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)
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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)
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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.

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

Mohamed Hanno

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V
Focus Area(s)
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3
Country of Reform
Interviewers
Rushda Majeed
Name
Mohamed Hanno
Interviewee's Position
Board Member
Interviewee's Organization
Alexandria Business Association
Language
English
Nationality of Interviewee
Egyptian
Town/City
Alexandria
Country
Date of Interview
Reform Profile
No
Abstract
Mohamed Hanno describes the relationship between the Alexandria Business Association and former Governor of Alexandria, General Mohamed Abdul Salam Mahgoub in working to develop the city of Alexandria. He details how Mahgoub worked with limited investment to stimulate the real estate market, reform the waste management system, and beautify the city. Hanno explains how this was possible due to relationships with private business and civil society organizations. He also details other reforms, such as one-stop shops and other improvements in government efficiency. Hanno also briefly discusses the role of the state media in educating citizens on Mahgoub’s initiatives. Finally Hanno touches on the next steps needed for Alexandria’s development, particularly heavy investment in infrastructure.
 
Profile
At the time of this interview, Mohamed Hanno was a board member of the Alexandria Business Association in Alexandria, Egypt and a board member of the Alexandria Chamber of Commerce’s Computer Division. He is the managing director and founder of Arab Computers. Hanno was a member of the Egyptian delegation to the United States Presidential Summit on Entrepreneurship in April 2010. He also headed the executive committee of the Alexandria Centre for International Arbitration and was a member of the Presidential Council’s subcommittee on intellectual property rights.
 
Full Audio File Size
72 MB
Full Audio Title
Mohamed Hanno Interview

Nasir El-Rufai

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D
Focus Area(s)
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1
Country of Reform
Interviewers
Graeme Blair and Daniel Scher
Name
Nasir El-Rufai
Interviewee's Position
Former Director General, Bureau of Public Enterprises, and Secretary, Council on Privatization
Interviewee's Organization
Nigeria
Language
English
Nationality of Interviewee
Nigerian
Town/City
Washington, D.C.
Country
Date of Interview
Reform Profile
Yes
Abstract

Nasir El-Rufai narrates his entry into public service in the context of the return to democracy under President Olusegun Obasanjo.  As an outsider to the political scene, he managed to advocate for privatization and eventually drafted and implemented a concrete multistage plan.  El-Rufai identifies the “easy” cases for privatization as companies that are (1) already listed on the stock exchange, (2) easy to value, (3) already operational in competitive markets, and/or (4) not politically contentious.  In contrast, the “hard” cases require progressive policy reform including regulatory sector review, enactment of legislation for independent oversight, implementation of antitrust measures and, notably, the creation of a pension system.  In dealing with trade unions and special interest groups, El-Rufai highlights the importance of legal tools and the support of the media, the general public and figures with considerable political capital, such as Obasanjo and Vice President Atiku Abubakar.  He also describes his office’s instrumental collaboration with the newly created Economic and Financial Crimes Commission in the fight against money laundering and, in particular, the Nigerian letter scams.  During Obasanjo’s second term, El-Rufai joined the Economic Management Team that successfully renegotiated the Nigerian external debt and pursued wide-ranging reform.  He attributes the success to the trust, sacrifice and synergy established within the team; their capacity to understand and integrate Obasanjo’s political goals into a reform plan; and their ability to capitalize on booming oil prices by using revenues to strengthen fiscal rule.  His commitment to reform continued during his tenure as minister for the Federal Capital Territory (FCT Abuja).  To improve the quality of service delivery, he promoted the involvement of the private sector in service provision and increased the range of options for public staff training, including attachment with public and private entities in Nigeria and abroad, and post-graduate training at Harvard Business School.  El-Rufai also sought to disincentivize engagement in corruption by increasing remuneration. He addressed the challenge of limited resources by focusing on civil service downsizing and reduction of state expenditure followed by a pay increase across the board.  The necessary downsizing was achieved through a double strategy.  First, following the computerization of personnel management, ghost workers were identified and eliminated from the system.  Second, permanent secretaries were tasked with identifying underperforming or corrupt civil servants, who were offered retirement packages.  As the administration could reject resignations, the drain of the best public servants was prevented, and El-Rufai aimed to address the sources of their discontent, such as shortcomings in the promotion system.  On the other hand, cost reduction mainly entailed the transfer of government-provided housing and vehicles to private ownership by civil servants, amortized through a newly created mortgage system and installment plans.  El-Rufai then discusses another major and controversial achievements of his tenure, namely the land titling initiative, highlighting the role of democratizing information to manage public pressure and increase transparency.  In closing, his personal reflections on public policy making include the need for immersion in the political scene to ensure the continuity of reform across administrations, and the importance of formal training in public administration to understand how to frame policy to overcome resistance and biases. 

