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.

Juwono Sudarsono

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C
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6
Country of Reform
Interviewers
Matthew Devlin
Name
Juwono Sudarsono
Interviewee's Position
Minister of Defense
Interviewee's Organization
Indonesia
Language
English
Nationality of Interviewee
Indonesian
Town/City
Jakarta
Country
Date of Interview
Reform Profile
No
Abstract

Juwono Sudarsono reflects on lessons learned from nation building and governance reform in Indonesia. He states that when he was named minister of defense in 2004 by the president, his instructions were to neutralize the political role of the military and its dominance of the government, to require the military to support national democratization, and to scrutinize the defense acquisition process in order to reduce corruption. He found it was not difficult to convince the military to withdraw from the political process, because the military had come to see its political role as a liability jeopardizing its credibility with the population. The police were removed from military control and placed under separate civilian control. Military-operated businesses were either eliminated or placed under control of a new agency. He says it was more difficult to reduce the number of police-operated businesses because the salaries of members of the police were low, so they inevitably seek ways to make the additional income they needed. He says that corruption cannot be eliminated, but it can be reduced step by step. He describes initiatives to reduce bribes and kickbacks in the defense acquisition process. He points out that the government was starved for revenue because $25 billion a year was being lost to illegal smuggling and organized crime. To advance the process of democratization, the military began to provide training and technical assistance to help build the capacities for democracy and development in other sectors of society. He points out that while there were individuals capable of assuming top positions, the country was very short of capabilities at the second and third levels. The military helped to train accountants, managers, specialized lawyers and other specialists at these levels, particularly in the marginal regions. He believes that while merit systems are essential to build the competence of the civil services, affirmative action needs to be taken to help marginalized people feel that they are part of the national society. This means that merit sometimes should not be the only standard taken into account. Democratization and development depend upon building up a trained middle class, he says.

Profile

At the time of this interview, Juwono Sudarsono was Indonesia's minister of defense, in a term that began in 2004. From 2003 to 2004, he was ambassador to the United Kingdom. From 1999 to 2000 he served as the first civilian minister of defense. He was minister for education and culture in 1998-1999, after serving as minister of state. From 1995 to 1998, he was vice governor of the National Defence College. He received bachelor's and master's degrees from the University of Indonesia, studied at the Institute of Social Studies in The Hague, Netherlands, and received a master's from the University of California at Berkeley. He earned a Ph.D. from the London School of Economics. 

Full Audio File Size
65 MB
Full Audio Title
Minister Juwono Sudarsono - Full Interview

Shri Himanta Biswa Sarma

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A
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8
Country of Reform
Interviewers
Rohan Mukherjee
Name
Shri Himanta Biswa Sarma
Interviewee's Position
Minister of Health
Interviewee's Organization
Government of Assam State, India
Language
English
Nationality of Interviewee
Indian
Town/City
Assam
Country
Date of Interview
Reform Profile
No
Abstract
Shri Himanta Biswa Sarma talks about his role in the reform efforts in the state government of Assam over the previous decade. He talks about the financial reforms put in place to improve recruitment standards and salary payments, such as initiating a Value Added Tax program as a way of balancing the books to allow for further reform efforts, and overcoming the challenges associated with the these new reforms. He talks about dealing with different parts of society putting pressure on the government once the financial reforms were put in place and money became available to spend, and balancing competing interests. He also goes into detail about how the government of Assam dealt with the insurgency problem affecting the state through cease-fire negotiations, concessions and the establishment of tribal councils. He also offers his opinions on how decentralization and democracy can empower people and contribute to economic development. Finally, he discusses the need to stay up to date on all the relevant issues affecting the local community, to know the problems and stay in touch with the people to help build trust and advance the development process.
 
Profile

At the time of this interview, Shri Himanta Biswa Sarma was the minister of health for the government of Assam state in India, and he also ran the Guwahati Development Department. He held various positions and roles during more than a decade of service to the government of Assam. In 2002, he was appointed as the minister of state in charge of agriculture, planning and development before becoming the minister of finance in Assam in 2004.

Full Audio File Size
63 MB
Full Audio Title
Shri Himanta Biswa Sarma - Full 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

Jayanta Madhab

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A
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6
Country of Reform
Interviewers
Rohan Mukherjee
Name
Jayanta Madhab
Interviewee's Position
Adviser
Interviewee's Organization
Chief Minister of Assam
Language
English
Nationality of Interviewee
Indian
Town/City
Assam
Country
Date of Interview
Reform Profile
No
Abstract
Jayanta Madhab goes into detail about the reform programs undertaken in Assam during his time as advisor to the chief minister of Assam from 2003-2009. He details the need to introduce new legislation into law in order to improve the financial situation in the state and improve funding, done through the value added tax system, and the challenges faced due to the recession and deficit financing. He talks about the need to implement reforms that will have far reaching affects across all ethnicities, minorities, and vulnerable groups, and how managing these factions and autonomous groups was essential to the reforms success. He describes the main problem in the reform process was changing the attitudes and building support within government for change through coalition building and management of insurgent groups in the region. Finally, he specifically address the need to improve employment and education opportunities as well as technical skills (such as improving agricultural practices in poor rural areas) as a means of keeping poor disaffected youth out of insurgent groups.
 
