing certain services to cut costs. The unit Garces created produced millions of dollars in savings during its first years and helped the mayor achieve some of his top policy goals. 

Tristan Dreisbach drafted this case study based on interviews he and Steven S. Strauss, John L. Weinberg/Goldman Sachs & Co. Visiting Professor at Princeton University, conducted in South Bend, Indiana in July 2018. Case published September 2018.

In 2014, an unprecedented outbreak of Ebola virus disease in Liberia, Sierra Leone, and Guinea shined a harsh spotlight on global capacity to deal effectively with a fast-moving epidemic that crossed international borders.  By the end of July, the outbreak had started to overwhelm health care systems in all three affected countries. In Liberia, health centers began to close, and President Ellen Sirleaf appealed for help from the United States. President Barack Obama tasked USAID’s Office of US Foreign Disaster Assistance (OFDA) to lead an interagency response. From early August 2014 to January 2016, an OFDA Disaster Assistance Response Team, or DART, deployed to Liberia to help coordinate efforts to stop the spread of infection. The DART was the first to involve a large-scale partnership with the US Centers for Disease Control and Prevention (CDC) to combat an infectious disease outbreak. Although the deployment, which scaled up earlier assistance, took place five months after the first reported cases and required extensive adaptation of standard practices, it succeeded in helping bring the epidemic under control: the total number of people infected—28,616—was well below the potential levels predicted by the CDC’s models. This US–focused case study highlights the challenges of making an interagency process work in the context of an infectious disease outbreak in areas where health systems are weak.

Jennifer Widner drafted this case study based on interviews from August 2016 to August 2017. The case is part of a series about the Liberian response to the 2014 Ebola outbreak, available through the Innovations for Successful Societies website. Case published June 2018. IBM’s Center for The Business of Government helped finance this case study.