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MODULE III READINGS: DECENTRALIZED GOVERNANCE STRATEGY ANDPROGRAM FRAMEWORK: FROM POLICY TO IMPLEMENTATION

The implementation of a decentralization policy officially adopted will require theestablishment of a decentralized governance strategy supported by an appropriate

programme of actions. The government will create an enabling environment for thepolicy implementation, including the human, material, and financial capacities to carryout this policy.Implementation is a critical juncture of the decentralization process where lack of strongpolitical, administrative (bureaucratic) and social will as well as lack of strong leadershipcommitment can derail the process. Mechanisms, institutional arrangements, andmanagement systems and tools including capable human resources, logistics andappropriate financial resources should be satisfactorily functional.

When a decentralization policy is in on force in a country, decentralized governance willconsist first and foremost in establishing functional mechanisms according to the lawand to be applied nation wide. These mechanisms encompass (i)administrative local

structure including the leadership deemed necessary for its functioning, (ii)the planningand updating regulatory framework, (iii)Human resource management in conjunctionwith the national development, (iv)financing schemes including fiscal decentralizationand funding sources, (v)decentralized cooperation leading to partnerships andresources mobilization, (vi)infrastructure development and service delivery,(vii)performance indicators and a monitoring and evaluation system.

THEME.1: ADMINISTRATIVE LOCAL STRUCTURE

Each country adopts the administrative divisions found relevant to its socio-political andeconomical context. The different cases below outline how diverse the choices are

considering each country.What makes the administrative local structure more challenging in decentralizedgovernance is the leadership system attached to it including the way local authoritiesand leaders are determined (preferably via Elections) and how the local governmentswill be run.

France Case

The 22 regions and 96 departments of metropolitan France include Corsica. Paris areais expanded.France is divided into 26 administrative regions. 22 are in metropolitan France (21 areon the continental part of metropolitan France; one is the territorial collectivity of Corsica)

, and four are overseas regions. The regions are further subdivided into 100departments which are numbered (mainly alphabetically). This number is used in postalcodes and vehicle number plates amongst others. Four of these departments are foundin the overseas regions and are simultaneously overseas regions and overseasdepartments and are an integral part of France (and the European Union) and thus enjoya status similar to metropolitan departments. The 100 departments are subdivided into341 arrondissements which are, in turn, subdivided into 4,032 cantons. These cantonsare then divided into 36,680 communes, which are municipalities with an electedmunicipal council. There also exist 2,588 intercommunal entities grouping 33,414 of the


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36,680 communes (i.e. 91.1% of all the communes). Three communes, Paris, Lyon andMarseille are also subdivided into 45 minicipal arrondissements.The regions, departments and communes are all known as territorial collectivities,meaning they possess local assemblies as well as an executive. Arrondissements andcantons are merely administrative divisions. However, this was not always the case.Until 1940, the arrondissements were also territorial collectivities with an elected

assembly, but these were suspended by the Vichy regime and definitely abolished bythe Four Republic in 1946. Historically, the cantons were also territorial collectivities withtheir elected assemblies.In addition to the 26 regions and 100 departments, the French Republic also has sixoverseas collectivities, one sui generis collectivity (New Caledonia) , and one overseasterritory. Overseas collectivities and territories form part of the French Republic, but donot form part of the European Union or its fiscal area. The Pacific territories continue touse the Pacific franc whose value is linked to that of the euro. In contrast, the fouroverseas regions used the French franc and now use the euro.France also maintains control over a number of small non-permanently inhabited islandsin the Indian Ocean and the Pacific Ocean: Bassas da India, Clipperton Island, EuropaIsland, Glorioso Islands, Juan de Nova Island, Tromelin Island. Overseas departments

have the same political status as metropolitan departments: Guadeloupe (since 1946),Martinique (since 1946), French Guiana (since 1946), Runion (since 1946).Italy CaseItaly is subdivided into 20 regions (regioni, singular regione). Five of these regions havea special autonomous status that enables them to enact legislation on some of their localmatters, and are marked by an *. It is further divided into 109 provinces (province) and8,101 municipalities (comuni).It is further divided into 109 provinces (province) and 8,101 municipalities (comuni). Theregions are as follows:Abruzzi(L'Aquila), Basilicata(Potenza), Calabria(Catanzaro),Campania(Naples), Emilia-Romagna(Bologna), Friuli-Venezia Giulia* (Trieste), Lazio(Rome), Liguria(Genoa), Lombardy(Milan), Marche(Ancona), Molise(Campobasso),Piedmont(Turin),Apulia(Bari), Sardinia* (Cagliari),Aosta Valley* (Aosta), Tuscany

