decentralization

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.

Clarence Kipobota

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Focus Area(s)
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6
Country of Reform
Interviewers
Varanya Chaubey
Name
Clarence Kipobota
Interviewee's Position
Outreach Services Coordinator
Interviewee's Organization
Legal and Human Rights Center
Language
English
Nationality of Interviewee
Tanzania
Place (Building/Street)
Legal and Human Rights Center
Town/City
Dar es Salaam
Date of Interview
Reform Profile
No
Abstract

Clarence Kipobota draws on his experience working on pre- and post-election issues at the Legal and Human Rights Center to address various aspects of Tanzania’s electoral process.  He highlights problems with the independence of the Electoral Committee, updating the permanent voter registry, ensuring the enfranchisement of marginalized groups and combating voter fraud.  He also details how the center and its partners were pushing for reform, and he discusses the voter-education activities they were leading.

Profile

Clarence Kipobota joined the Legal and Human Rights Center in Dar es Salaam, Tanzania, after graduating from law school in 2003.  At the time of this interview, he held the position of outreach services coordinator, working to coordinate nine different programs focusing on mass education, human rights monitoring, gender, legal aid, public engagement, election watch, Parliament watch, justice watch and government watch.  He was involved in the pre- and post-election activities of the center.

Full Audio File Size
61.8MB
Full Audio Title
Clarence Kipobota- Full Interview

Jairo Acuña-Alfaro

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Focus Area(s)
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1
Country of Reform
Interviewers
David Hausman
Name
Jairo Acuña-Alfaro
Interviewee's Position
Policy Adviser
Interviewee's Organization
United Nations Development Programme
Language
English
Nationality of Interviewee
Costa Rican
Town/City
Hanoi
Country
Date of Interview
Reform Profile
No
Abstract

Jairo Acuña-Alfaro discusses Vietnam’s past and, at the time of the interview, ongoing and future efforts to reform the civil service. He discusses the Vietnamese public sector’s shortcomings, including corruption, nepotism, politicization, low salaries, and a lack of clear job descriptions. He describes what Vietnam is doing to modernize its civil service by introducing merit-based considerations in recruitment and promotions; to encourage professionalism by restructuring and formalizing the civil service and improving performance management; to improve service delivery through decentralization, consolidation, and the establishment of one-stop shops; and to curtail corruption by enacting pay reform and monetizing benefits. He also discusses challenges specific to Vietnam, including the politicization of civil service through the single-party system, rigid hierarchism and the consequent lack of initiative from subordinates, and other cultural factors. Finally, Acuña-Alfaro emphasizes the establishment of best practices as key to reforming a country’s civil service.    

Case Study:  Measuring Citizen Experiences: Conducting a Social Audit in Vietnam, 2009-2013

Profile

At the time of this interview, Jairo Acuña-Alfaro had been working for the United Nations Development Programme since 2007. Prior to that, he had worked with the UNDP in Costa Rica; with the World Bank in Washington, D.C.; and at the World Bank Institute, where he studied governance and anticorruption. Acuña-Alfaro earned a doctoral degree in political economy from Oxford University.

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61MB
Full Audio Title
Jairo Acuña-Alfaro Interview

Pravin Gordhan

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Focus Area(s)
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4
Country of Reform
Interviewers
David Hausman
Name
Pravin Gordhan
Interviewee's Position
Minister of Finance
Interviewee's Organization
South Africa
Language
English
Nationality of Interviewee
South African
Place (Building/Street)
Treasury
Town/City
Pretoria
Country
Date of Interview
Reform Profile
No
Abstract

Former South African Revenue Service Commissioner Pravin Gordhan describes the internal organizational changes that helped the service consistently meet or exceed its revenue targets during his tenure. Appointed commissioner soon after the service obtained autonomy from South Africa’s civil service regulations, Gordhan talks about how he led a campaign of organizational transformation known as siyakha (“we are building” in Zulu), which reorganized tasks, shifted people within the organization, and led to large-scale racial transformation. The policy depended on aggressive outreach efforts both within the organization and to the public at large. By taking office staff on public campaigns during tax-filing season, Gordhan built public willingness to comply while motivating his employees.

Case Study:  Reworking the Revenue Service: Tax Collection in South Africa, 1990-2009

Profile

At the time of this interview, Pravin Gordhan was minister of finance for South Africa. He was the commissioner of the South African Revenue Service from 1999 to 2009. Before his career in government, Gordhan played a prominent role in the South African liberation movement; in the 1980s, he was secretary of Operation Vula, the African National Congress underground organization.

