Ethiopia’s Federal Ministry of Health was struggling to meet its goals in 2014 despite impressive gains in the health of its citizens during the previous 20 years. A new minister and his leadership team reached out for ideas by engaging Ethiopia’s regions, districts, and communities—an essential step in a large and ethnically diverse society. They then developed an ambitious transformation program to help realize the government’s national aspirations for health care, including commitments made to achieving the Millennium Development Goals. To bring their vision to fruition, however, the minister and his team had to link priorities to the budget process and use the health budget as a management tool. The ministries of health and finance matched goals and targets to available resources and worked to create actionable plans. And health officials took steps to build cooperation and extend coordination at every level of government in Ethiopia’s federal system. Technical and capacity constraints—plus unexpected political upheaval beginning in late 2015—slowed implementation, but in 2018 a new administration was taking steps to address those challenges.

Gordon LaForge drafted this case study based on interviews conducted in Addis Ababa, Ethiopia, in October 2018. Case published January 2019.

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In 2009, South Africa's health-funding system teetered on the verge of collapse. Despite the adoption of a transparent and credible budget framework in 1994, large parts of the public health system suffered from chronic overspending and poor financial control. As wage hikes and supply costs ate into the health budget and as government revenues plummeted in the wake of the 2008 global financial crisis, the national health department had to find ways to preserve priorities, linking them more effectively to the budget. The department won agreement on a list of non-negotiable expenditure items to protect in provincial budgets, used earmarked conditional grants to channel funds to key programs, cut medicine costs by improving central procurement, rolled out a new information technology system, and improved its monitoring of provincial finances. Although the country's nine provincial health departments had important roles to play, most of them struggled. However, the Western Cape was able to set a model by controlling personnel costs, improving monitoring, and creating incentives for health facilities to collect fees. Nationally, total per-capita government revenues dropped by 5% in the immediate aftermath of the financial crisis and grew only slowly thereafter, but the health sector's strategy helped ensure progress on its key priorities even as resources fluctuated.

Leon Schreiber drafted this case study based on interviews conducted in Pretoria and Cape Town, South Africa, in August 2018. Case published October 2018.

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In late 2015, Liberia’s newly appointed education minister, George Werner, recognized that the government school system was wasting money and failing its students. Shortly before Werner assumed office, a pilot project had identified significant numbers of ghost workers (teachers who never showed up for their jobs or were fraudulently included on the payroll) as well as teachers who lacked even basic qualifications. Although the project covered just three of Liberia’s 15 counties (the most populous counties of Montserrado, Nimba, and Bong), the findings illuminated a long-standing national problem. Resolving to put an end to the abuses, Werner and senior ministry officials created a program implementation unit dedicated to the nationwide project, refined vetting procedures for assessing qualifications, and introduced mandatory competency testing that laid the foundation for additional reforms. President Ellen Johnson Sirleaf provided crucial political support when the project ran into resistance from the national teachers’ association. By February 2018, the education ministry had removed 83% of the 2,046 ghost teachers, and planned to remove the remaining 17% that it identified during the last six months of the project. Overall, the project generated $2.3 million in annual savings that opened spaces for new teachers in the school system and budget, with the ministry expecting that this number would increase to $3.1 million once all ghost teachers were gone. As a result of the project, the ministry hired 1,371 trained new graduate teachers. Still, challenges remained: 49% of public school teachers had failed the competency tests. Armed with this important baseline data, the ministry had to decide what to do to improve teacher quality.

Leon Schreiber drafted this case study with assistance from Blaykyi Kenyah based on interviews conducted in Monrovia, Liberia, in August 2017. Case published February 2018.

In 1999, eight years after emerging from decades of Soviet domination, Kyrgyzstan began an ambitious effort to officially recognize property ownership throughout the country and lay the groundwork for a vibrant real estate market. During five and a half decades of rule by the Soviet Union, citizens were not allowed to own land, and after Kyrgyzstani independence in 1991, the country began a nationwide program of privatization in a bid to stimulate economic development. The question was how to register and document property rights so that people could transact efficiently in a new land market. To meet the challenge, a new land agency, known as Gosregister, had to hire and train staff in completely new responsibilities, establish performance management and funding structures, improve efficiency by introducing new technologies, and ensure that staff did not engage in corruption. Despite political upheaval—including the overthrow of two governments in the space of five years—Gosregister steadily built its capacity and evolved into an effective land registry. By 2012, the agency had registered 92% of the country’s privately held parcels, and in 2017, the World Bank’s Doing Business rankings recognized its services as among the best in the world.

