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.

Jay Wysocki

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M
Focus Area(s)
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3
Country of Reform
Interviewers
David Hausman
Name
Jay Wysocki
Interviewee's Position
Local Governance Adviser
Interviewee's Organization
United Nations Development Programme, Vietnam
Language
English
Nationality of Interviewee
American
Town/City
Hanoi
Country
Date of Interview
Reform Profile
No
Abstract
Jay Wysocki talks about civil service reforms in Vietnam.  The main impetus for the reforms was the Thai Binh riots involving corrupt government officials and land appropriation.  Other factors included the inflow of foreign direct investment that required political and administrative changes, the need for a growing economy to absorb the rising number of people in the job market, and the improvement of public services.  The reforms focused on institutions, performance, staffing and organizational structure.  Wysocki explains the capacity-building programs at the National Academy of Public Administration.  He also discusses decentralization and the privatization or “socialization” of services like education and healthcare.  The reform process was affected by corruption and lack of empirical data, which complicated program evaluations. 
Profile

At the time of this interview, Jay Wysocki was the United Nations Development Programme's local governance adviser in Vietnam. He first came to Vietnam in 1995 to participate in a British project run by Oxfam. He later designed a project to improve the quality of public administration training at the National Academy of Public Administration. He also served as the project’s chief technical adviser.  

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99.4MB
Full Audio Title
Jay Wysocki Interview

Robertson Nil Akwei Allotey

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C
Focus Area(s)
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2
Country of Reform
Interviewers
Ashley McCants
Name
Robertson Nil Akwei Allotey
Interviewee's Position
Chief Director
Interviewee's Organization
Ministry of Public Sector Reform
Language
English
Nationality of Interviewee
Ghanaian
Town/City
Accra
Country
Date of Interview
Reform Profile
No
Abstract

Robertson Nil Akwei Allotey explains the history of civil service reform in Ghana and the National Institutional Renewal Program. Phase 1 of the program began in 1994 and ended in 2000. It redefined the mission of the ministries and set out methods to improve the delivery of services to the citizenry and to publicize the services offered to the public. The Civil Service Improvement Program analyzed ministries, departments and agencies to reorganize them, to decide on the optimal size, to retrain, and to improve the efficiency and effectiveness in service delivery with attention to work ethics and transparency. The first task was to reduce political and social influence in recruitment and promotion by open civil service examinations and performance assessments carried out by retired senior civil servants. In Phase I, a “single spine” pay policy was instituted to insure pay equity. Increases in salary were based on performance. In Phase II, emphasis was placed on private sector growth for the government’s development agenda. He says that the reform effort targeted all public agencies, not just the civil service, with decentralization and the restructuring of central management agencies with emphasis on procurement and records management and information technology as support interventions. The major reform initiatives were part of the government’s poverty reduction strategy program, which was linked to the Millennium Development goals developed by the United Nations.

Profile

At the time of this interview, Robertson Allotey had been acting chief director at the Ministry of Public Sector Reform in Ghana for six months.  Allotey began his career in civil service reform in 1998, when he was the director in charge of the Customer Services Improvement Unit in the office of the head of civil service. He earned a master’s degree in urban policy and housing and was particularly interested in the accessibility of urban housing stock and what factors made people content with their environments. Improvement of public service delivery to citizens played an important role and prepared him for his work with the civil service to improve delivery of services. 

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114 MB
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Robertson Allotey - Full Interview

Awni Yarvas

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2
Country of Reform
Interviewers
Deepa Iyer
Name
Awni Yarvas
Interviewee's Organization
Former Director, Civil Status and Passports Department
Language
Arabic with English translation
Nationality of Interviewee
Jordan
Town/City
Amman
Country
Date of Interview
Reform Profile
No
Abstract

Awni Yarvas discusses reforms undertaken in Jordan’s Department of Civil Status and Passports, with a focus on those that took place under his tenure.  He explains how increases in efficiency were possible with changes in departmental structure, employee incentives, and, in particular, computerization.  Yarvas details how changes in procedures for issuing passports and national IDs improved the department's efficiency and accuracy.

Case Studies:  Creating a 'Citizen Friendly' Department: Speeding Document Production in Jordan, 1991-1996 and People and Machines--Building Operational Efficiency: Document Processing in Jordan, 1996-2005

Profile
Awni Yarvas served as director of Jordan’s Civil Status and Passports Department from 1996 to 2005.  He previously served as a major general in Jordan’s General Intelligence Department.  In 2005, he was appointed Jordan’s Minister of Interior, a position he held until 2010.
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50 MB
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Awni Yarvas - Full Interview

David Adom

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1
Critical Tasks
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Interviewers
David Hausman
Name
David Adom
Interviewee's Position
Consultant
Interviewee's Organization
AA&K Consulting
Language
English
Town/City
Accra
Country
Date of Interview
Reform Profile
No
Abstract

Former IRS Commissioner David Adom describes the organizational changes that helped improve revenue collection at the Ghanaian IRS between 1986 and 2001.  He focuses on changes to human resource policy and organizational structure.  On his watch, first as deputy Commissioner and then as Commissioner, the IRS became autonomous from Ghana’s civil service regulations.  Using that freedom, the organization tripled salaries and hired a large new cohort of professionals—mostly lawyers and accountants.  In order to integrate these new hires into the pool of existing employees, Adom kept retrenchments to a minimum, applied salary raises equitably throughout the whole organization, and spread new hires across different units in order to give new and old staff a chance to mix on the job.  Finally, in an attempt to target the small number of taxpayers who accounted for more than half of Ghana’s revenue, Adom introduced an elite Large Taxpayer’s Office, which offered better service—and more careful enforcement—to wealthy individuals and firms.  