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45MB
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Pravin Gordhan Interview

Charles Munyaneza

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10
Country of Reform
Interviewers
David Hausman and Daniel Scher
Name
Charles Munyaneza
Interviewee's Position
Executive Secretary
Interviewee's Organization
Rwandan National Electoral Commission
Language
English
Nationality of Interviewee
Rwandan
Place (Building/Street)
National Electoral Commission
Town/City
Kigali
Country
Date of Interview
Reform Profile
No
Keywords
Abstract

Charles Munyaneza speaks about his role as executive secretary of the Rwandan National Electoral Commission and the efforts to rebuild the country after the 1994 genocide. He begins his discussion by describing his experience working as the director of Political Affairs and Territorial Administration for the Ministry of Internal Affairs immediately after the genocide. He describes the situation in Rwanda in which many refugees had fled their land years before the genocide. With the new government, many refugees returned, causing a shortage of land and jobs. The Ministry of Internal Affairs was forced to look for innovative solutions to restructure the division of territory in Rwanda. Finally Munyaneza speaks about his efforts in the National Electoral Commission to push decentralization through promoting local self-determination.    

Case Studies:  The Promise of Imihigo: Decentralized Service Delivery in Rwanda, 2006-2010 and Government Through Mobilization: Restoring Order After Rwanda's 1994 Genocide

Profile

At the time of this interview, Charles Munyaneza was the executive secretary of the Rwandan National Electoral Commission. Beginning in 1994, Munyaneza served as the director of Political Affairs and Territorial Administration in the Ministry of Internal Affairs and Local Government. He played an active role in the restructuring of land ownership in Rwanda through a series of policies known as imidugudu. In 2000 he began work for the National Electoral Commission and oversaw its decentralization efforts. He earned a bachelor of arts degree in political science from Makere University in Uganda and a master of business administration degree from Maastricht University in the Netherlands. 

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667 MB
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Charles Munyaneza Interview

From Central Planning to Performance Contracts, New Public Management in Mongolia, 1996-2009

Author
David Hausman
Focus Area(s)
Country of Reform
Abstract

In 1996, Mongolia’s newly elected government, led by a group of market-oriented politicians, decided to reform civil service on the New Zealand New Public Management model, which required managers to sign contracts promising results in exchange for freedom to spend their budgets as they chose. The reforms were intended to modernize a civil service that, while legally changed since democratization in 1990, retained many of the characteristics, and staff, of the previous Soviet-modeled system. Reformers confronted a lack of robust accountability procedures, salary arrears and a lack of central control over local expenditures. The Democratic Coalition government, led by an economic team strongly committed to market-oriented reforms, settled on the contract-based New Public Management model as a way of preserving agency-level decentralization while making agencies’ managers directly accountable to the national government. When enacted, the system met with difficulty at every stage: in specifying outputs for agencies and individuals, in measuring performance, and in rewarding good performance. By 2009, thirteen years after the reforms started, officials reported that the contracts remained largely a formality.

David Hausman wrote this case study based on interviews conducted in Ulaanbaatar, Mongolia, in December 2009. 

Associated Interview(s):  Mendsaikhany Enkhsaikhan

Kwamena Ahwoi

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3
Country of Reform
Interviewers
Itumeleng Makgetla
Name
Kwamena Ahwoi
Interviewee's Position
Secretary
Interviewee's Organization
Ministry of Local Governance and Rural Development, Ghana
Language
English
Nationality of Interviewee
Ghanaian
Town/City
Accra
Country
Date of Interview
Reform Profile
No
Abstract

Kwamena Ahwoi recounts his experiences implementing decentralization policies in Ghana as part of his role in the Ministry of Local Governance and Rural Development. He goes into detail about the key challenges he faced, such as translating policy proposals into legislation, transferring functions from historically highly centralized agencies, and setting up political structures for decentralization. He talks about the methods to garner support for the initiatives through a consultative process with the support of a fully researched policy document, and effective use of the mass media, as well as the methods to overcome the challenges faced from those opposing the reform, such as some local chiefs. He details the bargaining that took place at the national level as a result of the policy document and the need for openness in the implementation process to allow people the opportunity to express their concerns. He explains that throughout the entire process there is a need to increase capacity at all levels to ensure the requisite skill set is assigned to its relevant area.  Finally, Ahwoi offers his thoughts on the best ways to deal with the devolution of power in the decentralization process.

 

Profile

At the time of this interview, Kwamena Ahwoi was a principal lecturer at the Ghana Institute of Management and Public Administration. Ahwoi has had an extensive career in the government of Ghana. He started his professional career as a professor of law at the University of Ghana before joining the Rawlings government in 1983.  Jerry Rawlings, Ghana's military leader after a coup d'etat from 1982-1992, became the first president of the Fourth Republic in 1993, serving until 2001. Ahwoi served as secretary for the Ministry of Local Governance and Rural Development from 1988 to 1999, and doubled as the minister of foreign affairs from 1997 to 1998. Ahwoi also established the Ministry of Planning Regional Economic Cooperation and Integration before the Provisional National Defense Council lost power in 2001. After leaving office he also worked for the National Democratic Congress as director of research. He earned a law degree from the University of Ghana before going on to continue his studies at Oxford University.

