budgeting

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

 

Building a Healthier Rwanda: Linking Social Priorities to the National Budget, 2011–2016

Author
Simon Engler
Country of Reform
Abstract

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.

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

Saah Charles N'Tow

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B
Ref Batch Number
31
Country of Reform
Interviewers
Blair Cameron and Pallavi Nuka
Name
Saah Charles N'Tow
Interviewee's Position
Former Director of PYPP and Scott Fellows
Language
English
Town/City
Monrovia
Country
Date of Interview
Reform Profile
No
Abstract

In this interview, Saah Charles N’Tow describes his roles as program director for the President’s Young Professional Program (PYPP) and John Snow Inc.’s (JSI) Scott Family Liberia Fellows Program. He talks about the process of designing a two-year fellowship program to bring young Liberians into key government ministries and agencies. He explains the creation of a selection criteria for fellows and the procedures that ensured the applicant-screening process remained transparent and fair. He discusses how the program held support sessions for applicants focused on resume writing and interview preparation. He addresses the program’s coordination practices with donors on budget support. He notes instances of resistance against the program from ministries and agencies and describes how the program responded to problems arising from the placement of fellows. He highlights the program’s administrative components that included mentoring, training, performance management, and program immersion. Finally, he describes the importance of sustainable funding procedures and talks about the likelihood of continued support for the program through future administrations

Profile

At the time of this interview, Saah Charles N’Tow was Liberia’s minister of youth and sports. He previously served as the program director of the President’s Young Professional Program (PYPP) and John Snow Inc.’s (JSI) Scott Family Liberia Fellows Program. He formerly served as a conflict sensitivity and training officer for the United Nations (UN) Liberia Peacebuilding Office. He obtained his bachelor’s degree in mathematics from the University of Liberia and his master’s degree in humanitarian assistance from Tufts University. 

Full Audio File Size
99 MB
Full Audio Title
Saah Charles N'Tow Interview

Stanley Murage

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ZP
Focus Area(s)
Ref Batch Number
3
Country of Reform
Interviewers
Rushda Majeed
Name
Stanley Murage
Interviewee's Position
Former Special Advisor to the President
Language
English
Town/City
Nairobi
Country
Date of Interview
Reform Profile
No
Abstract

In this interview, Stanley Murage discusses results based management in the Kenyan government, particularly the implementation of Rapid Results Initiatives (RRI). He begins by recounting the early stages of reforming, from when he first started looking at results based management five years before its execution. The process began in 2003 with different economic sectors creating service charters with measurable goals and timelines. Departments set these goals in conjunction with citizens through stakeholder forums that discussed what aims to establish and how to achieve the desired results. This citizen participation is one demonstration of how citizen-centered the reforms were. In addition to soliciting public input, the Rapid Results reforms also improved communication to the public regarding what services to expect and how the reforms benefited citizens. As part of the new emphasis on results and evaluation, the reform teams also implemented results-based budgeting. Murage identified the political steering from the top as a key factor enabling the success of the RRIs. Having skilled people in government was another critical element. Overall, Murage explains that RRIs require accompanying reform structures such as a policy setting body, political will and a good communication strategy. He outlines the set up and process for each of these elements in Kenya’s implementation of Rapid Results. 

Profile

At the time of this interview, Stanley Murage was an engineering consultant. Prior to that he had served as Special Adviser to President Mwai Kibaki for strategic policy analysis. He had previously held other government posts, including Permanent Secretary of Labor, Transport and Communications, and Public Works. Early in his career he served in the public service as a surveyor. In 2005, he was awarded the Chief of the Order of the Burning Spear (CBS) for his government service. 

Harold Jonathan Monger

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ZF
Focus Area(s)
Ref Batch Number
2
Country of Reform
Interviewers
Yoni Friedman
Name
Harold Jonathan Monger
Interviewee's Organization
Liberian Institute of Public Administration
Language
English
Town/City
Monrovia
Country
Date of Interview
Reform Profile
No
Abstract

In this interview, based on his experiences at the Liberia Institute of Public Administration (LIPA), Harold Jonathan Monger explains the challenges involved in institutionalizing capacity building. LIPA is an internal consulting and civil service trainer entity. Monger discusses the budgeting problems in equipping the institute to be able to provide better training and to improve the marketing of its services to government agencies. He also details LIPA’s changing relationships with other internal and external capacity-building consultants such as the Governance and Economic Management Assistance Program and IBI International, both of which have also played significant roles in the designs of certification trainings and civil service workshops. Finally, Monger draws from his extensive experience to comment on what he says are the main obstacles to improving governance in Liberia. He recommends establishing formal, uniform systems and procedures and improving communication and collaboration between agencies to avoid duplication.

