Government capacity to contract: health sector experience and lessons

Using case-study material of contracting for clinical and ancillary services in the health care sector of developing countries, this article examines the capacities required for successful contracting and the main constraints which developing country governments face in developing and implementing contractual arrangements. Required capacities differ according to the type of service being contracted and the nature of the contractor. Contracting for clinical as opposed to ancillary services poses considerably greater challenges in terms of the information required for monitoring and contract design. Yet, in some of the case-studies examined, problems arose owing to government's limited capacity to perform even very basic functions such as paying contractors in a timely manner and keeping records of contracts negotiated. The external environment within which contracting takes place is also critical; in particular, the case-studies indicate that contracts embedded in slow-moving, rule-ridden bureaucracies will face substantial constraints to successful implementation. The article suggests that governments need to assess required capacities on a service-by-service basis. For any successful contracting, basic administrative systems must be functioning. In addition, there should be development of guidelines for contracting, clear lines of communication between all agents involved in the contracting process, and regular evaluations of contractual arrangements. Finally, in cases where government has weak capacity, direct service provision may be a lower-risk delivery strategy. © 1998 John Wiley & Sons, Ltd.     

The moral hazards of neo-liberalism: lessons from the private insurance industry

The key tenets of neo-liberalism regarding risk, governance, and responsibility are critically evaluated through an empirical study of the private insurance industry. Recent tendencies in this industry towards increasing segmentation of consumers regarding risk, and towards an expansion of private policing of insurance fraud, are analysed. The definition of moral hazard is broadened to include all parties in the insurance relationship, not just the insured. Moral hazards embedded in the social organization of private insurance lead to various kinds of immoral risky behaviour by insureds, insurance companies, and their employees, and to intensified efforts to regulate this behaviour. The analysis concludes with some critical observations about the neo-liberal emphasis on minimal state, market fundamentalism, risk-taking, individual responsibility, and acceptance of inequality.     

Fighting corruption in developing countries: Some aspects of policy from lessons from the field

Corruption persists in developing countries despite the proliferation of legal, institutional, and other measures that have been put in place to fight said corruption. The cancer of corruption has therefore spread exponentially in most developing countries with devastating socioeconomic and governance consequences. This practitioner perspective draws on the author's field experience and backed up by the research literature. It identifies, outlines, and discusses some aspects of policy in 3 areas—institution strengthening, the development and implementation of national anticorruption plans/strategies, and political will and leadership—and the conclusions that can be drawn from them for policy development and implementation in the ongoing quest to fight corruption in developing countries.     

Public management reform and lessons from experience in New Zealand

This article is edited from a speech delivered to the University of Victoria, Wellington—IPMN Workshop on the theme lessons from experience in New Zealand. The author articulates a number of lessons that have been learned, and identifies some lessons that should have been learned. Scott writes from the perspective of having been directly and centrally involved in the development and implementation of what has been characterized as “the New Zealand model” of public management for more than twenty years, a record of service that continues to date. The views expressed also benefit from extensive consulting by the author for governments around the world. Among the lessons learned are (a) the need for clarity of roles, responsibilities and accountability in the implementation of management reform, (b) the importance of matching decision capacity to responsibility, (c) the significance of ministerial commitment and clarity on expectations, (d) the advantages gained from structural innovations within the New Zealand cabinet, (e) the need to analyze disasters carefully for what they teach, (f) approaches to embrace and foibles to avoid in implementing performance specification, (g) problems caused by confusion over ownership and improper assessment of organizational capability, (h) the fact that actually doing strategic management in the public sector is hugely complicated, (i) that it is time to put an end to the notion that there is an “extreme model” of public management in application in New Zealand, and (j) that public management, government and governance innovations in New Zealand are no longer novel compared to those advanced in other nations. With respect to lessons not learned satisfactorily, many are simply the dark shadow of positive lessons, i.e., having not understood or implemented the successes achieved in some parts of New Zealand government into others. The author concludes with an admonition to avoid jumping too quickly, in response to post-electoral rhetoric, to the conclusion that past reforms in have to be modified quickly and radically, and that the New Zealand Model has failed.     

The flawed promise of National Security Risk Assessment: nine lessons from the British approach*

Since 2010, quinquennial UK National Security Strategies – and the Strategic Defence and Security Reviews that follow – have been based on a public National Security Risk Assessment (NSRA). The purpose of the NSRA is to identify and prioritize UK security risks for the coming five-yearly cycle based on their likelihood and impact. This article recognizes that trading off severity against likelihood is a valuable strategic heuristic. Yet it concludes that until the NSRA can address nine key limitations, it will remain a flawed exercise. Such findings carry implications for UK policy, and for other states operating NSRA-style risk matrices.     

Fostering subnational autonomy and accountability in decentralized developing countries: lessons from the Papua New Guinea experience

Using the experience of Papua New Guinea as a case study, this article examines the importance of political and administrative organization, electoral politics and revenue assignments for fostering subnational autonomy and accountability in decentralized developing countries, and hence the success of fiscal decentralization programmes. Copyright © 2002 John Wiley & Sons, Ltd.     

Learning lessons from experience: The role of evaluation in the administration of the U.K. aid programme

Formal evaluation has now become well established in the Overseas Development Administration (ODA) which has a separate Evaluation Department with an annual budget of £300,000 for commissioned studies. This enables about twenty to twenty-five evaluations to be carried out annually, usually by mixed ODA/outside teams. The reports are submitted to ODA'S Projects and Evaluation Committee and are usually made available to people with a professional interest. Many useful lessons have been learnt not only about ODA'S internal aid procedures, but also about factors that affect the success or otherwise of projects and programmes and also concerning aid and development strategy as a whole. The evaluations have led to improved monitoring, greater emphasis on sociological and environmental factors, greater awareness of the need to associate manpower and training with capital aid, and more appreciation of the need to look at projects in their wider context.     

