Local government decentralization and the health sector in Tanzania

An evaluation of primary-level healthcare undertaken in Tanzania 1989-91 found that district health managers felt powerless to address health care performance weaknesses, although the district is the unit to which government management functions have been decentralized. In order to understand the managers views, this article analyses the pattern of decentralization within the health system from their perspective. It reviews the hislorical development of government structures and the theory and practice of decentralization within Tanzania. The matrix of accountability for health care has become very confusing, with multiple and cross-cutting flows of authority within and between levels of the system. District health managers have limited authority to take management action, such as managing resources, in ways that would begin to address problems of inefficiency and poor quality of care within primary care. District health management also suffers from weak resource allocation and financial management piocedures. The main obstacles preventing more effective management are: resource constraints; conflicts between the demands for central control and local discretion; limited institutional capacity; and political and cultural influences over the implementation of decentralization. Evaluation of past experience suggests that future policy influencing the organizational structure of government health services must be developed cautiously, recognizing the critical importance of complementary action to develop both institutional capacity and political and economic support for the health system.     

Public sector personnel management in three African countries: Current problems and possibilities

Following visits to three less developed countries (LDCs) in Sub-Saharan Africa (Tanzania, Kenya and Zimbabwe) to study public sector personnel systems, the author offers a review of personnel practice in Civil Service and parastatal organizations. In the main, despite a recognition that personnel issues were crucial to organizational success and thereby, ultimately, to economic development, the personnel function was found to be a largely reactive administrative operation, often combined with non-personnel ‘housekeeping’ roles and lacking a strategic role within the organization. Reasons for this restricted role are suggested and include a lack of alternative models of best personnel practice, the historical legacy of colonial administration, and the continuing need for administrative controls in the face of favouritism and corruption. Prospects for reform are considered in the light of current conditions and the view is advanced that changes in the personnel practices and policy are most desirable and urgent in the parastatal sector, and that a reformed parastatal sector might serve as a model for selective improvements to personnel management in the Civil Service.     

Taxation and local government accountability in a clientelist context: Colombia

Increasing the accountability of local government is an important objective of decentralisation. One way to achieve greater accountability is to enhance the reliance of local governments on locally raised taxes. Property taxes are a prime source of increased revenue for local governments. However, it is difficult to levy them effectively in clientelist political systems, like that of Colombia. Recent reforms there have increased the capacity of municipal governments to raise revenue through property taxation. Giving responsibility for assessments of property values to an independent national agency has been especially useful. Municipal government finances are now to some degree independent and protected from the influence of clientelistic political parties. However continuing problems include: the reluctance of mayors to enforce taxation liabilities; the obstacles to opening local political debates on taxation; and the problems faced by national governments in trying to monitor municipal revenues and expenditures. Copyright © 2003 John Wiley & Sons, Ltd.     

Information, market government, and health policy: a study of health data organizations in the states.

Information is essential to the success of market-oriented policies. Information on health care costs and quality is collected and distributed by state governments through health data organizations (HDOs) to enhance competition and lower costs in the medical industry and to improve consumer choice among medical alternatives. This article examines the information collected, produced, and distributed by state health data organizations in Colorado and Pennsylvania. Findings reveal that information was not the objective determinant of choice and competition as market-oriented policy designers had hoped. Nor did market-oriented bureaucracies produce and distribute data readily accessible for public choice. Instead, information produced and distributed by these HDOs was the result of political and bureaucratic exercises that conform much more to classic interest group policymaking and captured bureaucracies than to contemporary market-oriented government ideals. The findings underscore the extraordinary difficulties facing federal-level policy designers as they contemplate introducing market-oriented health care policies on the national level.     

Legitimacy and context: implications for public sector reform in developing countries

This article examines the interplay between legitimacy and context as key determinants of public sector reform outcomes. Despite the importance of variables such as legitimacy of public institutions, levels of civic morality and socio‐economic realities, reform strategies often fail to take such contextual factors into account. The article examines, first, relevant literature – both conceptual and empirical, including data from the World Values Survey project. It is argued that developing countries have distinctive characteristics which require particular reform strategies. The data analysed shows that in Latin American countries, there is no clear correlation between confidence in public institutions and civic morality. Other empirical studies show that unemployment has a negative impact on the level of civic morality, while inequality engenders corruption. This suggests that poorer and socio‐economically stratified countries face greater reform challenges owing to the lack of legitimacy of public institutions. The article concludes that reforms should focus on areas of governance that impact on poverty. This will in turn help produce more stable outcomes. Copyright © 2008 John Wiley & Sons, Ltd.     