Profile

At the time of this interview, Harold Jonathan Monger was director general of the Liberia Institute of Public Administration (LIPA). He has a bachelor of science from Liberia’s Cuttington University and a Master of Public Administration from the University of Southern California. And he has extensive public- and private-sector experience in civil-service capacity building, having been with both the United Nations Development Programme and the United Nations Children’s Fund as well as a Ghanaian consulting company. He has been at LIPA since 2004.

Gregory Ellis

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N
Focus Area(s)
Ref Batch Number
1
Country of Reform
Interviewers
David Hausman
Name
Gregory Ellis
Interviewee's Position
Senior Operations Officer, Fragile and Conflict-Affected Countries Group
Interviewee's Organization
World Bank
Language
English
Nationality of Interviewee
Australian
Place (Building/Street)
World Bank
Town/City
Washington, D.C.
Country
Date of Interview
Reform Profile
No
Abstract
Gregory Ellis, drawing on his experience in reform programs in various countries, discusses general themes in civil reform service across various contexts, especially from the point of view of donor organizations. He emphasizes the need for understanding the political economy of countries undergoing reform, and the need for understanding indigenous customs. He places immense import on the citizen-state relationship in fragile states, and discusses how a state should be involved in service delivery. Ellis especially emphasizes deference to the host nation’s priorities in creating a reform agenda. In discussing capacity building in the Solomon Islands, Ellis reflects upon the dichotomy between service delivery by donors and the sometimes deleterious effect of technical assistance on long-term capacity building. He goes on to discuss restructuring organizations and combating patronage through professional associations, decentralized recruitment and autonomous decision making. Ellis emphasizes especially the role of local consultation, continuity in visionary leadership and long-term commitment in achieving success in fragile states.
Profile

At the time of this interview, Gregory Ellis had been a senior operations officer at the Fragile and Conflict-Affected Countries Group at the World Bank for about a year. His parent organization was the Australian Agency for International Development. He was posted by AusAID in the Solomon Islands between 2005 and 2007, as deputy program manager for the Machinery of Government Program, part of the Regional Assistance Mission to Solomon Islands. Prior to that, between 2000 and 2002 he held a posting in Timor-Leste after the withdrawal of Indonesian forces. 

Full Audio File Size
71MB
Full Audio Title
Gregory Ellis Interview

Ram Prasad Ghimire

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ZH
Focus Area(s)
Ref Batch Number
2
Country of Reform
Interviewers
Rushda Majeed
Name
Ram Prasad Ghimire
Interviewee's Position
Under Secretary
Interviewee's Organization
Ministry of General Administration
Language
English
Town/City
Kathmandu
Country
Date of Interview
Reform Profile
No
Abstract
Mr. Ram Prasad Ghimire draws on his decades of experience working within the Ministry of General Administration (MOGA), which is responsible for managing and reforming the civil service. Additionally, it oversees the implementation of the Governance Reform Program (GRP). He discusses the history of reforms, which ultimately culminates in the GRP. Ghimire reviews the weaknesses of the GRP as well as resulting challenges. Specifically he explains that the GRP was crippled by extensive externally-driven aid conditions that were often not established in response to baseline data, socio-cultural realities, nor existing hierarchies of command. Additionally, Ghimire goes into detail over the various information systems MOGA has initiated to improve coordination across ministries and better track the size and activities of ministries. Two such systems are the Personnel Information System and Teacher-Partner Information Systems.  Finally, Ghimire emphasizes the importance of securing the commitment of high-level authorities to reform for ensuring high-quality implementation. 
Profile

Mr. Ram Prasad Ghimire was in charge of the Organization and Development Section of the Ministry of General Administration (MOGA). He began his career in the Nepalese Civil Service in 1995 as a finance officer. He later served on the Ministry of Tourism and Civil Aviation, National Planning Commission, and was responsible for one of Nepal’s academies of management. 

