Goal setting

A Solid Start for Every Child: The Netherlands Integrates Medical and Social Care, 2009 - 2022

Author
Leon Schreiber
Focus Area(s)
Core Challenge
Country of Reform
Abstract

Despite having a sophisticated health-care system and spending more on health care than do most countries in the world, by the early 2010s the Netherlands experienced some of the poorest perinatal-health outcomes in the European Union. Birth-related complications among women and infants were driven primarily by economic and social inequality. For example, women living in the country’s low-income neighborhoods were up to four times more likely to die during childbirth than the Dutch average. In partnership with university researchers, the municipalities of Rotterdam, Groningen, and Tilburg began tackling the problem. After discovering that the growing disparities in perinatal health outcomes were driven in large part by social and economic challenges rather than by purely medical factors, the cities set out to build integrated, multisectoral teams­—local coalitions—that brought together service providers working in both the health-care and social domains. To tailor care to an individual patient’s own circumstances, the coalitions transcended the traditional boundaries that separated physicians, midwives, municipal officials, social workers, and other service providers. They worked to integrate their records and come to agreement on ways to monitor progress, and they designed referral systems and procedural road maps to deal with specific and individual client problems. In 2018, the national Ministry of Health, Welfare and Sport expanded the use of such local coalitions to reduce early-childhood health disparities in municipalities throughout the country. By early 2022, 275 of the Netherlands’ 345 municipalities were participating in the program, dubbed Solid Start, and the new national government pledged to expand the program to every municipality in the country.

 

Leon Schreiber drafted this case study based on interviews conducted between September 2021 and April 2022. Case published May 2022. This case study was supported by Bernard van Leer Foundation as part of a policy learning initiative. Please note that the Solid Start program described in the case is not an instance of the foundation’s Urban95 strategy, which features in several other ISS case studies that are part of the learning project.

Learning To Be Smart: Using Data and Technology to Improve Services in Kansas City, Missouri, 2009 – 2019

Author
Tyler McBrien
Focus Area(s)
Country of Reform
Abstract

When Troy Schulte took over as interim city manager of Kansas City, Missouri, in 2009, the local economy was struggling and the government faced hard choices about how to use scarce resources. With a slashed budget and a diminished workforce, Schulte had to figure out how to deliver city services without reducing quality. Together with a small team of employees, he began to create a culture of data-driven decision making in municipal offices, to invest selectively in technology, and to give nonprofit organizations and firms an opportunity to develop their own, innovative solutions to city problems by making more information available to them. Schulte found a kindred spirit in Mayor Sly James, who negotiated a public–private partnership with a view to developing what Kansas City’s chief innovation officer called “the smartest 54 blocks in the country” along the city’s new streetcar corridor. As initial efforts came to a close and a new mayor entered office, Schulte and other officials stepped back to assess what they had learned. The new, data-driven culture had yielded positive improvements, whereas the technology-based smart-city initiative had had a more limited impact—at least in the shorter term. The experience generated important lessons about the scale of the benefits that technology could generate in midsize cities and in what kind of time frame.

Tyler McBrien drafted this case study based on interviews conducted in Kansas City, Missouri, in January 2020. Case published March 2020.

 

Reducing Inequality by Focusing on the Very Young: Boa Vista, Brazil, Deepens Its Investment in Early Childhood Development, 2017 – 2019

Author
Bill Steiden
Focus Area(s)
Country of Reform
Abstract

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.

 

Staying Afloat: South Africa Keeps a Focus on Health Priorities During a Financial Storm, 2009-2017

Author
Leon Schreiber
Country of Reform
Abstract

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.

To view a short version of the case, please click here

 

Rebooting a Rust Belt City: An Innovation Office for South Bend, 2013-2018

Author
Tristan Dreisbach
Country of Reform
Abstract

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.

All Hands on Deck: The US Response to West Africa’s Ebola Crisis, 2014-2015

Author
Jennifer Widner
Focus Area(s)
Country of Reform
Abstract

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.

Responding to Global Health Crises: Lessons from the U.S. Response to the 2014-2016 West Africa Ebola Outbreak

Author
Jennifer Widner
Focus Area(s)
Country of Reform
Abstract

The report “Responding to Global Health Crises: Lessons from the U.S. Response to the 2014-2016 West Africa Ebola Outbreak” is a version of the “All Hands on Deck” case produced in partnership with the IBM Center for The Business of Government. 

The DART was the first to involve a large-scale partnership with the U.S. 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 U.S.—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.