Modeling health insurance expansions: effects of alternate approaches.

Estimates of the costs and consequences of many types of public policy proposals play an important role in the development and adoption of particular policy programs. Estimates of the same, or similar, policies that employ different modeling approaches can yield widely divergent results. Such divergence often undermines effective policymaking. These problems are particularly prominent for health insurance expansion programs. Concern focuses on predictions of the numbers of individuals who will be insured and the costs of the proposals. Several different simulation-modeling approaches are used to predict these effects, making the predictions difficult to compare. This paper categorizes and describes the different approaches used; explains the conceptual and theoretical relationships between the methods; demonstrates empirically an example of the (quite restrictive) conditions under which all approaches can yield quantitatively identical predictions; and empirically demonstrates conditions under which the approaches diverge and the quantitative extent of that divergence. All modeling approaches implicitly make assumptions about functional form that impose restrictions on unobservable heterogeneity. Those assumptions can dramatically affect the quantitative predictions made.     

Hitting a moving target: income-related health insurance subsidies for the uninsured.

New government health insurance programs are likely to emphasize voluntary purchases in a market setting, with subsidies targeted at low-income populations and stress on managed care. Such programs are best structured with a guaranteed enrollment period that is as long as six months to a year. However, given that incomes change over time, errors will be made in awarding income-related subsidies for that long. These errors are assessed in simulations undertaken with longitudinal data from the Survey of Income and Program Participation. Two allocations of the subsidies, based on current income at the beginning of the enrollment period and on actual income assessed at the end, are compared for a variety of program designs. Prospective determination of subsidies is somewhat biased toward overpayment. Net overpayments amount to 5-10 percent of subsidy costs. However, prospective payment encourages participation in the subsidy program. The simulated participation rate for true eligibles is as high as 73 percent with prospective subsidies, compared to 69 percent with retrospective reconciliation. Net overpayments are slightly reduced by testing income less frequently and over longer periods.     

Managing local development: lessons from Spain

This paper analyzes an operational method that regional government agencies can use to enable locally-based firms to compete effectively in their industries. This method, which emerged in southern Spain after the transition to democracy, embodies many precepts found in the contemporary public management literature. The paper begins the task of cumulating the clinical knowledge needed to translate action plan precepts into specific managerial decisions.     

Abandoned housing: Exploring lessons from baltimore

Abstract

Population loss and economic decline have resulted in thousands of abandoned homes in major U.S. cities. Although abandoned homes are symptomatic of other problems, they also contribute to neighborhood decline and frustrate revitalization. This article provides an overview of the national scope of abandoned housing and profiles Baltimore's strategy for addressing this problem.

Challenges in Baltimore's revitalization planning include the necessity of and financial requirements for a comprehensive approach and the difficulty of reaching consensus. Widespread property “flipping” hampers prevention. Efforts to acquire and demolish units are constrained by difficulties in tracking ownership, felons’ ownership of derelict units, and a shortage of staffing to process takings. Challenges in rehabilitating and marketing row houses include the need for subsidies to make units affordable to the most likely buyers, the omnipresence of lead paint, and the lack of foreign immigration. The article proposes a more strategic approach to the city's revitalization planning.     

Designing policy resilience: lessons from the Affordable Care Act

Policy Sciences - Public policies are the products of political conflict, constituted by mixes of diverse tools and instruments intended to achieve multiple goals that may change over time and not...     

Fighting fiscal corruption: lessons from the Tanzania Revenue Authority

Over the last decade, several African countries have undertaken comprehensive reforms of their tax administrations to increase revenue and curb corruption. This article examines recent experiences in the fight against corruption in the Tanzania Revenue Authority (TRA). Two lessons of broader relevance are highlighted. Firstly, even with relatively high wages and good working conditions, corruption may continue to thrive. In a situation where there is high demand for corrupt services, it is unrealistic to provide tax officers with pay rates that can compensate for the amount gained through bribery. Without extensive and effective monitoring, wage increases may produce not only a highly paid, but also a highly corrupt tax administration. Secondly, hiring and firing procedures may lead to more corruption. Corrupt tax officers often operate in networks, which also include external actors. These corruption networks seem to have been strengthened because many of those fired were recruited to the private sector as ‘tax experts’. This partly explains why the positive process experienced in the initial phase of the new revenue authority was later reversed. Copyright © 2003 John Wiley & Sons, Ltd.     

Transnationality and diaspora advocacy: lessons from disaster

A number of catastrophic disasters in the last decade have raised questions about their transnational impacts and about the role of the diaspora. The 2010 Haiti earthquake, the focus of our study, provided a lens to further our understanding of evolving conceptualizations about transnationalism, transmigrants, and social capital. We hypothesize that sustained ‘intensive transnationalism’ by diaspora and linking forms of social capital between diaspora, other civil society organizations and advocacy groups, and government institutions are critical during post-disaster recovery in affected nation states and in countries to which survivors turn for refuge. We conducted 103 in-depth, semi-structured interviews with a wide range of civil society actors in South Florida, Boston, New York, Atlanta, and Washington DC between June 2010 and June 2015. We found that linking forms of social capital were more important after the earthquake than in previous disasters. Overall, the longevity and variety of Haitian diaspora advocacy work, particularly in immigration, have resulted in broader social networks and alliances, work groups, task forces, interfaith coalitions, and support groups to address complex social and policy issues.