priority setting

When Curbing Spending Becomes the Top Priority: Colombia Tries to Balance Health Needs and Fiscal Capacity, 2013-2017

Author
Gordon LaForge
Country of Reform
Abstract

In 2012, Colombia’s public health system was headed for bankruptcy. The country had made significant progress on important public health priorities: expanding immunizations, reducing infant mortality, and attaining near-universal insurance coverage. But a Constitutional Court ruling that the government had to pay for almost all health services and technologies for those it subsidized, combined with rising pharmaceutical prices, was pushing the budget into deficit. Economist Alejandro Gaviria became minister of health and social protection amid that simmering crisis. To contain spiraling costs while enabling the sector to focus on some of its priorities, he worked to create new legislation that would limit the services the government would cover, regulate the drug market, and adjust an incentive structure that had lowered accountability and encouraged excess. In parallel, budget officials in the health ministry, the Ministry of Finance and Public Credit, and the National Planning Department tried to improve financial management of the system in order to increase efficiency and reduce costs. In the end, some of Gaviria’s efforts paid off and the ministry averted immediate insolvency, but as of 2018, the viability of Colombia’s health-care system remained in doubt even as health indicators improved.

Gordon LaForge drafted this case study based on interviews conducted in Bogota, Colombia in September 2018. Case published November 2018.

To view a short version of the case, please click here

Richard Messick

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A
Focus Area(s)
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1
Country of Reform
Interviewers
Gabriel Kuris
Name
Richard Messick
Interviewee's Organization
World Bank
Language
Enlish
Nationality of Interviewee
American
Town/City
Washington DC
Country
Date of Interview
Reform Profile
No
Abstract

Richard Messick of the World Bank discusses the state of the anti-corruption field worldwide. Messick points out the difficulty of measuring both the extent of national corruption and the impact of an anti-corruption agency. He then explains his own framework of evaluating the need for anti-corruption agencies, of building support for the agency, and for adapting an agency to specific national situation. In particular, having a respected leader to represent and structure the agency is important to its credibility and legitimacy. Additionally, Messick recommends that young agencies focus on projects that are easier to accomplish and galvanize widespread support of the agency. 

Profile

Mr. Richard Messick was a Senior Public Sector Specialist in the Public Sector and Governance Group at the World Bank. In this role, he advises World Bank staff on a broad range of anti-corruption and governance issues. Prior to joining the World Bank, Dr. Messick was a senior consultant to Freedom House, A U.S. based organization that promoes human rights and freedom around the globe. He was also a senior fellow at Hernando de Soto’s Instituto Libertad y Democracia in Lima, Peru as well as an advisor to the Ukrainian Center for Independent Political, a non-government in Kyiv, Ukraine. In addition, he served as chief counsel to the Senate Foreign Relations Committee in the 99th Congress and was chief counsel and research director of the National Senatorial Committee. Mr. Messick has also published extensively; his writings and reviews have appeared in the Wall Street Journal, the Washington Post, the American Political Science Review, and other respected journals.  

Full Audio File Size
31 MB
Full Audio Title
Richard Messick - Full Interview

Gord Evans

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D
Focus Area(s)
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8
Critical Tasks
Country of Reform
Interviewers
Yoni Friedman
Name
Gord Evans
Language
English
Nationality of Interviewee
Canadian
Town/City
Vilnius
Country
Date of Interview
Reform Profile
No
Abstract

In this interview, Gord Evans discusses his experience working in Lithuania on center of government reforms from 1998 to the early 2000s and again starting in 2009. He explains the importance of the Chancellery’s office and later Prime Minister Kubilius in building support for the initial center of government reforms.  Evans emphasizes that the leadership of top officials was necessary for the institutionalization of reforms as well as for ensuring that officials continued to adapt reforms to Lithuania’s specific context and changing needs. It was critical to reform effectiveness that Lithuanian officials from across ministries took ownership over reform planning, sustainability, and evolution. Evans also describes the processes of several specific reforms, such as aligning budgeting and policy planning, instituting impact assessments, and improving legislative efficiency. In addition, Evans talks about how the requirements of EU accession influenced the motivation, challenges, and speed of reform.    

Case Study:  Focusing on Priority Goals: Strategic Planning in Lithuania, 2000-2004

Profile

Since 1998, Gord Evans has worked as an international consultant on government decision-making, strategic planning, and policy formulation. He has extensive experience, having worked in Lithuania, Albania, Moldova, Russia, Serbia, Ghana, South Sudan, Qatar, Afghanistan, and China. He has also co-authored a publication on policy and planning for the World Bank. Prior to his international consulting career, Evans held several senior positions in the Canadian Government. Most notably he was Deputy Clerk of the Executive Council. In that role, he was responsible for coordinating the planning across government. 

Full Audio File Size
61 MB
Full Audio Title
Gord Evans - Full Interview