(Florence), Trentino-Alto Adige/Sdtirol* (Trento), Umbria(Perugia), Sicily* (Palermo),Veneto(Venice).
http://en.wikipedia.org/wiki/Abruzzohttp://en.wikipedia.org/wiki/L%27Aquilahttp://en.wikipedia.org/wiki/Basilicatahttp://en.wikipedia.org/wiki/Potenzahttp://en.wikipedia.org/wiki/Calabriahttp://en.wikipedia.org/wiki/Catanzarohttp://en.wikipedia.org/wiki/Campaniahttp://en.wikipedia.org/wiki/Napleshttp://en.wikipedia.org/wiki/Emilia-Romagnahttp://en.wikipedia.org/wiki/Bolognahttp://en.wikipedia.org/wiki/Friuli-Venezia_Giuliahttp://en.wikipedia.org/wiki/Triestehttp://en.wikipedia.org/wiki/Laziohttp://en.wikipedia.org/wiki/Romehttp://en.wikipedia.org/wiki/Liguriahttp://en.wikipedia.org/wiki/Genoahttp://en.wikipedia.org/wiki/Lombardyhttp://en.wikipedia.org/wiki/Milanhttp://en.wikipedia.org/wiki/Marchehttp://en.wikipedia.org/wiki/Anconahttp://en.wikipedia.org/wiki/Molisehttp://en.wikipedia.org/wiki/Campobassohttp://en.wikipedia.org/wiki/Piedmonthttp://en.wikipedia.org/wiki/Turinhttp://en.wikipedia.org/wiki/Apuliahttp://en.wikipedia.org/wiki/Barihttp://en.wikipedia.org/wiki/Sardiniahttp://en.wikipedia.org/wiki/Cagliarihttp://en.wikipedia.org/wiki/Aosta_Valleyhttp://en.wikipedia.org/wiki/Aostahttp://en.wikipedia.org/wiki/Tuscanyhttp://en.wikipedia.org/wiki/Florencehttp://en.wikipedia.org/wiki/Trentino-Alto_Adige/S%C3%BCdtirolhttp://en.wikipedia.org/wiki/Trentohttp://en.wikipedia.org/wiki/Umbriahttp://en.wikipedia.org/wiki/Perugiahttp://en.wikipedia.org/wiki/Sicilyhttp://en.wikipedia.org/wiki/Palermohttp://en.wikipedia.org/wiki/Venetohttp://en.wikipedia.org/wiki/Venicehttp://en.wikipedia.org/wiki/Venicehttp://en.wikipedia.org/wiki/Venetohttp://en.wikipedia.org/wiki/Palermohttp://en.wikipedia.org/wiki/Sicilyhttp://en.wikipedia.org/wiki/Perugiahttp://en.wikipedia.org/wiki/Umbriahttp://en.wikipedia.org/wiki/Trentohttp://en.wikipedia.org/wiki/Trentino-Alto_Adige/S%C3%BCdtirolhttp://en.wikipedia.org/wiki/Florencehttp://en.wikipedia.org/wiki/Tuscanyhttp://en.wikipedia.org/wiki/Aostahttp://en.wikipedia.org/wiki/Aosta_Valleyhttp://en.wikipedia.org/wiki/Cagliarihttp://en.wikipedia.org/wiki/Sardiniahttp://en.wikipedia.org/wiki/Barihttp://en.wikipedia.org/wiki/Apuliahttp://en.wikipedia.org/wiki/Turinhttp://en.wikipedia.org/wiki/Piedmonthttp://en.wikipedia.org/wiki/Campobassohttp://en.wikipedia.org/wiki/Molisehttp://en.wikipedia.org/wiki/Anconahttp://en.wikipedia.org/wiki/Marchehttp://en.wikipedia.org/wiki/Milanhttp://en.wikipedia.org/wiki/Lombardyhttp://en.wikipedia.org/wiki/Genoahttp://en.wikipedia.org/wiki/Liguriahttp://en.wikipedia.org/wiki/Romehttp://en.wikipedia.org/wiki/Laziohttp://en.wikipedia.org/wiki/Triestehttp://en.wikipedia.org/wiki/Friuli-Venezia_Giuliahttp://en.wikipedia.org/wiki/Bolognahttp://en.wikipedia.org/wiki/Emilia-Romagnahttp://en.wikipedia.org/wiki/Napleshttp://en.wikipedia.org/wiki/Campaniahttp://en.wikipedia.org/wiki/Catanzarohttp://en.wikipedia.org/wiki/Calabriahttp://en.wikipedia.org/wiki/Potenzahttp://en.wikipedia.org/wiki/Basilicatahttp://en.wikipedia.org/wiki/L%27Aquilahttp://en.wikipedia.org/wiki/Abruzzo


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United Kingdom Case

The United Kingdom is divided into four home nations or constituent countries: England,Scotland, Wales, and Northern Ireland. The latter three each has a unicamerallegislature, devolved from the United Kingdom Parliament, which relates specifically toeach constituent country: the Scottish Parliament, the National Assembly for Wales, and

the Northern Ireland Assembly. Each also has its own Executive, led by a First Minister,which controls separate law making and constitutional powers devolved fromWestminster. However, despite being the largest of the United Kingdom's fourconstituent countries, England, (with the exception of the Greater London Authority), hasno devolved executive; it is ruled directly by the UK government.Each nation is further subdivided for the purposes of local government. The Queenappoints a Lord-Lieutenant as her personal representative in lieutenancy areas acrossthe UK; this is little more than a ceremonial role. The following table highlights thearrangements for local government, lieutenancy areas and cities across the homenations:

ConstituentCountry

Population Subdivisions

England 50,431,700RegionsMetropolitan and non-metropolitan countiesLieutenancy areas

Scotland 5,094,800Council areasLieutenancy areas

Wales 2,958,600Unitary authoritiesLieutenancy areas

Northern Ireland 1,724,400 DistrictsLieutenancy areas

Historically, the four nations were divided into counties as areas for local governmentadministration. Although these are still used to some extent for this purpose and asgeographical areas, they are no longer the sole basis for local governmentadministration.In recent years, England has, for some purposes, been divided into nine intermediate-level Government Office Regions. Each region is made up of counties and unitaryauthorities, apart from London, which consists of london boroughs. Although at one pointit was intended that these regions would be given their own elected regional assemblies,the plan's future is uncertain following a rejection, by referendum, of a proposed

assembly in the North East region.City status is governed by Royal Charter. There are sixty-six British cities: fifty inEngland; six in Scotland; five in Wales; and five in Northern Ireland.The Crown has sovereignty over the Isle of Man and the Bailiwiks of jersey andGuernsey. Collectively, these three territories are known as the Crown dependencies,lands owned by the British monarch but not part of the United Kingdom. They are alsonot part of the European Union. However, the Parliament of the United Kingdom has theauthority to legislate for the dependencies, and the British government manages theirforeign affairs and defence.