The future of the nonprofit sector: Its entwining with private enterprise and government

The nonprofit sector—neither private enterprise nor governmental—is growing rapidly, and not only in the United States. This article explores three questions about the sector, which includes large elements of such service industries as universities, hospitals, nursing homes, day-care centers, museums, social services, and organizations promoting medical research, environmental protection, and the arts. These questions are: (a) Why is the nonprofit sector expanding worldwide?; (b) How is the growth of nonprofits affecting other parts of the economy?; and (c) What evidence is there that nonprofits make a difference, that they perform functions which private firms or government cannot perform? A major theme is that the sector's growth necessitates finding ways to increase revenues, and that has brought side effects, particularly as nonprofits have become more and more “commercial.” In the process, borders between the nonprofit and both the for-profit and public sectors are being crossed increasingly, and with consequences that often pose problems.     

Constitutional,legal and political problems of local government in Nigeria

The new Nigerian local government system was clearly intended by its creators to be a representative and democractic system of devolution. The speed with which elected councils have been dissolved and replaced by caretaker committees and state appointees contrasts strangely with the constitutional provision that there should be a system of local government by democratically elected local councils. The constitutionality of dissolution has been confused with the constitutionality of further local government reform. Dissolution should be seen as an emergency measure to be used rarely in cases of proven maladministration by a local government. Further reform and reorganization of a state's system of local government should be regarded as a legitimate power of the state legislature. The role given by the Constitution to local government should not be interpreted as entrenching the system. Constitutional amendment is not required should further reform be necessary.     

Reforming the public sector for leaner government and improved performance: The New Zealand experience

Over the 10 year period from 1984 to 1994 New Zealand has gone through an intense period of restructuring, both of the public sector and of the wider economy. In the process New Zealand has been transformed from a highly protected and regulated economy with a range of intrusive and expensive interventions, to an open and deregulated economy with an efficient and leaned down public sector. The article presents the “New Zealand experience” in restructuring, not necessarily as an example to be copied but as a benchmark to be used in examining the most appropriate restructuring to apply in other circumstances. The stages in the reform are described and the three key success factors set out. One of the key factors is the establishment of a set of clear principles which are then applied with determination. The principles developed in the New Zealand context are set out. The article examines the restructuring of the science sector in New Zealand as one case study; in part because of the author's personal involvement but also because it is a particularly complete example. Areas where work remains to be done are identified including the reforms in education and health and the need for collective action across government. Finally lessons to emerge from the New Zealand experience are discussed. These include especially putting time into fully understanding market characteristics before a market oriented reform is started, carrying reforms through to their conclusion rather than stopping partway, and establishing clear principles to guide the reform process.     

Market forces and private sector processes in government policy: The job training partnership act

This article examines those provisions of the Job Training Partnership Act designed to introduce the presumed efficiency of marketlike forces and incentives into federal employment and training programs. First, the JTPA replaced the administrative system used in earlier training programs (which emphasized detailed federal control and monitoring of the programs at the local level) with a system that, in effect, set a price for a prescribed level of performance and reduced oversight of the training process. Second, the Act gave people in private business some control over programs at the local level. According to available data, JTPA program performance is no different in local areas with a strong private-sector involvement than in areas where that involvement is weak and passive. The performance standards have had an effect, although the relationship between the standards and the goals of the JTPA is ambiguous at best. The article outlines the limitations of a market-oriented system for the administration of public policy.     

Defining the policy-making function in government: An organizational and management approach

Applying what is in effect a roles and missions approach to the management of the office of the chief planner in large scale public operations is at variance with modern public administration theories. However, a definitional approach is advanced here as a needed step in organizing and managing the policy-making process, which in most agencies is in constant flux. Five key functions are defined: Planning, Analysis, Research, Demonstration and Evaluation. A simplified scenario is used to show how these functions and their management interact over several years of policy-making. Activities identified with each function are spaced chronologically and are shown to be mutually reinforcing. The scenario also makes extensive use of the initial earmarking of portions of the Research and Evaluation budgets for coordinated use in response to requirements growing out of the overall policy determination process.     