Full Audio File Size
92 MB
Full Audio Title
Ram Prasad Ghimire Interview

Joshua Galeforolwe

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L
Focus Area(s)
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2
Country of Reform
Interviewers
Daniel Scher
Name
Joshua Galeforolwe
Interviewee's Position
Chief Executive Officer
Interviewee's Organization
Public Enterprise Evaluation and Privatisation Agency, Botswana
Language
English
Nationality of Interviewee
Botswanan
Place (Building/Street)
Public Enterprises and Privatisation Agency
Town/City
Gabarone
Country
Date of Interview
Reform Profile
No
Abstract
Joshua Galeforolwe discusses the creation of Botswana’s Public Enterprise Evaluation and Privatisation Agency, using a consultancy model.  He outlines the goals behind Botswana’s privatization efforts and the challenges of putting together a privatization strategic plan, identifying candidate enterprises for privatization and restructuring other state owned enterprises.  Galeforolwe also discusses the difficulty of coordinating privatization efforts and policies across ministries and in dealing with lack of support from many of those ministries.  He touches on the challenges for Botswana of a self-directed structural adjustment program.  He also offers advice for other countries attempting the privatization of public enterprise.
Profile

At the time of this interview, Joshua Galeforolwe was the chief executive officer of the Public Enterprise Evaluation and Privatisation Agency in Botswana.  Prior to creating and running PEEPA, Galeforolwe was general manager of Air Botswana.  Under his leadership, the airline was restructured and made a profit for the first time since it was established in the 1960s.   He earneds a bachelor’s degree in accounting from Makerere University in Uganda and a bachelor’s in economics from the University of Botswana, Lesotho, and Swaziland.

Full Audio File Size
68MB
Full Audio Title
Joshua Galeforolwe Interview

Alejandro Echeverri

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J
Ref Batch Number
19
Country of Reform
Interviewers
Matthew Devlin
Name
Alejandro Echeverri
Interviewee's Position
Former Director of Urban Projects
Interviewee's Organization
Medellín, Colombia
Language
Spanish
Nationality of Interviewee
Colombian
Town/City
Medellín
Country
Date of Interview
Reform Profile
Yes
Abstract
Alejandro Echeverri, former director of urban projects under Mayor Sergio Fajardo, talks about the strategic urban development projects that transformed the city of Medellín, Colombia. He discusses the urban development strategy he followed, which focused on putting the largest public investments in the poorest and most violent parts of the city. Echeverri explains the process through which the government worked with community leaders and created forums through which the community could weigh in on urban development projects, with the aim of giving them ownership of the process. He describes how public communication and a focus on local workers were key in building community support. He discusses some specific projects that were undertaken and explains how the needs for renewal were prioritized. Finally he touches on how the urban renewal programs helped bring tourism to Medellín and how working with private sector partners is important to ensure sustainability of those projects beyond individual political terms.    
Profile

Alejandro Echeverri was the director general of the Urban Development Company from 2004-2005 and the director of urban projects for the mayor's office of Medellin, Colombia from 2005-2007 under Mayor Sergio Fajardo.  He is an architect by training and was a professor of architecture at the Universidad Pontificia Bolivariana. Among his many architecture awards, his work with Mayor Fajardo in urban renewal won them both the Curry Stone Prize for Transformative Public Works from Architecture for Humanity in 2009. Their urban renewal projects have been praised not just for revitalizing poor neighborhoods but also for the quality and innovation of the architecture itself.

Full Audio File Size
55MB
Full Audio Title
Alejandro Echeverri Interview

Giorgi Vashadze

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J
Focus Area(s)
Ref Batch Number
7
Country of Reform
Interviewers
Andrew Schalkwyk
Name
Giorgi Vashadze
Interviewee's Position
Chairman
Interviewee's Organization
Deputy Minister of Justice; Head of Civil Registry Agency
Language
English
Nationality of Interviewee
Georgian
Town/City
Tbilisi
Country
Date of Interview
Reform Profile
No
Abstract
Giorgi Vashadze,  the Deputy Minister of Justice; Head of the Civil Registry Agency in Georgia, an independent one-stop agency created in 2005 under the Ministry of Justice, discusses the agency's responsibility for issuing citizen identifications, voter registrations, passports, marriage licenses and divorce papers, name changes, and birth and death certificates.  The agency is partially supported by the fees it collects from citizens applying for papers.  The goal is to make it entirely self-supporting financially in the near future.  He describes how the Civil Service Registry was established to eliminate a predecessor process that was highly corrupt and paper-based, and he notes that the process has been computerized and almost all corruption eliminated from the system. The objective in creating the registry was to create a one-stop process for all important papers needed by citizens and to establish a system so that the government knew who was in the country. The system is linked to the process for driver’s licenses and to the Central Electoral Commission. The registry has helped other ministries eliminate corruption by providing software and links to a central information system.
 
Profile
At the time of this interview, Giorgi Vashadze was chairman of the Civil Registry Agency of the Ministry of Justice of Georgia.  He began serving in the organization in 2005 as head of one of the local territorial offices in Tbilisi.  In August 2005 he was promoted to deputy chairman of the agency, and he was named agency head in 2006.
Full Audio File Size
65MB
Full Audio Title
Giorgi Vashadze Interview