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The UK also has fourteen overseas territories around the world, the last remainingterritories of the Brtish Empire. The overseas territories are also not considered part ofthe UK, but in most cases, the local populations have British citizenship and the right toabode in the UK. This has been the case since 2002.

THEME.2: PLANNING AND UPDATING THE REGULATORY FRAMEWORK

Planning process is considered in decentralization as a problem solving mechanismfocusing primarily on development growth and on the way of regulating the commonlyused public services or a vital resource such as drinkable water.

To be more effective whatever the local entity (local governments, cities, etc.) theplanning exercise will be characterized by the followingconsiderations:

(i) Being consistent with the national development pan and policies,(ii) Being fashioned according to the solutions found from the priority needs andproblems local communities are experiencing,

(iii) Developing peace sensitive, accommodating and participatory approachesthat enable greater involvement and engagement of local communities especiallymarginalized and vulnerable groups,(iv) Matching planned activities with available resources,(v) Access to additional funding and need for partnerships including technicalsupport,(vi) Technology in place and capacity to be developed,(vii) Outlining current identified areas set aside for public good and interests andfor national development. This will depend upon the nature of each local entity(local governments, cities, municipalities or communes, etc.)(vii) Clarifying the benefits expected to local communities, and then translatethem into performance indicators to be reviewed during monitoring and

evaluation phase.

In addition to planning regulatory frameworks should be outlined for a soundmanagement of crucial areas such as:(a) streets and traffic circulation; (b) roads pavements and street furniture (seating,shelter, litter bins..); (c) market areas, street activities and parking stand; (d) drainageand public lighting (contributing for more security safety and better running of someservices); (e) refuse collection and sewerage; (f) water supply, sanitation and publicconvenience; (g) soft landscaping and areas for specific development activities; (h)accommodation of disabled.

The experiences below highlight some practical aspects of planning process within a

decentralized governance framework.


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Ethiopia Casehttp://www.mdpafrica.org.zw/Publications/Ethiopia%20Strategic%20Planning%20Report.pdf

Malawi Casehttp://www.mdpafrica.org.zw/Publications/Strategic%20Planning%20Malawi.pd

f

Dcentralisation et Dveloppement urbainhttp://www.isted.com/periodiques/villes-developpement/bulletin_pdf/bull77f.pdf

THEME.3: HUMAN RESOURCES MANAGEMENT AND NATIONAL DEVELOPMENT

A critical factor for a decentralized governance to be successful is the human resourcesmanagement at national and local levels. Assuming that the civil service is regulating thecivil servants and the public officials working in public institutions to deliver vital services

for the development of people and the nation, it becomes hard to set the new humanresources management systems in a decentralization realm. A sound thinking should bemade on the following:

How to transfer qualified people from center (central government institutions) tothe periphery (local government institutions)

How to review public sector institutions according to the transfer of humanresources, capacities, responsibilities, files and records

How to transfer the files and records related to decentralized functions includingattached responsibilities

How to transfer the existing staff management systems or how to adjust them How to motivate staff to be transferred How to increase and recruit qualified staff and best talent at local level How to practice talent management at local level How to make local entities more attractive for human resources (accommodation

services, existing of markets, schools, health care centers, transport andcommunication facilities, amenity areas, cultural events, local communities wellknown for their welcoming tradition, etc..)

The Tanzanian experience below is illustrative in this regard.
http://www.mdpafrica.org.zw/Publications/Ethiopia%20Strategic%20Planning%20Report.pdfhttp://www.mdpafrica.org.zw/Publications/Ethiopia%20Strategic%20Planning%20Report.pdfhttp://www.mdpafrica.org.zw/Publications/Ethiopia%20Strategic%20Planning%20Report.pdfhttp://www.mdpafrica.org.zw/Publications/Strategic%20Planning%20Malawi.pdfhttp://www.mdpafrica.org.zw/Publications/Strategic%20Planning%20Malawi.pdfhttp://www.mdpafrica.org.zw/Publications/Strategic%20Planning%20Malawi.pdfhttp://www.isted.com/periodiques/villes-developpement/bulletin_pdf/bull77f.pdfhttp://www.isted.com/periodiques/villes-developpement/bulletin_pdf/bull77f.pdfhttp://www.isted.com/periodiques/villes-developpement/bulletin_pdf/bull77f.pdfhttp://www.isted.com/periodiques/villes-developpement/bulletin_pdf/bull77f.pdfhttp://www.isted.com/periodiques/villes-developpement/bulletin_pdf/bull77f.pdfhttp://www.mdpafrica.org.zw/Publications/Strategic%20Planning%20Malawi.pdfhttp://www.mdpafrica.org.zw/Publications/Strategic%20Planning%20Malawi.pdfhttp://www.mdpafrica.org.zw/Publications/Ethiopia%20Strategic%20Planning%20Report.pdfhttp://www.mdpafrica.org.zw/Publications/Ethiopia%20Strategic%20Planning%20Report.pdf


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Tanzania Experiencehttp://www.vuw.ac.nz/commonwealthseminar/Papers/2002/Tanzania%20Case%20Study.pdf

Tanzania Experience(cont d)Development of a Motivation Package for Rural Health Workers in Voluntary