Profile

Jayanta Madhab is an economist who served as an advisor to the chief minister of Assam, India, from 2003 to early 2009. During his time in government he advised the chief minister on economic and financial affairs before taking up the mandate of employment generation in Assam in the chief minister’s second term. He has worked for the Asian Development Bank, as well as the North Eastern Development Finance Corporation (NEFDI). He holds a Ph.D. from the London School of Economics.

Full Audio File Size
55 MB
Full Audio Title
Jananta Madhab - Full Interview

The Promise of Imihigo: Decentralized Service Delivery in Rwanda, 2006-2010

Author
Daniel Scher
Country of Reform
Abstract

In the wake of the 1994 genocide, the Rwandan Patriotic Front inherited the remnants of a highly centralized state administration.  For a number of years the government engaged in crisis management, attempting to meet the basic needs of a traumatized population.  In 2000, in an effort to improve local service delivery, the RPF-led government began a program of decentralization.  Under the new arrangement, mayors were responsible for implementing development programs.  A chief concern for the central government was how to make mayors accountable.  In response to this challenge, the government in 2006 launched an innovative system known as the imihigo process.  Imihigo had its roots in a pre-colonial Rwandan cultural practice whereby leaders or warriors would publicly vow to achieve certain goals and face public humiliation if they failed.  The modern imihigo process linked this traditional Rwandan practice with planning, monitoring and oversight.  By 2010, government officials believed that the imihigo process had resulted in improved service delivery in the districts.

Daniel Scher drafted this case study with Christine MacAulay on the basis of interviews conducted in Rwanda in May 2010. 

Associated Interview(s):  Fabien MajoroFred Mufulukye, Charles Munyaneza, Protais Musoni, Leonard Rugwabiza

 

Alfredo Gamito

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M
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10
Country of Reform
Interviewers
Itumeleng Makgetla
Name
Alfredo Gamito
Interviewee's Position
Chairman, Commission on Public Administration, Local Power and the Mass Media
Interviewee's Organization
National Assembly of Mozambique
Language
Portuguese
Nationality of Interviewee
Mozambican
Town/City
Maputo
Country
Date of Interview
Reform Profile
No
Abstract

Alfredo Gamito describes his experience as Mozambique's minister of state administration, which involved implementing a reform program to modernize, professionalize and decentralize the administration. He describes the steps that the ministry took to integrate individuals nominated by the opposition RENAMO party into the state administration, describing in particular the training that these new civil servants underwent. Gamito additionally discusses the process of determining which cities the government would designate as municipalities ahead of the country’s first municipal elections in 1998.

Case Study:  Embracing the Power of Tradition: Decentralization in Mozambique, 1992-2000

Profile

Alfredo Gamito served as the minister of state administration in Mozambique from 1995 to 2000. In this position, he managed a broad reform agenda that included decentralizing the state administration as well as professionalizing the civil service. Gamito began his career in the private sector before being appointed as the secretary of the state cashew company. He also served as the vice minister of agriculture and the governor of Nampula province. At the time of this interview, Gamito was a member of the National Assembly,where he was chairman of the Commission on Public Administration, Local Power and the Mass Media.

Full Audio File Size
98.3MB
Full Audio Title
Alfredo Gamito- Full Interview

Kim Sedara

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2
Country of Reform
Interviewers
Rohan Mukherjee
Name
Kim Sedara
Interviewee's Position
Senior Researcher
Interviewee's Organization
Cambodia Development Resource Institute
Language
English
Nationality of Interviewee
Cambodian
Town/City
Phnom Penh
Country
Date of Interview
Reform Profile
No
Abstract
Kim Sedara comments on international donors who try to import reforms and models of governance into Cambodia without understanding the need to take context into account. He suggests that the task is not to build a system from scratch, but to fix and cure the problems of existing institutions. Referring to the challenges of institution building in his home country, he notes that Cambodia “is still very much in a post-conflict stage.” From the early 1970s to 2009, Cambodia went through at least six major political regimes, leading to numerous “institutional interruptions,” making it very difficult for the state to be responsive and accountable to its citizens, he says. The first challenge was to provide security; the second, food; the third, re-integration of formerly warring factions. He states that a major problem had been a shortage of professional talent, and an educational system poorly designed to correct it. He believes that the rule of law can be achieved only if it is internalized by the population, and that takes time. Sedara says corruption cannot be controlled until people are able to feed themselves and their families from their legitimate earnings. He suggests targeting four major reform areas: courts, the military, administration and public finance. Decentralization and de-concentration are part of administrative reform. Citing a World Bank report, Sedara says that 45 percent of post-conflict societies fall back into civil war within five years of emerging from conflict. Cambodia avoided this fate, and Sedara says he is hopeful for the future.
Profile