 

Profile

A quantity surveyor by training, Nasir Ahmad El-Rufai worked as a consultant in the construction private sector for years.  After declining several offers to join the public sector, in 1999 he became president Olusegun Obasanjo’s director general of the Bureau of Public Enterprises  and Secretary of the National Council on Privatization.  During Obasanjo’s second term, he served as a member of the Economic Management Team and took over as minister for the Federal Capital Territory (Abuja), where he led civil service reform and undertook the computerization of Abuja’s land register.  He served briefly under President Umaru Yar’Adua.  After leaving public service, he completed legal and public management training programs at the University of London and the Kennedy School of Government at Harvard. 

Full Audio File Size
136 MB
Full Audio Title
Nasir El-Rufai - Full Interview

Nasouh Marzouqa

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X
Focus Area(s)
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1
Country of Reform
Interviewers
Deepa Iyer
Name
Nasouh Marzouqa
Interviewee's Position
Former Director
Interviewee's Organization
Civil Status and Passports Department
Language
Arabic with English translation
Nationality of Interviewee
Jordanian
Town/City
Amman
Country
Date of Interview
Reform Profile
No
Abstract

Nasouh Marzouqa discusses major reforms in Jordan’s Civil Status and Passports Department during his time as its director.  He describes how he improved the physical infrastructure of the department and streamlined the process for issuing passports.  Marzouqa also worked to institute a system of national identification numbers and began the process of computerizing the department.  He also discusses his efforts to motivate employees.    

Case Study:  Creating a 'Citizen Friendly' Department: Speeding Document Production in Jordan, 1991-1996

Profile

Nasouh Marzouqa served as head of Jordan’s Civil Status and Passports Department from 1991 to 1996, during which he oversaw massive reforms to the department. He previously served as director of the police departments in Irbid and Amman, and was director general of the Department of Public Security from 1985 to 1989.

Full Audio File Size
207 MB
Full Audio Title
Nasouh Marzouqa - Full Interview

Clay Wescott

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G
Focus Area(s)
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7
Country of Reform
Interviewers
Andrew Schalkwyk
Name
Clay Wescott
Interviewee's Position
Visiting Lecturer
Interviewee's Organization
Princeton University
Language
English
Nationality of Interviewee
USA
Place (Building/Street)
Princeton University
Town/City
Princeton, New Jersey
Country
Date of Interview
Reform Profile
Yes
Abstract

Clay Wescott draws on his global experience and talks about civil service reform programs in countries around the world.  He talks about his involvement in such programs in Vietnam, including aspects such as downsizing and the introduction of one-stop shops.  He also recalls the introduction of an effective but contentious computer-based budgeting system in Kenya in the 1980s.  Wescott reflects on the difficulty of reforming a civil service that had been used as a tool of a peace process, such as in Cambodia, where positions were parceled out in order to get different factions to buy into the process.  He also identifies the importance of building reforms to last beyond a current window of opportunity, and of selling a vision of reform that people want to buy into.  He also talks about civil service censuses and outsourcing in Nepal and capacity-building programs in Eritrea, Timor-Leste and Afghanistan.

Case Study:  Policy Leaps and Implementation Obstacles: Civil Service Reform in Vietnam, 1998-2009

Profile

At the time of this interview, Clay Wescott was a visiting lecturer at Princeton University and the principal regional cooperation specialist for the Asian Development Bank.  His work has covered e-government, regional cooperation, governance assessment, civil service reform, public finance, decentralization, citizen participation and combating corruption.  He worked all over the world, including Kenya, Bangladesh, Vietnam, Cambodia, Ghana, Nepal, Eritrea, Timor-Leste and other countries.  Before joining the ADB, he worked in the governance division of the United Nations Development Programme, assisting countries to formulate and carry out reform programs in Asia and the Pacific, Africa and the Caribbean.  He earned a bachelor's degree in government from Harvard University and a doctorate from Boston University, and he was an editorial board member of the International Public Management Journal and the International Public Management Review.

 

Full Audio File Size
84.4MB
Full Audio Title
Clay Wesctott- Full Interview