Agencies (VA) Owned Hospi talsIn line with its Strategic Plan, the Christian Social Services Commission identified anurgent need to address specific constraints adequately in order to prevent furtherdegradation of the health services in the rural areas. The CSSC prioritised in 2005 thedevelopment of a Motivation Package (MP) for health workers working in the VAhospitals in the rural areas.Assessment of Health Personnel Management and Cost Recovery MechanismsRelated to Capacity Building in Church Hospitals

This study is meant to enable the Christian Social Services Commission to strengthenthe coordination of the health personnel hired by church hospitals. On the part of theadministration of the hospitals, the study is meant to harmonize the criteria andprinciples on which the management of the health staff can be based. The study is

ultimately to lead to a human resource policy package, which in turn should lead to theproduction of a Health Personnel Management Policy Manual for the church hospitalscoordinated by the CSSC.Teaming Up in Tanzania: Supporting the National Response to HIV

In [Tanzanias] response to HIV, the Ministry has deemed its shortfall in humanresources for health (HRH) as an emergency. To begin to address this gap, the Ministryis expanding antiretroviral therapy services through an Emergency Hiring Program thatwill bring 365 new health workers to 25 underserved districts in two phases. The firstphase, now underway, will place 176 new hires in 19 districts.Evaluation of Knowledge, Attitudes, and Practices of Health Care Providerstoward HIV-Posit ive Patients in Tanzania

This study conducted structured interviews with 204 health care providers in three publichospitals in Dar es Salaam, Tanzania, to evaluate the prevalence of stigma anddiscrimination among providers toward people living with HIV/AIDS (PLWHAs) and thefactors associated with stigmatizing attitudes. Information on HIV/AIDS-relatedknowledge, perceived risk of infection, willingness to care, and availability of protectivegear was also obtained.Assessing the Impact of Educat ional Interven tion fo r Improv ing Management ofMalaria and Other Childhood Illnesses in K ibaha Distric t Tanzania

The study was carried out to evaluate short term effects of one to one educationalintervention approach, conducted with 40 drug sellers in order to improve the privatesector's practices, compliance and performance in using the national treatmentguidelines for malaria and other common childhood (diarrhoea, acute respiratory tract

infection-ARI) illnesses in Kibaha district-Tanzania.Acting Now to Overcome Tanzania's Greatest Health Chal lenge: Address ing theGap in Human Resources for Health

The focus of McKinseys research effort is on the HRH constraint, faced by manydeveloping countries, in absorbing development aid and scaling up urgently neededhealth programs. HRH in this context is defined as the health workers at the front line ofhealthcare service delivery. The field work necessary to diagnose the problem andidentify possible solutions has been initiated in Tanzania. We believe these findings,
http://www.vuw.ac.nz/commonwealthseminar/Papers/2002/Tanzania%20Case%20Study.pdfhttp://www.vuw.ac.nz/commonwealthseminar/Papers/2002/Tanzania%20Case%20Study.pdfhttp://www.vuw.ac.nz/commonwealthseminar/Papers/2002/Tanzania%20Case%20Study.pdfhttp://www.hrhresourcecenter.org/node/1756http://www.hrhresourcecenter.org/node/1756http://www.hrhresourcecenter.org/node/1754http://www.hrhresourcecenter.org/node/1754http://www.hrhresourcecenter.org/node/1748http://www.hrhresourcecenter.org/node/1747http://www.hrhresourcecenter.org/node/1747http://www.hrhresourcecenter.org/node/1720http://www.hrhresourcecenter.org/node/1720http://www.hrhresourcecenter.org/node/1702http://www.hrhresourcecenter.org/node/1702http://www.hrhresourcecenter.org/node/1702http://www.hrhresourcecenter.org/node/1702http://www.hrhresourcecenter.org/node/1720http://www.hrhresourcecenter.org/node/1720http://www.hrhresourcecenter.org/node/1747http://www.hrhresourcecenter.org/node/1747http://www.hrhresourcecenter.org/node/1748http://www.hrhresourcecenter.org/node/1754http://www.hrhresourcecenter.org/node/1754http://www.hrhresourcecenter.org/node/1756http://www.hrhresourcecenter.org/node/1756http://www.vuw.ac.nz/commonwealthseminar/Papers/2002/Tanzania%20Case%20Study.pdfhttp://www.vuw.ac.nz/commonwealthseminar/Papers/2002/Tanzania%20Case%20Study.pdf


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accounting for certain differences, will be broadly applicable to several developingcountries.Infectious Disease Surveill ance (IDS) in Tanzania

In Tanzania, the PHRplus project developed and tested a set of training materials andtools designed to strengthen the Integrated Disease Surveillance and Response (IDSR)system. All of the tools were implemented in twelve project districts in eight regions of

the country. The tools can be adapted for use in other countries and include job aids fordistrict training of trainers, facility training of trainers, district and facility level IDSRtraining materials and other supporting training tools.Traditional Health Practitioner and the Scientist: Bridging the Gap inContemporary Health Research in Tanzania

Traditional health practitioners (THPs) and their role in traditional medicine health caresystem are worldwide acknowledged. Trend in the use of Traditional medicine (TRM)and Alternative or Complementary medicine (CAM) is increasing due to epidemics likeHIV/AIDS, malaria, tuberculosis and other diseases like cancer. Despite the wide use ofTRM, genuine concern from the public and scientists/biomedical heath practitioners(BHP) on efficacy, safety and quality of TRM has been raised. This paper discussesglobal, regional and national perspectives of TRM development and efforts that have so

far been directed towards bridging the gap between THPs and scientist/BHP incontemporary health research in Tanzania.Tumaini Home-Based Care Program: a Case Study