Bias in the formulation of local government budget problems

Government budgets are premised on forecasts of revenues and expenditures. These forecasts are subject to both stochastic error and strategic manipulation. Circumstantial evidence in the budgeting literature and in the popular media suggest that government officials routinely bias the forecasts underlying budgets. The research reported here asked three primary questions: To what extent are budget forecasts systematically biased? Why? (Are fiscal and electoral variables systematically related to the magnitude and direction of the biases?) What political and ethical difference do the biases make? From the literature and an analysis of the incentives facing politicians and bureaucrats, we developed hypotheses about budget biases. These hypotheses were tested using time series data for the City of Pittsburgh, Pennsylvania (1941–1983); the City of San Diego, California (1950–1982); and the Pittsburgh (Pennsylvania) School District (1946–1983). In these locales over the periods examined, budgets were systematically pessimistic; revenues were underestimated and expenditures were overestimated. The fiscal and electoral factors hypothesized to account for this pessimism are, however, very mixed in their ability to explain the biases.     

Graduate education in public management: Working the seams of government

Public management means quite different things when it is understood in terms of its intellectual roots in policy analysis, in terms of what managers actually do in the public sector, and in terms of the knowledge and skills required for effective performance in higher-level jobs in the public sector. As taught in the public policy schools, public management has inherited a deep skepticism about public intervention and an active decision-forcing attitude toward the practice and teaching of management. These attributes distinguish it from public administration. The public management curriculum has developed in a number of different ways, and four broad models can be discerned from existing practice: the core survey model, the elective model, the modified MBA model, and the generic model. These models differ in several ways but share a common bias toward grounding in the technical core of management skills, a strong decision-forcing emphasis, and an active view of the manager's role.     

The New Public Administration: management innovations in government

Over the last two decades there have been some fundamental changes in the working of government which have resulted in major and visible management innovations in the organizational structures and systems of government aimed at delivering greater efficiency, and more responsive and flexible public services. The innovations have led to the ‘New Public Administration’. This article identifies the innovations in thinking about the role and functioning of government; about service users; about administrative structures and about staff. The article also discusses the strategies and actions employed in the new synergy between the public and private sectors, as well as the reforms in financial planning and control systems. In conclusion, the broad objectives of these reforms have been to shift emphasis from developing plans to developing key strategic areas; to shift emphasis from inward-looking systems to developing partnerships; to shift emphasis from inputs and processes to outputs and outcomes; and to shift emphasis towards managing diversity within a unified public service. Finally, managerial pragmatism and political conviction are highlighted as essential to motivating management innovation in government. (© 1997 by John Wiley & Sons, Ltd.)     

Towards virtuous and ethical organisational performance in the context of corruption: A case study in the public sector

With the increasing number of ethical violations reported across the public sector, the emphasis on ethics and values in governance is on the rise. Corruption is widely accepted as a form of unethical behaviour that can have detrimental effects on organisations as well as society at large. Research calls for empirical studies focusing on the contextual factors surrounding corruption. Based on the Contextually Based Human Resource Theory and using the case study method, this paper examines the role of context through a systematic analysis of corruption in a public sector organisation. We integrate corruption and human resource literature to understand employee behaviour, employee relations, HRM strategies, and organisational outcomes in the context of organisational corruption.     

Organizational reform within government: accountability and policy management

The article considers, from a United Kingdom perspective, the ways in which relations between Government Departments and Agencies are organized to ensure clarity of roles and effective accountability; and also looks at the ongoing need for effective policy management at the centre of Government. It describes the progress of the Next Steps programme, examining its successes and perceived weaknesses. In particular, it rehearses the debate running in the UK on the question of Ministerial accountability, and considers the distinctions between responsibility and accountability, and between policy matters and operations. (© 1997 by John Wiley & Sons, Ltd.)     

Explaining variations in enforcement strategy: A comparison of the Swedish health care,eldercare, and compulsory school sector

This article analyzes whether, and if so, why, national inspectorates adopt different enforcement strategies when controlling the provision of welfare services, such as health care, eldercare, and the compulsory school. The findings show that the Swedish Schools Inspectorate uses a predominantly strict strategy, while the Health and Social Care Inspectorate relies on a more situational strategy. To explain this variation in enforcement strategy, the article tests four hypotheses derived from the literature on regulatory enforcement. The findings suggest that the variation between the agencies is not primarily the result of differences in resources or the authority to issue punitive decisions, as suggested by previous research. Instead, we find support for the hypothesis that the definition of quality can explain variation in adopted strategies, and partial support for the hypothesis that differences in regulatory mission can account for a variation in the agencies' formal enforcement strategies.