Jorge Muñoz had long championed efforts to improve the lives of children in his relatively well-off district of Peru’s capital city, Lima. In 2019, he had a chance to take some of his ideas to scale. As newly elected mayor of metropolitan Lima, a city of almost 11 million, he oversaw basic services for about a third of the country’s population. At the time, a fifth of Peru’s population lived in poverty, and one in three people lived in informal settlements, where supporting families to give infants and toddlers a healthy start on life presented many challenges. The mayor directed the metropolitan government’s Social Development Department and a small interdisciplinary team of architects and social scientists (1) to identify lessons learned from pilot projects, (2) to establish new ways of assisting infants and young children, and (3) to coordinate to get the job done. When the COVID-19 pandemic broke out in the capital city in 2020, the metropolitan government and its team continued this work, using some of their newly created systems to respond to the larger challenge of caring for vulnerable populations during months of emergency lockdown measures. The national government labeled Lima’s program, which engaged residents in project development, as a promising model for helping local governments implement a countrywide strategy for the promotion of early childhood development.

Miguelángel Verde drafted this case study with the help of Tyler McBrien based on interviews conducted in Lima, Peru, during 2020 and 2021. Case published August 2021. The Bernard van Leer Foundation supported this case study to foster early-stage policy learning.

By the mid-2010s, Istanbul, the biggest city in Turkey, had developed a reputation as a bustling concrete jungle notoriously unfriendly to the 1.2 million children aged four years and younger who lived there. As part of a decade-long construction boom, multistory skyscrapers increasingly replaced green spaces and parks throughout the city. But such insufficient consideration for the developmental needs of young children was not confined to the design of public and urban spaces: in many Istanbul homes, parents worked hard to put food on the table and had little time to consider how to give their young children the best possible start in life. In February 2016, a coalition of policy research organizations and private enterprises launched an ambitious effort to persuade officials in Istanbul’s 39 districts to begin taking the needs of young children seriously. The group drew on help from a network of prominent Turkish universities and partnered with four district municipalities that agreed to join a program called Istanbul95, supported by the Bernard van Leer Foundation, a Dutch foundation. The group created a digital-mapping tool to help locate vulnerable children, conducted regular home visits to support hundreds of families, and designed new prototypes for child-friendly public spaces. This effort to embed principles of early childhood development into the work of Turkish local governments passed a milestone when, in 2019, the major metropolitan area governments of Istanbul and İzmir also agreed to join, a key step toward reaching many more children.

Leon Schreiber and Gordon LaForge drafted this case study based on interviews conducted in Istanbul in June and July 2020. Case published November 2020. The Bernard van Leer Foundation supported this case study to foster early-stage policy learning.

During the first decade and a half after Nigeria returned to democracy in 1999, the country struggled to adequately fund its primary health care system. Despite a nearly 10-fold increase in the size of the economy, Nigeria in 2014 was still spending only US$11 per capita on health care—equal to only 6% of total government expenditure and far below regional norms and the nation’s own stated aspiration. As a result, Nigerian citizens were paying 69% of their medical expenses out of pocket, and the cost discouraged many from seeking treatment. A new National Health Act, adopted in 2014 after a decade of delay, raised hopes for a solution by stipulating that at least 1% of the government budget go into a new fund to improve basic services provided at the thousands of primary health care clinics located throughout the country. However, owing to Nigeria’s longstanding neglect of primary health care, there was a real risk that the fund might never become reality. To demonstrate the viability of the program and press for its implementation, the federal health ministry, led by Minister Isaac Adewole, developed operational procedures that spelled out crucial steps to ensure financial accountability and transparency, won international backing for a pilot project that would validate the system, and built a support coalition that spanned the government and civil society. The effort took three years, but in 2018 the Nigerian legislature passed an appropriations bill that for the first time included the 1% allocation for the fund—significantly boosting the resources available to improve the quality and accessibility of primary health care services across Nigeria. Even more significantly, in September 2019, the government declared the fund a statutory allocation that it would automatically renew every year, and clinics in three states began receiving the new resources in November 2019.