This case study was conducted to impart a thorough understanding of the TumainiHome-Based Care Program model and to document lessons learned that could beapplied to other initiatives. While the Tumaini program addresses the needs of bothpeople living with HIV and AIDS (PLHA) as well as OVC, the case study focusesparticular attention on specific services and program impact for OVC. The program goalswere to provide care and support to OVC; to provide care and support to PLHA;Tumaini: Home-Based Care and to build the capacity of local organizations to providesustainable HBC services.Motivating Tanzanian Primary Health Care Workers

While decent salaries for health workers are important, other issues also matter ifworkers are to remain motivated. The study recommends that health workers: areproperly supervised and supported. Supervisors will need to be trained to do their jobeffectively; have their work assessed and receive regular feedback; and are given aclear career structure with straightforward procedures for promotion.Recognition of High Risk Pregnancies and Referral Practices Among TraditionalBirth Attendants in Mkuranga Distr ict , Coast Region, Tanzania

A cross-sectional study was carried out in Mkuranga District of Tanzania with the aim ofcomparing the ability of trained and untrained traditional birth attendants (TBAs) inidentifying women with danger signs for developing complications during pregnancy andchildbirth as well as their referral practices. Study findings revealed that majority of the

TBAs (86.5%) had not received any training. Trained TBAs were more knowledgeableon danger signs during pregnancy and childbirth and were more likely to refer womenwith complications to a health facility, compared to untrained TBAs. The authorsrecommend that in resource constrained countries like Tanzania and especially inremote rural areas, TBAs should be trained on early identification of mothers withobstetrical complications and on their prompt referral to health facilities that can provideemergency obstetric care.HIV and Infant Feeding Counselling: Challenges Faced by Nurse-Counsellors inNorthern Tanzania
http://www.hrhresourcecenter.org/node/1684http://www.hrhresourcecenter.org/node/1680http://www.hrhresourcecenter.org/node/1680http://www.hrhresourcecenter.org/node/1536http://www.hrhresourcecenter.org/node/1513http://www.hrhresourcecenter.org/node/1493http://www.hrhresourcecenter.org/node/1493http://www.hrhresourcecenter.org/node/1441http://www.hrhresourcecenter.org/node/1441http://www.hrhresourcecenter.org/node/1441http://www.hrhresourcecenter.org/node/1441http://www.hrhresourcecenter.org/node/1493http://www.hrhresourcecenter.org/node/1493http://www.hrhresourcecenter.org/node/1513http://www.hrhresourcecenter.org/node/1536http://www.hrhresourcecenter.org/node/1680http://www.hrhresourcecenter.org/node/1680http://www.hrhresourcecenter.org/node/1684


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Infant feeding is a subject of worry in prevention of mother to child transmission(pMTCT) programmes in settings where breastfeeding is normative. Nurse-counsellors,expected to counsel HIV-positive women on safer infant feeding methods as defined innational/international guidelines, are faced with a number of challenges. This study aimsto explore the experiences and situated concerns of nurses working as infant feedingcounsellors to HIV-positive mothers enrolled in pMTCT programmes in the Kilimanjaro

region, northern Tanzania.Development of a Framework for the Development of a Benefit and MotivationPackage for Rural Health Workers in Voluntary Agencies (VA) Owned Hospitals:Based on Finding in the Lake Zone

This presentation was given as part of the Christian Health Association's Conference:CHAs at a Crossroad Towards Achieving Health Millennium Development Goals. Itdiscusses the human resources for health situation in Tanzania in general, and specificfindings from the Lake zone in terms of health workers in church health institutions. Theauthor proposes options for a motivation package to address the issues of retention forthese workers.CSSC Geographic and Human Resource Information Systems

This presentation was given as part of the Christian Health Association's Conference:

CHAs at a Crossroad Towards Achieving Health Millennium Development Goals. Itintroduces geographic information systems (GIS), human resource information systems(HRIS) and the Christian Social Services Commission (CSSC). It outlines the progressmade in creating the systems, the benefits and reasons to have GIS and HRIS andpresents the preliminary results in terms of health infrastructure, human resources andprograms and interventions.Accreditation of Providers for the National Health Insurance Fund of Tanzania

This report will review the critical elements of quality assessment in Section 1. In thesecond section it will review the National Health Insurance Fund Act requirements foraccreditation and the current means of registering and evaluating health providers. Whatis needed in accreditation, the options for Tanzania, and the potential problems theremay be with accreditation. The final section provides practical guidance for implementinga short-term and longterm strategy for accreditation of NHIF providers and more broadlyfor all Tanzanian providers. Appendix A provides a practical tool: An AccreditationSurvey Instrument for Hospitals.Does the Integrated Management of Childhood Illness Cost More than RoutineCare? Resul ts f rom the United Republ ic of Tanzania

The Integrated Management of Childhood Illness (IMCI) strategy seeks to reduce[childhood] deaths through three main components: improving the skills of healthworkers, improving health systems an improving family and community practices. IMCIhas been shown to be associated with improved quality of care, which should result inimproved health outcomes. However, concern about the costs of implementing IMCI hadbeen given as a reason why some countries have not adopted it on a large scale. It isimportant, therefore, to assess whether IMCI does, in practice, cost more than routinecare for children who are less than 5 years old, and if so, by how muchHere wepresent results from the cost components of the MCE study in the United Republic ofTanzania.
http://www.hrhresourcecenter.org/node/1302http://www.hrhresourcecenter.org/node/1302http://www.hrhresourcecenter.org/node/1302http://www.hrhresourcecenter.org/node/1301http://www.hrhresourcecenter.org/node/1237http://www.hrhresourcecenter.org/node/870http://www.hrhresourcecenter.org/node/870http://www.hrhresourcecenter.org/node/870http://www.hrhresourcecenter.org/node/870http://www.hrhresourcecenter.org/node/1237http://www.hrhresourcecenter.org/node/1301http://www.hrhresourcecenter.org/node/1302http://www.hrhresourcecenter.org/node/1302http://www.hrhresourcecenter.org/node/1302


