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.

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.

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.

In the early 2010s in Tel Aviv, parents with children under four years of age were mostly on their own when it came to finding the child care services and support they needed. Although the city was an economic and technology powerhouse, the government showed little interest in providing for the youngest residents. Public concern about the cost and quality of day care and a shortage of opportunities to ensure infants and toddlers thrived drew parents into the streets. In 2016, the city began to respond. Municipal departments expanded services, launched a digital platform for parents, and renovated public spaces to suit children three years old and younger. By 2019, early childhood development had become a government priority and part of the mayor’s reelection campaign platform, although scaling services to some of the poorest neighborhoods remained a challenge.

Gordon LaForge drafted this case study based on interviews conducted in Tel Aviv in May 2019. The Bernard van Leer Foundation sponsored this case study to support learning in its Urban95 initiative. Savvas Verdis and Philipp Rode of the London School of Economics served as independent reviewers. Case published August 2019. 

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. 

When Pete Buttigieg became mayor of South Bend, Indiana, in 2012, the city was struggling to overcome its image as a dying community. More than a thousand abandoned homes blighted urban neighborhoods, and the unemployment rate was more than 10%. Although these problems had their roots in the changing structure of the US economy, Buttigieg said he believed that more-efficient and more-effective government could help the city attract new businesses and residents, charting a path forward. In 2013, he hired Santiago Garces, a 2011 graduate of nearby University of Notre Dame, to create a new office that would identify opportunities for improving city operations and saving money. On a tight budget, Garces assembled a small team of business analysts, who used new technologies to help streamline and modernize the city’s code enforcement department, greatly accelerating the process of dealing with abandoned homes. Garces’s team then took on dozens of other projects to improve service delivery while also consolidating the city’s information technology resources, including outsourcing certain services to cut costs. The unit Garces created produced millions of dollars in savings during its first years and helped the mayor achieve some of his top policy goals. 

Tristan Dreisbach drafted this case study based on interviews he and Steven S. Strauss, John L. Weinberg/Goldman Sachs & Co. Visiting Professor at Princeton University, conducted in South Bend, Indiana in July 2018. Case published September 2018.

In 2011, voters in Chicago elected Rahm Emanuel, a 51-year-old former Chicago congressman, as their new mayor. Emanuel inherited a city on the upswing after years of decline but still marked by high rates of crime and poverty, racial segregation, and public distrust in government. The Emanuel administration hoped to harness the city’s trove of digital data to improve Chicagoans’ health, safety, and quality of life. During the next several years, Chief Data Officer Brett Goldstein and his successor Tom Schenk led innovative uses of city data, ranging from crisis management to the statistical targeting of restaurant inspections and pest extermination. As their teams took on more-sophisticated projects that predicted lead-poisoning risks and Escherichia coli outbreaks and created a citywide network of ambient sensors, the two faced new concerns about normative issues like privacy, ethics, and equity. By 2018, Chicago had won acclaim as a smarter city, but was it a fairer city? This case study discusses some of the approaches the city developed to address those challenges and manage the societal implications of cutting-edge technologies.

Gabriel Kuris drafted this case study based on interviews he and Steven S. Strauss, Lecturer and John L. Weinberg/Goldman Sachs & Co. Visiting Professor at Princeton University, conducted in Chicago in July 2018. Case published September 2018.

In the mid 2000s, Indonesia’s Directorate General of Taxes (DGT) was still struggling to recover from the shock of the Asian financial crisis of the previous decade. Tax revenue had plummeted during the crisis, and the collection rate remained well below accepted standards, as well as below the standards of many peers in the region. In 2006, the directorate’s new leaders launched a nationwide overhaul, drawing lessons from a successful pilot program that had reorganized the DGT’s biggest offices and enabled large taxpayers to settle all of their tax-related affairs with a single visit to one office rather than having to go through multiple steps. Expanding that pilot to more than 300 locations across a 3,000-mile archipelago presented no small challenge. The implementers built a digital database that linked all offices to a central server in the capital of Jakarta, developed competency testing and training that bolstered the quality of staff, and created new positions to improve relationships with taxpayers. Other measures aimed to reduce corruption and tax fraud. When political and practical crosswinds frustrated the DGT’s efforts to build the workforce its leaders thought it needed, the agency turned to big-data analytics to improve compliance and broaden the tax base. By 2018, domestic revenue mobilization had plateaued, but the changes introduced had produced important improvements. The question was then what to do to broaden the base further without decreasing incentives for investment or raising administrative costs to unsustainable levels.

Leon Schreiber drafted this case study based on interviews conducted in Jakarta in January and February 2018. Case published April 2018.

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