 

For more information on the IBM Center for The Business of Government, please visit: www.businessofgovernment.org

 

Swimming Against the Tide: Implementing Ghana’s Anticorruption Action Plan, 2014–2016

Author
Tristan Dreisbach
Focus Area(s)
Country of Reform
Abstract

In 2014, Ghana began to implement its National Anti-Corruption Action Plan, adopted a decade after the West African country signed the United Nations Convention against Corruption.  With over 120 goals, the plan’s strategy was wide-ranging and ambitious. The goals included strengthening the public service code of conduct, improving the asset declaration system, and expanding freedom of information, as well as adopting many new laws. About 15 other countries around the globe had announced similar aims, though few included as many goals in their plans or required as many statutory changes. Ghana’s Commission on Human Rights and Administrative Justice, which was responsible for translating the strategy into practical accomplishments, faced stiff challenges, including limited coordination capacity, electoral disruption, reluctant legislators, and a few scandals that drew the government’s credibility into doubt. By the early months of 2017, the commission was still struggling to implement important parts of the strategy, but there were a few signs of progress: more public agencies were beginning to report regularly on the actions they had taken to meet their goals, a memorandum of understanding to improve coordination among parts of the anticorruption system was in place, and the Electoral Commission had stepped in to require asset declaration by candidates—even while bigger changes remained mired in the legislature. Ghana’s experience illuminated the challenge of introducing broad anticorruption policies in the face of embedded opposition and the ways that dedicated citizens and officials could take smaller but still significant steps to improve governance.

Tristan Dreisbach drafted this case study based on interviews conducted with the assistance of Gordon LaForge in Accra, Ghana, during September 2016, February 2017, and August 2017. The British Academy-Department for International Development Anti-Corruption Evidence (ACE) Progamme funded the development of this case study. Case published September 2017.

 

Chasing an Epidemic: Coordinating Liberia’s Response to Ebola, 2014–2015

Author
Leon Schreiber
Focus Area(s)
Country of Reform
Abstract

In mid 2014, health-care services in Liberia were being overwhelmed by the largest-ever outbreak of Ebola virus disease. Transmitted through contact with the bodily fluids of an infected person, the disease was spreading at a rate of 80 new cases per week by the end of July, killing up to 70% of the people it infected. The country’s fragile health-care system, damaged by a 14-year civil war, could not respond to all of the demands it faced. The rate of new infections rose, and schools and health facilities closed. Collaborating with international partners and five months into the epidemic, the Liberian government created a dedicated Incident Management System (IMS) to coordinate all elements of the country’s fight against the disease. The IMS team created a clear decision-making framework, provided responders with adequate infrastructure and technical support, and set up a coherent procedure for communicating with a frightened and anxious public. At the end of the outbreak, the question was whether Liberia’s approach had provided a model for managing responses to infectious disease outbreaks in other, similar settings or whether the approach had left room for making the system work better.

Leon Schreiber drafted this case study in consultation with Jennifer Widner of Princeton University based on interviews conducted in Monrovia, Liberia and London in November and December 2015.

Princeton University’s Grand Challenge supported the research and development of this case study, which is part of a series on public management challenges in the West African Ebola Outbreak response.

 

Timeline: West African Ebola Outbreak (poster infographic)

Timeline: West African Ebola Outbreak (page version)

Offering a Lifeline: Delivering Critical Supplies to Ebola-Affected Communities in Liberia, 2014-2015

Author
David Paterson and Jennifer Widner
Focus Area(s)
Country of Reform
Abstract

When an outbreak of Ebola virus disease began to spill over national borders in West Africa in 2014, halting the epidemic depended as much on logistics as on addressing the medical challenge the virus posed. As the rate of infection in Liberia rose in June and July, J. Dorbor Jallah of the government’s Incident Management System knew that without chlorine, protective gear, and other critical items, it would be impossible for doctors and nurses to work safely. But Jallah faced obstacles at every level of the supply chain. Uncertain estimates of need, competing product standards, and limited vendor partnerships initially hampered procurement. Cargo volume strained capacity at ports of entry, and warehouse space was inadequate—or nonexistent. The country’s limited road network hampered the transport of materials to rural areas during the rainy season. At clinics, safe disposal of contaminated items presented additional difficulties. And to make matters worse, responding organizations all had different policies and approaches. After initial disarray, the Liberian government, international organizations, nonprofit groups, and private companies began cooperating to simulate some of the features of a centralized and integrated supply chain. The volume, speed, and responsiveness of delivery increased across Liberia—just as the epidemic began to wane. The experience triggered a search for innovations that could address similar constraints more effectively during any future infectious-disease outbreak whether in Liberia or elsewhere. 

David Paterson, Jennifer Widner, and staff drafted this case study based on interviews conducted in Liberia and other countries from 2015 to August 2016.

Pfizer Inc. supported the research and development of this case, which is part of a series on public management challenges in the West African Ebola outbreak response.

 

Timeline: West African Ebola Outbreak (poster infographic)

Timeline: West African Ebola Outbreak (page version)