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Human Resources for Health in Tanzania: Challenges, Policy Options andKnowledge Gaps

NORAD commissioned this study in order to learn how the human resource challengecurrently is being addressed in Tanzania. Over the last few years, awareness hasincreased among policy makers in Tanzania that the country is facing a health workercrisis, and the Ministry of Health has initiated the development of a strategy to address

the problem. A study of the ongoing process in Tanzania can provide useful insights forsimilar efforts in other countries. A second aim of the study was to identify knowledgegaps for the development of evidence-based human resource strategies in Tanzania. Bystructuring available evidence within a strategic policy framework, and by identifying keyknowledge gaps, this study may serve as an input to the further efforts to strengthen thehealth workforce in Tanzania.Team Players: Build ing the Skills of Local Health Care Planners

Training and innovative tools were key to the success of the Tanzania Essential HealthInterventions Project, along with small funding increases. The tools and strategiesallowed the districts of Rufiji and Morogoro to target their new resources on the largestcontributors to the burden of disease and on health care delivery. The most dramaticresult, among many, has been an average decline in child mortality of more than 40%.

Technical Review of Health Service Delivery at Distr ict Level

The 2003 technical review report covers only one main strategy: district health services.It looks at district health service performance from the viewpoint of Council HealthManagement Teams (CHMT) and LG. The report presents a short general appraisal ofdistrict health services (section 1). Planning and budgeting for better health (section 2)looks at what the requirements are for a performing planning and budgeting process(section 2.1, including guidelines and process) and what information should be availableat council level to develop a comprehensive council health plan (section 2.2). Issuesrelated to implementing the council health plan (section 3) include financial resources(3.1), non-financial resources (3.2), systems development (3.3) and service delivery(3.4).Tanzania Join t Health Technical Review 2002: HMIS Sub-Group Final Report

This report reviews the implementation of a Health Management Information System(HMIS) in Tanzania to determine its success, identify issues and constraints, asses keyissues, and identify additional capacity requirements.Report on Human Resources: Tanzania Joint Health Sector Review 2003

The human resources for health (HEH) strategy in the context of ongoing reforms,including HRH planning, development and management was one of the majorcomponents that was undertaken as part of the 2002 joint MoH/Partners review of thehealth sector as a follow up of the 2001 joint review. The main objective of the terms forthe human resources review was to propose strategies and approaches for developing anew and implementable long term plan which should address current health sector andlocal government reform needs and requirements.

Support ing the Retention of Health Resources for Health: SACD Policy ContextThis report presents a review of issues in the regional policy context that are ofrelevance to the retention of human resources for the health sector (HRH) within theregion, based on a rapid appraisal in selected countries and at regional level. This workspecifically focussed on the actions needed to stem the flow of international migration byencouraging the retention of health staff within countries. A particular concern raisedacross countries is staff retention in the public and rural services that preferentially servethe poorest populations. Importantly, policy documents and national
http://www.hrhresourcecenter.org/node/849http://www.hrhresourcecenter.org/node/849http://www.hrhresourcecenter.org/node/787http://www.hrhresourcecenter.org/node/756http://www.hrhresourcecenter.org/node/754http://www.hrhresourcecenter.org/node/753http://www.hrhresourcecenter.org/node/742http://www.hrhresourcecenter.org/node/742http://www.hrhresourcecenter.org/node/753http://www.hrhresourcecenter.org/node/754http://www.hrhresourcecenter.org/node/756http://www.hrhresourcecenter.org/node/787http://www.hrhresourcecenter.org/node/849http://www.hrhresourcecenter.org/node/849


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Tanzania: Assistant Medical Officers and Clinical Officers in the Health System

This video clip is 6 minutes and 48 seconds. It is a brief overview of Tanzania's use ofassistant medical officers and clinical officers to address the shortage of doctors in ruralareas. It contains short interviews with health workers and administrators on how thesesubstitute workers are viewed and the role they play in the health system.You must have access to a media player to see the video. Download instructions are

available from the WHO Best Practices in Human Resources for Health Developmentwebsite.Investing in Tanzanian Human Resources for Health

Using Tanzania as a case study, this report advocates that the only effective means ofreally addressing the HRH challenge inpoor countries is to begin to immediately scale uptraining capacity, and that approach is relatively inexpensive when compared to its long-term benefits.Mapping of Community Home-Based Care Services in Five Regions of theTanzania Mainland

The study documents the concerns of [People Living with AIDS] PLWHA, CommunityHealth Workers (CHWs), primary care providers, and other stakeholders to informPathfinders support to national efforts to scale-up [Community Home-Based Care]CHBC. The proposed project aims to replicate Pathfinders successful CHBC model forPLWHA in other areas and improve access to HBC for more Tanzanians.Public Private Partnership for Equitable Provision of Quality Health Services

This report presents the findings of an independent Technical Review that focused onthe promotion of Public Private Partnership (PPP) for equitable provision of qualityhealth services in Tanzania.Improving Motivation Among Primary Health Care Workers in Tanzania: A HealthWorker Perspective

