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.

Muhammad A.S. Hikam

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C
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2
Country of Reform
Interviewers
Matthew Devlin
Name
Muhammad A.S. Hikam
Interviewee's Position
Senior Adviser
Interviewee's Organization
Kiroyan Kuhon Partners, consultants
Language
English
Nationality of Interviewee
Indonesian
Town/City
Jakarta
Country
Date of Interview
Reform Profile
Yes
Abstract

Muhammad A.S. Hikam describes constitutional and governance reforms and efforts to build a civil society in Indonesia since 1998. A member of the Hanura (People’s Conscience) political party, a former member of the Indonesian Parliament, and a former state minister for research and technology, he explains that prior to Indonesia’s financial crisis in 1988 and the collapse of the Suharto government, civil society in Indonesia was “corporatist”; that is, that except for the Nahdlatul Ulama (Islamic Scholars Awakening) Party, all civil society organizations and political parties were controlled by the state. In 1998, it was recognized that a strengthened civil society was the only avenue to challenge the overwhelming power of the state. The result was a flowering of as many as 100,000 civil society organizations and 38 political parties. However, nearly all came into being without the capacity or understanding to pursue their roles effectively. Many were based on ethnic or identity interests and did not know how to relate to the political life of the country. The challenge was to train civil and political society to find synergies between interests and needs. Without that, governmental reform has been, and will continue to be, a patchwork, he says. He discusses the successes and shortcomings of reforms in four principal areas: changing the constitution to reduce state domination, opening the political process to opposition parties, removing the military from politics and placing civilian control over the police and armed forces, and decentralizing government and ceding some autonomy to the regions. These efforts have proceeded without regard for capacity building, he says. As a result, poorer regions simply establish regional governments funded by the central government without developing their own capabilities. Hikam stresses that economic development is essential if regional autonomy is to work.    

Profile

At the time of this interview, Muhammad A.S. Hikam was a member of the Hanura (Hari Nurani Rakyat or People’s Conscience) political party and a senior adviser to the consulting firm of Kiroyan Kuhon Partners in Jakarta. He first joined the government in 1983 as a researcher with the Indonesian Institute of Sciences. From 1999 to 2001, he was minister for research and technology, and from 2004 to 2007 was a member of Parliament’s House of Representatives. He received his undergraduate education at Gadjah Mada University in 1981 and received master’s degrees in communications and political science and a Ph.D. in political science from the University of Hawaii in 1995.    

Full Audio File Size
83 MB
Full Audio Title
Muhammad A.S. Hikam - Full Interview

Julius Chan

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10
Country of Reform
Interviewers
Rohan Mukherjee and Matthew Devlin
Name
Julius Chan
Interviewee's Position
Former Prime Minister
Interviewee's Organization
Papua New Guinea
Language
English
Nationality of Interviewee
Papua New Guinean
Town/City
Port Moresby
Date of Interview
Reform Profile
No
Abstract
Sir Julius Chan talks about the early years of decentralization following Papua New Guinea's independence in 1975. In his capacity as finance minister in the years that followed independence, Chan was unsure of the ability of provincial governments to successfully manage the autonomy given to them by decentralization. He gradually grew concerned about the inability of provincial governments to deliver services at the local level. When he became deputy prime minister in 1992, Chan assisted Prime Minister Paias Wingti in his attempt to reform the provincial government system. Chan himself became prime minister in 1994 and completed the reform effort despite threats of secession from provincial leaders in island provinces who opposed the reform.
 
Profile

At the time of this interview, Sir Julius Chan was the governor of New Ireland province and a member of the national Parliament in Papua New Guinea. He was prime minister from 1980 to 1982 and from 1994 to 1997. Chan was a national politician even before PNG’s independence in 1975. Over the years he was repeatedly re-elected to Parliament and held a number of cabinet positions such as finance, industry, external affairs and trade, and also was deputy prime minister. Chan was deputy prime minister in the 1992 government of Paias Wingti that actively pursued a reformist agenda on decentralization. He became prime minister in 1994 and championed the Organic Law on Provincial Government and Local Level Government, which was passed in 1995. Chan lost the 1997 national elections and remained out of politics for a decade, returning in 2007 as a member of Parliament and governor of New Ireland province.