Leon Schreiber drafted this case study based on interviews conducted in Abuja, Nigeria, in July and August 2019 with the help of Bunmi Otegbade. Case published November 2019.

Narrowing the gap between rich and poor was a top priority for Teresa Surita, five-time mayor of Boa Vista, Brazil. Surita had long viewed early childhood development services as crucial for improving life chances and attaining that goal, and she had partnered with several programs to expand parent coaching and other opportunities. As her fifth term began in 2017, she turned to a program called Urban95, which called for making a top priority the needs of young children and their families in all of the city’s planning and programs. Building on work the city had already done, Surita and her department heads undertook projects that included adapting a neighborhood to the needs of young children and their caregivers and building a cutting-edge data dashboard and alert system designed to ensure citizens would get help when they needed it. The city sought to keep those efforts on track while also extending assistance to families among the refugees fleeing deprivation and violence in neighboring Venezuela. As the term of the initial phase drew to a close in September 2019, municipal officials began to take stock of progress and results. Despite some philosophical disagreements and some uncertainties about the future of vital federal funding, the city was on track to achieve its project goals. 

Bill Steiden drafted this case study based on interviews conducted in Boa Vista and Sao Paulo, Brazil, in July and August 2019. Case published October 2019. The Bernard van Leer Foundation supported this case study to foster early-stage policy learning.

When Erion Veliaj became mayor of Tirana, Albania, in 2015, he inherited a fast-growing city with unchecked construction and traffic that threatened the health and well-being of all citizens—especially the youngest and most vulnerable. Overcoming public distrust and budgetary shortfalls, Veliaj’s administration worked with private donors and international experts to quickly construct parks, playgrounds, nurseries, schools, and pedestrian spaces. At the beginning of the mayor’s second term in July 2019, the city was poised to adopt new models for streets and neighborhoods redesigned to serve the interests of infants, toddlers, and their caregivers.

Gabriel Kuris drafted this case study based on interviews conducted in Tirana, Albania, in April 2019. Case published July 2019. Format revised January 2020. The Bernard van Leer Foundation supported this case study to foster early-stage policy learning.

In 2017, Geraldo Julio, the mayor of Recife, Brazil, heard scientific evidence that ensuring children from birth to age six years got a better start in life resulted in long-term benefits such as improved health, more-effective learning, less likelihood of criminal involvement, and increased employability. Julio, a technically-oriented leader in his second and final term, saw investment in early childhood development as an innovative strategy for addressing chronic crime and economic inequality in some of the city’s toughest neighborhoods. To enable parents and young children to move more safely and more quickly to locations where they could find efficiently clustered resources would require the city to align efforts in several city departments, including parks, public works, health, and education. Julio set up a management team and a steering committee to guide that work and won passage of legislation that authorized him to devote municipal resources and grant funding from private groups to the new strategy. The city engaged an existing public–private urban planning partnership to launch and manage pilot projects in two poor but contrasting neighborhoods: one where homes clung to steep, slide-prone hillsides and another where many residents lived in stilt houses on flood-prone riverbanks. It collaborated with a community peace center that could reach target neighborhoods effectively. Further, the mayor’s teams helped municipal departments start projects that would support the new agenda. In mid 2019, nearly two years after the program began, the pilot projects yielded key lessons about how to improve access to services for families with young children. 

Bill Steiden drafted this case study with the help of Sam Dearden based on interviews conducted in Recife, Brazil, in March and May 2019. Case published June 2019. The Bernard van Leer Foundation sponsored this case study, which is part of a series, to support learning in the early stages of its Urban95 program. Savvas Verdis and Philipp Rodeof the London School of Economics served as independent reviewers. 