The aim of this study was to explore the experiences of health workers working in theprimary health care facilities in Kilimanjaro Region, Tanzania, in terms of their motivationto work, satisfaction and frustration, and to identify areas for sustainable improvement to

the services they provide.Exploring the Influence of Workplace Trust over Health Worker Performance:Preliminary National Overview Report: Tanzania

A study exploring the influence of workplace trust over health worker performance atprimary care level was undertaken in Tanzania and South Africa in 2003. The mainfactors identified by respondents as underlying poor health worker performance andmotivation in the public sector were: staff shortages and low salaries; poor workingconditions; favoritism and lack of transparency in human resource managementpractices; limited supervision and monitoring; weak disciplinary procedures; limited andslow opportunities for promotion; differential salary levels; rigid employmentmanagement policies; slow decision-making across the public service; and conflictinglines of accountability at district level.
http://www.hrhresourcecenter.org/node/665http://www.afro.who.int/broadcast/hrh_bestpractices/index.htmlhttp://www.hrhresourcecenter.org/node/516http://www.hrhresourcecenter.org/node/513http://www.hrhresourcecenter.org/node/513http://www.hrhresourcecenter.org/node/503http://www.hrhresourcecenter.org/node/406http://www.hrhresourcecenter.org/node/406http://www.hrhresourcecenter.org/node/364http://www.hrhresourcecenter.org/node/364http://www.hrhresourcecenter.org/node/364http://www.hrhresourcecenter.org/node/364http://www.hrhresourcecenter.org/node/406http://www.hrhresourcecenter.org/node/406http://www.hrhresourcecenter.org/node/503http://www.hrhresourcecenter.org/node/513http://www.hrhresourcecenter.org/node/513http://www.hrhresourcecenter.org/node/516http://www.afro.who.int/broadcast/hrh_bestpractices/index.htmlhttp://www.hrhresourcecenter.org/node/665


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Community-Based Distribution in Tanzania: Costs and Impacts of AlternativeStrategies to Improve Worker Performance

Donor funds may be inadequate to support the growing demand for services provided bycommunity-based distribution (CBD) programs. One solution may be to reduce theremuneration of CBD agents, but this approach may lower their productivity. Programsalso need to consider reducing other costs, including those for supervision and training.

The cost per agent visitincluding costs associated with payments to agents and tosupervisors and the costs of trainingwas calculated for three CBD programs inTanzania. The output measure was visits in which contraceptives were provided orreferrals made for family planning services.

THEME.4: Financing Schemes and Funding Sources

Financing schemes are developed to support the decentralization process and financelocal development activities. Financing instruments include transfers, grants, subsidies,and sharing of tax revenues between central and sub-national governments, and theability of local governments to pursue alternative sources of funding for development

projects. Starting with fiscal decentralization to special funding bodies the variousfinancing schemes become operational through a budgeting process.

Fiscal decentralization

Fiscal decentralization consists of the alignment of the fiscal functions among differentlevels of government. The responsibilities of which level of government sets and collectswhat taxes, or which tier undertakes what expenditures must be clearly spelled out.The central government must adopt a delicate balance between trying to improve theefficiency of service delivery at the local level and maintaining a fiscal discipline at thenational level.

A fiscal decentralization program must, in a straightforward way, delineate whether andon what basis local governments can self-finance or recover costs through user charges.It must clearly set out: the nature of intergovernmental transfers; whether municipalitiescan expand local revenues through property taxes, sales taxes or indirect taxes; whetherthere is to be any type of co-financing arrangements between central government andlocal government; and whether municipalities have the authority to borrow and mobilizefunds from local, national or international sources. If local administrations obtain theability to impose taxes, then the tax base must first become adequate for that purpose.Fiscal decentralization can result in an expansion of aggregate demand at a time whenthe central government may be attempting to contain it.

Local governments may underutilize their own tax bases, inflate their revenue, and

overspend, in an effort to keep or increases their shares of the common resources. Inthis situation, the burden of local service provision is shared vertically (between levels ofgovernment) and horizontally among the local jurisdictions.Under revenue-sharing arrangements characterized by automatic intergovernmentaltransfers of resources, or total (no local co-funding) funding, or unconditional funding oflocal spending, the central government may have difficulties dealing with the commonpool problems.
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Transfers of financial resources from the central governments are necessary, at least inthe first stages of the process, until newly formed sub-national governments haveacquired the capacity to raise their own funds. However, if local government leaders failto use the received transfers for the stated purposes or if they use the funds to promotepolitical patronage of their own, the macroeconomic consequences may be undesirablebecause the central government may still have to pick up the tabs for the provision of the

services that the local governments would have failed to provide.Sequencing may involve either a central government pushing down spendingresponsibilities to the sub-national governments without first devolving enough resourcesfor the local governments to meet the new spending requirements. This should beproperly managed to build trust at different levels of the government.

China Experience: Growth and equity Tradeoff in Decentralization Policyhttp://isp-aysps.gsu.edu/papers/ispwp0216.pdf

Participatory Budgeting

Participatory budgeting is a democratic planning process as a mechanism of localgovernment in which ordinary local residents within a community participate indeliberation and decide how to allocate public resources to development activities. Theybecome active key decision-makers, active stakeholders and active developmentagents. They familiarize themselves with the development challenges and priorities aswell as the financial constraints and the ultimate benefits resulting from a sound budgetexecution. In so doing they are well equipped to ask for evaluation and accountability inthe future.

Since its emergence in Porto Alegre, participatory budgeting has spread to hundreds ofLatin American cities, and dozens of cities in Europe, Asia, Africa, and North America.