Full Audio File Size
99MB
Full Audio Title
Sir Julius Chan Interview

Babatunde Fashola

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12
Country of Reform
Interviewers
Graeme Blair
Name
Babatunde Fashola
Interviewee's Position
Governor
Interviewee's Organization
State of Lagos, Nigeria
Language
English
Nationality of Interviewee
Nigerian
Town/City
Lagos
Country
Date of Interview
Reform Profile
Yes
Abstract

Babatunde Fashola describes an overhaul of the tax collection system in Lagos that successfully increased revenue for the state and indirectly financed various other reforms.  He secured public support for the overhaul after revealing the corruption in the previous tax agency through an orchestrated, public sting operation, which revealed that corrupt officials sold fraudulent tax documents on the street. He replaced the old tax agency with a smaller internal revenue service staffed by no-contract employees governed by performance incentives rather than state civil-service workers. The new service better enforced existing tax requirements and expanded the taxpayer base by introducing a simplified, single-page tax form for informal businesses.  

Case Study:  Remaking a Neglected Megacity: A Civic Transformation in Lagos State, 1999-2012

Profile

At the time of this interview, Babatunde Fashola was the governor of the Nigerian state of Lagos.  He previously served on the Lagos State Executive Council, State Security Council, Treasury Board, and as chief of staff for the former governor of Lagos.  He received a law degree from the University of Benin, after which he worked at a private Nigerian law firm for more than decade, dealing with mergers and acquisitions, intellectual property and commercial law.

Full Audio File Size
72 MB
Full Audio Title
Babatunde Fashola - Full Interview

Mangosuthu Buthelezi

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3
Country of Reform
Interviewers
Daniel Scher
Name
Mangosuthu Buthelezi
Interviewee's Position
MP and Leader
Interviewee's Organization
Inkatha Freedom Party
Language
English
Nationality of Interviewee
South African
Town/City
Cape Town
Country
Date of Interview
Reform Profile
No
Abstract

Mangosuthu Buthelezi, describes his role as a political party leader in apartheid and post-apartheid South Africa. As leader of the Inkatha Freedom Party (IFP) in apartheid South Africa, he opposed creation of his home region as an independent “homeland.” His goal was to attempt reform from within by remaining within the Union of South Africa. He opposed the imposition of sanctions by the international community and the armed struggle espoused by the African National Congress. He and his party at first refused to take part in elections after the apartheid regime relinquished power, but then agreed to participate in the elections, in government, and in drafting the constitution. He was and remains a staunch advocate of a federal system of government with significant provincial autonomy. He describes his reasons, and provides examples of actions he took as a leader in Kwazulu-Natal.    

Case Study:  Managing Spoilers at the Bargaining Table: Inkatha and the Talks to End Apartheid, 1990-1994

Profile

At the time of this interview, Mangosuthu Buthelezi had been a member of parliament from the Inkatha Freedom Party (IFP) since 1994. Following the elections after the apartheid regime relinquished power, Buthelezi served as minister of affairs and, during President Mandela’s absence, as acting president of South Africa. A member of the Zulu royal family, he became involved in liberation politics after his studies at Fort Hare University in 1950. He returned home in 1953 to assume chieftainship of the Buthelezi clan. As traditional prime minister of the Zulu nation, Buthelezi also holds the title Undunankulu Ka Zulu. He was named chief executive officer of the Kwazulu Territorial Authority in 1970. He organized the IFP in 1975 with support of the African National Congress (ANC). In 2004, President Mbeki offered Buthelezi the Deputy Presidency. Because this meant the IFP would lose its political position in Kwazulu-Natal, Buthelesze refused and the IFP left the unity government.

Full Audio File Size
39 MB
Full Audio Title
Mangosuthu Buthelezi - Full Interview

Decentralizing Authority After Suharto: Indonesia's 'Big Bang,' 1998-2010

Author
Richard Bennet
Core Challenge
Country of Reform
Abstract

When President Suharto's regime fell in 1998, reform leaders in Indonesia responded to public calls for democracy by implementing reforms in the structure of government, decentralizing authority to the country's districts.  This transformation altered the relationship between the Indonesian people and the state, granting greater autonomy to local leaders.  In theory, decentralizing to the district level would reduce demands for separatism in the provinces while strengthening the accountability of local governments to their constituents.  However, the new structures also risked empowering local politicians who might be inexperienced, corrupt or interested in secession, triggering the very disintegration of the country that the reformers sought to prevent.  This policy note outlines the ways in which Indonesia implemented sweeping reforms-consolidating regional and central government services and empowering local governments-while avoiding this governance trap.  It also traces the process by which the government incrementally revised the initial laws and policies as it encountered challenges. 

Richard Bennet drafted this case study with the help of Itumeleng Makgetla and Rohan Mukherjee on the basis of interviews conducted in Jakarta and Surakarta, Indonesia, during April and June 2010. 

Associated Interview(s):  Siti Nurbaya, Hadi Soesastro

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