Maya Gainer drafted this case study based on interviews conducted in Bishkek and Kant, Kyrgyzstan, during November and December 2016. The British Academy-Department for International Development Anti-Corruption Evidence (ACE) Program funded the development of this case study. Case published February 2017

In 2001, registering or transferring land in Jamaica was an uphill battle. Four separate departments handled different aspects of land administration, leading to weak coordination and delay. Even straightforward transactions dragged on for weeks, simply getting information was a struggle, and fraud was commonplace. In April of that year, Jamaica established the National Land Agency, charged with merging the four departments, speeding up services, and improving their quality. As the new agency’s CEO, Elizabeth Stair led a team of managers that had to oversee the consolidation, design systems to prevent fraud, improve performance, and implement new procedures and technologies to increase speed and transparency. During its first decade and a half of operation, the National Land Agency significantly reduced processing times and won acclaim for its customer service and innovative use of technology. Despite these successes, there was still room to improve land tenure security. Stiff documentation requirements, high costs, and limited awareness of the process meant that registration and related services remained out of reach for many Jamaicans.

Lessons Learned

• Advantages of functional consolidation. Merging four divisions into a single semi-autonomous agency allowed the government to streamline service delivery, standardize procedures, and reduce processing times.
• Overcoming resistance and curbing graft. A strong, unified management team and a consistent message helped answer internal opposition and external critics of the transition. Staff retraining, individualized targets for performance tied to financial incentives, and new procedures and technologies helped establish a new operational culture.
• Additional barriers remain. Despite the agency’s successes, Jamaica’s overall experience also demonstrates the range of additional barriers to land registration, including stiff documentation requirements, high costs in the form of fees and taxes, and limited awareness of the requirements, that can prevent many property owners from formalizing their claims.

Maya Gainer drafted this case study based on interviews conducted in Kingston, Jamaica, in June 2016. The Omidyar Network funded the development of this case study. Case published January 2017.

A 2017 workshop, Driving Change, Securing Tenure, profiled recent initiatives to strengthen tenure security and reform land registration systems in seven countries: South Africa, Canada, Jamaica, Kyrgyzstan, Mozambique, Australia and Tanzania.

Watch the video of Elizabeth Stair - CEO and Commissioner of Lands, Jamaican National Land Agency.

In 2005, when Ellen Johnson Sirleaf became Liberia’s first democratically elected post-conflict president, she found her country’s government in shambles. Years of cronyism under military rule and a 14-year civil war had left behind a bloated civil service corps riddled with unqualified employees, most of whom did not have a university education and some of whom could not read or write. The president needed more-capable employees at every level of government. Externally supported capacity-building programs helped fill top and middle management roles with Liberians who had fled abroad during the war, but Sirleaf also wanted to attract the most-talented and most-ambitious young graduates from Liberian universities to work in the public service. With assistance from international donors, Saah N’Tow, a Liberian working at an international consulting firm, set up a fair and transparent recruitment process and coupled it with strong training and mentorship to create the President’s Young Professionals Program. Beginning in 2009 and annually thereafter, the program placed 10 to 20 Liberian youth into government ministries for two-year fellowships. By 2016, 72 young professionals had completed their fellowships and about 75% were still working for the government. Many stood out as some of the top performers in the civil service and several had been promoted to positions as divisional directors and assistant ministers.

Blair Cameron drafted this case study based on interviews he and Pallavi Nuka conducted in Monrovia, Liberia and Paris, France, in March and April 2016. This case study was funded by the Open Society Foundations, which in 2015 donated $250,000 to the program profiled. This case draws from a variety of sources including an independent evaluation ISS conducted in 2016. Case published July 2016.