In 2005, Vietnam’s legislature voted to develop a new health insurance system that would reduce most citizens’ out-of-pocket health-care costs and instructed the health ministry to take steps to make care more accessible, more affordable, and more effective—especially for those who lived in remote, mountainous regions. One of the challenges was how to manage scarce resources in order to constrain soaring costs. Another was how to coordinate with provinces and local governments (districts and communes)—which controlled much of the country’s health-care spending—in order to achieve national priorities, such as improved preventive care. During the next several years, the health ministry’s Department of Planning and Finance worked with those subnational units to improve the financial information system, hone strategies and plans, and align activities. By 2014, Vietnam’s government had more than tripled its per-capita health-care spending—to US$48.82 in 2014 from US$15.52 per capita in 2005, in current US dollars—a rate of growth that outpaced the average in both low-income and lower-middle-income countries. Although the ministry still struggled to keep patients’ costs down, the share of out-of-pocket spending fell to 45% in 2015 from 67% in 2005, according to government figures.

ISS staff members drafted this case study based on interviews conducted in Hanoi, Vietnam by Simon Engler and Huong Dang in May, June, and August 2018. Case published in May 2019. This case is part of an ISS series on linking health priorities to the budget process.

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.

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

In its 2006 national vision to end poverty, Ethiopia set its sights on becoming a middle-income country by 2025. It was a hugely ambitious goal for a country that, at the time, was one of the poorest in the world. To support development objectives put on hold during a decade of political turbulence, including a costly border war with Eritrea that drained public coffers, the Ethiopian government sought to expand its resources by significantly boosting tax revenues. The new plan called for a sharp increase in the ratio of tax revenue to the size of the economy—and within four years. The government merged its separate customs and domestic tax offices into a single entity and restructured the new agency’s operations along functional lines, increased salaries, adopted stringent anticorruption rules, implemented a modern information technology system, and launched public awareness campaigns. It was important that the new revenue authority worked to improve its coordination with the tax offices of subnational governments, which operated with substantial independence under the country’s federal system. Although unproven charges of corruption against the Ethiopian Revenues and Customs Authority’s long-serving director general in 2013 stalled progress, a new round of IT and legal reforms in 2016 helped increase tax collection significantly: to US$7.8 billion in 2017 from US$1.3 billion in 2006 (measured in constant 2010 US dollars). Nonetheless, revenue gains continued to lag behind economic growth. In 2018, under a new prime minister, the government began to take further steps to strengthen tax collection.

Leon Schreiber drafted this case study based on interviews conducted in Addis Ababa, Ethiopia, in October 2018. Case published December 2018.

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

Following the 1994 transition from racial apartheid to democracy, South Africa’s government aimed to provide tenure security for the estimated 16 million black South Africans living in communal areas. But the lack of a clear legal framework applicable to most communal areas meant that progress was slow. In contrast, a viable legal framework did exist to guide tenure reform in smaller communal areas formerly known as “coloured reserves,” where a series of apartheid laws had settled people of mixed race. In 2009, land reform Minister Gugile Nkwiti designated one such area—Ebenhaeser, on the country’s west coast—as a rural “flagship” project. The aim was both to transfer land held in trust by the government to Ebenhaeser community members and to settle a restitution claim. Provincial officials from Nkwinti’s ministry, working with private consultants, organized a communal association to serve as landowner. They helped negotiate an agreement with white farmers to return land that had originally belonged to coloured residents. The community also developed a land administration plan that would pave the way for Ebenhaeser’s residents to become the legal owners of their communal territory.

Lessons Learned

• A legal framework to guide tenure reform in communal areas is vital. The lack of a law to guide the process in the former homelands made it nearly impossible to make any progress in those regions.
• In many of the communal areas of South Africa, the key question is whether traditional leaders should become legal landholding entities. Despite the lack of capacity that hampered many CPAs, Ebenhaeser’s experience offers an alternative to granting legal ownership to traditional leaders.
• A strong, high-level project steering committee was critical for driving implementation. The project required cooperation between a range of different stakeholders. And the creation of a central venue encouraged that collaboration.
• Providing communities with financial and human resources support after they obtain ownership over communal lands is crucial. Documentation proving they were landowners was not enough to immediately enable the Ebenhaeser CPA to use its land productively or access credit.

Leon Schreiber drafted this case study with Professor Grenville Barnes of the University of Florida-Gainesville based on interviews they conducted in the Western Cape, Gauteng, and Eastern Cape provinces of South Africa, in March 2017. Case published May 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 David Mayson - Managing Director, Phuhlisani