Case Study:  Professionalization, Decentralization and a One-Stop Shop: Tax-Collection Reform in Ghana, 1986-2008

Profile

At the time of this interview, David Adom was a consultant at AA&K Consulting.  He was deputy commissioner for research and planning in the Ghana Internal Revenue Service between 1986 and 1996, and he went on to serve as commissioner of the organization from 1996 until 2001.  Before he joined the IRS, he worked as a chartered accountant in Nigeria. 

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63 MB
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David Adom Interview

Clay Wescott

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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

Leonard Rugwabiza

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Focus Area(s)
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11
Country of Reform
Interviewers
Daniel Scher
Name
Leonard Rugwabiza
Interviewee's Position
Director General for National Planning and Research
Interviewee's Organization
Rwanda Ministry of Finance and Economic Planning
Language
English
Nationality of Interviewee
Rwandan
Town/City
Kigali
Country
Date of Interview
Reform Profile
No
Abstract
Leonard Rugwabiza describes the integrated planning, budgeting, and implementation process involved in imihigo, the Rwanda’s initiative to improve local governance by increasing accountability and implementing economic and social development. Rugwabiza reports on the procedures used to harmonize national and local planning and priorities through an integrated bottom-up and top-down process. He explains that officials at all levels, national and local, were on “performance contracts.” About three-fourths of the mayors in the country’s 30 districts left their jobs in the prior year because of the stress. Nevertheless, Rugawabiza says, measurable improvements in performance and execution could be credited to the process.
 
Profile

At the time of this interview, Leonard Rugwabiza was the director general for national planning and research at Rwanda's Ministry of Finance and Economic Planning. Prior to that, he spent two years as an economist with the African Development Bank. Earlier, he served in the strategic planning unit of the Ministry of Finance.    

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43MB
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Leonard Rugwabiza Interview

Fatbardh Kadilli

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13
Country of Reform
Interviewers
Jona Repishti
Name
Fatbardh Kadilli
Interviewee's Position
Adviser to the Prime Minister
Interviewee's Organization
Albania
Language
Albanian
Nationality of Interviewee
Albanian
Town/City
Tirana
Country
Date of Interview
Reform Profile
No
Abstract

Fatbardh Kadilli, adviser to Albania's prime minister on anti-corruption policies, presents his views on the efforts to reform public administration. He says that the country adopted Western models for reform legislation and implementation, but that breaking old habits acquired under the former communist system was difficult. He believes that protecting civil servants from arbitrary firing impeded efforts to modernize the government because so many administrators were still in positions where they could not perform. He describes the difficulties of trying to institute a successful performance management system because Albania had few leaders who understand management. He reports on initiatives to downsize and consolidate ministries and to install Internet-based systems to reduce corruption in procurement, licensing and a number of other public services.

Profile

At the time of this interview, Fatbardh Kadilli was adviser to the prime minister on anti-corruption matters, a position he had held since 2005.  Prior to that he served for four years as a consultant on anti-corruption with an American firm financed by the U.S. Agency for International Development. Prior to that he led a program on integrated services for children at UNICEF. From 1998 to 2005, he was also a consultant with the Institute for Contemporary Studies, where, among other tasks, he advised the government on decentralization reforms. Earlier, he served in the State Secretariat for Local Governance, where he was in charge of the Refugee Office and drafted the law on asylum seekers.

Full Audio File Size
78 MB
Full Audio Title
Fatbardh Kadilli - Full Interview

Nasouh Marzouqa

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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.

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207 MB
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Nasouh Marzouqa - Full Interview

Senator Sumo Kupee

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4
Country of Reform
Interviewers
Graeme Blair
Name
Senator Sumo Kupee
Interviewee's Position
Senator
Interviewee's Organization
National Legislature of Liberia
Language
English
Nationality of Interviewee
Liberian
Town/City
Monrovia
Country
Date of Interview
Reform Profile
No
Abstract

Senator Sumo Kupee provides insight based on his experiences as Chairman of the Senate Ways, Means, Finance and Budget Committee. He describes the committee’s endeavors to ensure that the oversight responsibility of the legislature with respect to the executive is filled, specifically by scrupulous monitoring of the approval and implementation of the national budget.  He further outlines the committee’s work in drafting a public financial management law, and improving the existing investment incentive code, looking to bring about economic revitalization to facilitate poverty reduction. Kupee stresses the importance of the decentralization of the budget, and details the committee’s efforts to ensure that the budget is county-sensitive and efficiently allocated. He also discusses the creation and plans of the Legislative Modernization Committee, going into depth about problems with appointed personnel and the need for qualified/trained staff. In this respect, Kupee describes his experience with his own staff and the training strategies he employed. Acknowledging the competing factional interests that often need to be overcome when conducting negotiations within governance, he outlines the fragmented conception of loyalties within Liberia and discusses how these play out in Liberian politics. Kupee also stresses the need for reconstruction and infrastructure building within Liberia, considering this a major national task. He concludes by providing information about the avenues he explores when looking to draft new legislation. 

 

Profile

Sumo G. Kupee served as a senator in the National Legislature of Liberia, being elected to the position in 2005. Kupee was also the chair of the Senate Ways, Means, Finance and Budget Committee. In the past, Kupee has served in various capacities at the Ministry of Finance, starting as Commissioner, Bureau of Income Tax, progressing to Special Assistant and Policy Adviser to the Minister of Finance, and later becoming Commissioner of Customs and Excise, the latter being a position he held immediately prior to elections. With an MSc in Development Economics from the People’s Friendship University of Russia (PFUR), Kupee taught at the University of Liberia from 1986-1997, and served as Chairman of the Department of Economics for six years.

 

Full Audio File Size
58 MB
Full Audio Title
Sumo Kupee - Full Interview