At the time of this interview, Kim Sedara was a senior researcher at the Cambodia Development Resource Institute, an independent think tank in Phnom Penh. In 1994, he received a degree in archeology in Cambodia and another from the University of Hawaii in 1996. He won a 1998 Fulbright scholarship in 1998 and degrees in economics and political anthropology from the University of Illinois and Stanford. He earned a Ph.D. from Gothenburg University in Sweden in 2005. Sedara has written widely on issues of post-conflict reconstruction, elections, decentralization and deconcentration, and governance in Cambodia.

Full Audio File Size
43MB
Full Audio Title
Kim Sedara Interview

Kartlos Kipiani

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J
Focus Area(s)
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3
Critical Tasks
Country of Reform
Interviewers
Andrew Schalkwyk
Name
Kartlos Kipiani
Interviewee's Position
Chief of Staff
Interviewee's Organization
Constitutional Court of Georgia
Language
English
Nationality of Interviewee
Georgian
Town/City
Tbilisi
Country
Date of Interview
Reform Profile
No
Abstract
Kartlos Kipiani, chief of staff of the Constitutional Court of Georgia at the time of the interview, discusses his time as head of the Public Service Bureau of Georgia and the efforts he was involved in to implement civil service reform projects.  The projects, which were wide-ranging, included efforts to improve technical skills of civil servants and to create a single information-management system across the ministries.  Kipiani also explains the role donors such as the World Bank played in setting the reform agenda.  He discusses the difficulty of dealing with poorly defined and sometimes overlapping government bureaucracies.  He touches on the question of decentralized versus centralized public-administration reform, and he explains why he thinks centralization of reform concepts is important.  He also discusses the difficulties he ran into with attempts to create one codification of job descriptions across all ministries.
 
Profile

At the time of this interview, Kartlos Kipiani was the chief of staff of the Constitutional Court of Georgia, a position he held from 2006 until March 2010.  In April 2010 he became deputy head of the Government Chancellery.  He previously served as secretary of the Public Service Council and acting head of the Public Service Bureau.  Kipiani also headed the Division for Civil Service Reform under the previous government in 2000.  He worked on various programs as a coordinator for the United Nations Development Programme.  He first began working for the government in the Office of State Chancellery in 1995.  Kipiani earned a master's degree in public policy from Japan’s National Graduate Institute for Public Policy Studies at Saitama University in 2003.

Full Audio File Size
59MB
Full Audio Title
Karlos Kipiani Interview

Fabien Majoro

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S
Focus Area(s)
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8
Country of Reform
Interviewers
Daniel Scher
Name
Fabien Majoro
Interviewee's Position
Director General, Coordination Unit
Interviewee's Organization
Office of Rwanda's Prime Minister
Language
English
Nationality of Interviewee
Rwandan
Town/City
Kigali
Country
Date of Interview
Reform Profile
No
Abstract

Fabien Majoro explains how the Rwandan government was able to adapt and utilize the traditional concept of imihigo to improve the delivery of programs and services to the people of Rwanda. Imihigo, a traditional approach to motivating youth that was employed in the military service during the precolonial era, involves, in Majoro’s words, “pledging to do things beyond the normal assignment and effectively doing them.” Beginning in 2006, this concept served as the basis for national campaigns to promote healthy behaviors such as handwashing and shoe wearing; its success led Rwandan officials to adapt it to more comprehensive programs designed to address larger issues, such as “fighting soil erosion, mobilizing the population for health insurance [and] reforestation.”  Currently, the concept is utilized as the foundation of competitions whereby provinces and their subdivisions--districts, sectors, cells, and villages--compete at each level to determine who can carry out government programs and initiatives most effectively. The Prime Minister presides over quarterly evaluations and assessments of the competitions; results are publicized on a website and disseminated to the Rwandan people via radio.     

Case Study:  The Promise of Imihigo: Decentralized Service Delivery in Rwanda, 2006-2010 and Improving Coordination and Prioritization: Streamlining Rwanda's National Leadership Retreat, 2008-2011

Profile

At the time of the interview, Fabien Majoro was director general of the Coordination Unit in the Office of Rwanda’s Prime Minister. Majoro, an attorney specializing in human rights law and the law of war, holds law degrees from a law school in Rwanda as well as from Notre Dame Law School in the United States. He worked for the International Committee of the Red Cross for four years, and advised the national government of Rwanda in matters of international law prior to being appointed to his current position. He has also taught human rights law and other legal subjects as a visiting lecturer at Kigali Independent University.  

Full Audio File Size
34 MB
Full Audio Title
Fabien Majoro Interview