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75 MB
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Kwamena Ahwoi- Full Interview

Benjamin Mkapa

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6
Country of Reform
Interviewers
Jennifer Widner
Name
Benjamin Mkapa
Interviewee's Position
Former President
Interviewee's Organization
United Republic of Tanzania
Language
English
Nationality of Interviewee
Tanzanian
Town/City
Dar es Salaam
Date of Interview
Reform Profile
No
Abstract
Benjamin Mkapa discusses the reform of Tanzania’s civil service during his presidency. He explains the need for reform to curtail corruption and inefficiency, spur economic growth, promote more egalitarian policies for workers and retain support from international donors. He discusses Tanzania’s largely voluntary retrenchment program and pay reform for state employees, as well as efforts to privatize state-owned commercial enterprises. Measures to restructure and decentralize civil service, as well as improvements in performance management, also played a large role in Tanzania’s success in achieving civil service reform. Mkapa also discusses the role of leadership in creating and sustaining support for his reform program. He examines the role of the executive branch in mustering support from the civil service, the private sector, the legislature and other political entities, and international donors to ensure the efficacy and longevity of reform. He also emphasizes the importance of an active press, consistent provision of law and order, economic growth, and intelligent sequencing of reforms in the success of reform programs.
 
Profile

Benjamin Mkapa was the third president of Tanzania, holding the office from 1995 to 2005. Mkapa began his career at the Ministry of Foreign Affairs but soon began work in journalism. After editorial work for newspapers, he was appointed press secretary for the president. His career then turned toward foreign affairs and politics again, and his appointments included the offices of ambassador to the United States, minister for foreign affairs, minister for information and broadcasting, minister for information and culture, and minister for science, technology and higher education.  

Full Audio File Size
53.1MB
Full Audio Title
Benjamin Mkapa Interview

Rose N. Kafeero

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2
Country of Reform
Interviewers
Andrew Schalkwyk
Name
Rose N. Kafeero
Interviewee's Position
Deputy Secretary of the Public Service Commission
Interviewee's Organization
Uganda
Language
English
Nationality of Interviewee
Ugandan
Town/City
Kampala
Country
Date of Interview
Reform Profile
No
Abstract

Rose Kafeero describes the challenges she faced to implement “results-oriented management” reforms in the Ugandan government. While she believes that the mindset changed over the years and that budgets were prepared on the basis of outcomes, she says the impetus for outcome-based performance weakened when some of the managers leading these reforms left agencies. She also did not have full backing from top officials. She believes that other civil service reforms such as downsizing and divestiture of functions have been more successful. She outlines the merit-based selection process at both the national and district levels. She says that universities do not produce skill levels that match government requirements in some categories. She describes the difficulties of recruiting or retaining civil servants in some categories because of low pay and a failure to provide core benefits such as housing.

Profile

At the time of this interview, Rose N. Kafeero was deputy secretary of the Public Service Commission in Uganda. Upon graduation from university, she was appointed as a personnel officer and subsequently was promoted to higher positions. In 1992, she was elevated to head of department in the Ministry of Public Service and subsequently to her position at the time of the interview.  In that position, she also headed the Department of Monitoring and Guidance, which served as the secretariat to the Public Service Commission.

Full Audio File Size
78 MB
Full Audio Title
Rose N. Kafeero - Full Interview

Emile Short

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I
Focus Area(s)
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14
Country of Reform
Interviewers
Itumeleng Makgetla
Name
Emile Short
Interviewee's Position
Former Commissioner
Interviewee's Organization
Commission on Human Rights and Administrative Justice, Ghana
Language
English
Nationality of Interviewee
Ghanaian
Town/City
Accra
Country
Date of Interview
Reform Profile
No
Abstract

Emile Short recounts his experiences establishing the Commission for Human Rights and Administrative Justice in Ghana from 1993 to 2004. He goes into detail about the strategies put into place to establish the commission while avoiding any politicization and patronage within this process. He recalls how he and others set up the commission with a triple mandate encapsulating human rights, ombudsman and anti-corruption activities, and how cases were selected and prioritized. The need for effective recruitment was essential in the initial stages, as well as the training that staff would receive initially, and continue to receive.  He details the character of the individuals sought for the commission and the particular skills set that was required. Throughout, he explains the challenges that were encountered and how these were overcome.    

Case Study:  Earning a Reputation for independence: Ghana's Commission on Human Rights and Administrative Justice, 1993-2003

Profile

Emile Short served as commissioner of Ghana's Commission on Human Rights and Administrative Justice from 1993 to 2004. Before that, he was head of a Ghanaian law firm for 20 years. He also served as a justice on the United Nations International Criminal Tribunal for Rwanda. He earned an LLM degree from the London School of Economics and Political Science in 1967. He also received an honorary doctorate from Northwestern University in Illinois.

Full Audio File Size
74 MB
Full Audio Title
Emile Short Interview