More than 200 municipalities are estimated to have initiated participatory budgeting. Insome cities, participatory budgeting has been applied for school, university, and publichousing budgets. These international approaches differ significantly, and they areshaped as much by their local contexts as by the Porto Alegre model.

In Europe, towns and cities in France, Italy, Germany, Spain and the United Kingdomhave initiated participatory budgeting processes. Participatory budgeting has beenimplemented in Canada with public housing, neighborhood groups, and a public school,in the cities of Toronto, Guelph, and West Vancouver. Similar budget processes havebeen used in communities in India and Africa.In France, the Region Poitou-Charenteshas launched an experience of participatory budgeting in all its secondary schools.

A guide for Part ic ipato ry Budgetinghttp://www.internationalbudget.org/resources/library/GPB.pdf
http://www.internationalbudget.org/resources/library/GPB.pdfhttp://www.internationalbudget.org/resources/library/GPB.pdfhttp://www.internationalbudget.org/resources/library/GPB.pdf


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THEME.5: DECENTRALIZED COOPERATION: PARTNERSHIPS AND RESOURCESMOBILIZATION

Decentralized cooperation is instrumental for strengthening governance initiatives atlocal level whatever the institutions (private sector, public sector, or civil Society). Thiscooperation is supposed to be mutual beneficial for the institutions involved and covers

mainly the areas of capacity development, transfer of technology and livelihood projects.

However in the context of international assistance for development and povertyreduction, decentralized cooperation has been more and more championed by centralgovernment and local authorities even though institutional relationships betweendifferent countries still flourish. Some thoughts are going on to see how to increase adirect cooperation between local entities (local governments, local authorities, cities,communes and municipalities, etc..) of different countries.

Case Studies:

Coopration dcentralise et Dveloppement

http://www.diplomatie.gouv.fr/fr/IMG/pdf/366_Int_Coop.decentral_1_.pdf

Geman Development Cooperation and Support to Zambia DecentralizationIn the recent past in Zambia Decentralization has been both, a heated debate and attimes a dormant process. Since the decentralization policy was launched in August2004, development discussions in Zambia have begun increasingly to acknowledge andsupport the essence of the decentralization policy: This recognizes that LocalGovernment, specifically the district councils, have to be the focal point for developmentmanagement if significant changes are to be made in terms of poverty alleviation. This isbased on the rationale that only when the processes of identifying development needsand orchestrating development programs are brought closer to people, that the quality ofprograms and the relevance and quality of services can increase significantly.

There is a common concern, however, that necessary capacity for organizing horizontaland vertical planning and monitoring mechanisms at local government bodies is still, atbest, limited. It is also of particular concern that the general rural population is not yetintegrated in the process of formulating development needs nor into the implementationof the resulting programmes.The implementation of the decentralization policy has started, and the long expectedimplementation strategy was finally developed, published and shared with all concerneddevelopment players in Zambia. Though the author of this strategy is theDecentralization Secretariat, which is part of the Ministry of Local Government andHousing, the owners and managers of the implementation processes will have to be allthose institutions, which are directly or indirectly participating and affected. This includesSector Line Ministries at national, provincial and district level, civil society organizations,

private sector, and most importantly the 72 district, city and municipal councils ofZambia..It is expected that with these interventions local government will have more decisionmaking powers and in the long run will be able to coordinate development programs ondistrict level and steer service delivery from private sector and government for localeconomic development.

It is against this background that the combined efforts of the four organizations ofGerman Development Cooperation (KfW, GTZ. DED, and CIM) operate in the Priority
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Area Decentralized Rural Development. The Priority Area is almost entirely housed inthe Ministry of Local Government and Housing, except for one intervention of KfW,which partners with the Ministry of Works and Supply. The coordination of the PriorityArea rests with GTZ.

This Priority Area of Zambian-German Economic Cooperation follows a joint approach

between all four involved organizations and the Zambian Government to ensure thesuccessful implementation of the decentralization policy based on agreed andharmonized strategies. This support is guided and harmonized by the policy statementsof the 5thNational Development Plan of the Government of the Republic of Zambia asoutlined in the chapters Decentralization and Local Government and Decentralization.

German Development Cooperation basically provides assistance in two ways:

1. Inputs, such as concepts, tools, best-practice examples and funding, to nationallevel policy formulation and refinement processes, and policy implementationbased on lessons learnt from local experiences and a harmonized strategy,which is aligned with all other cooperating partners in the sector. This is intendedto help government and its partners clarify roles and processes for thedecentralization process and build capacity for it.

2. Capacitating sub-national institutions and their partners to fulfill their new roles inthe decentralized system of governance, and to implement national policies andstrategies on the ground. With this intervention, better and more effectivecoordination, planning and monitoring procedures are addressed, and themanagement capacity of district councils (administration, financial management,revenue management, etc) is being strengthened. An additional essential part ofthe package is the development of institutional arrangements and developmentof processes, which support local economic development.

With the establishment of national forums for sector coordination, policy guidance andmonitoring of sector performance (Sector Advisory Group) for the Ministry of LocalGovernment and Housing the Government of Zambia has created a potentially effectivemechanisms for making better use of lessons learned from operations on the ground.The Sector Advisory Group and associated Working Groups can be employed to makesure that demands for process support in decentralization implementation voiced atnational level are being worked-on. These can address interventions at national,provincial and district levels including research, piloting, development of guidelines,financing certain strategies and updating legal documents.Here German Development Cooperation, through the joint efforts of its instruments(KfW, GTZ, DED, CIM), has the strength to combine its long term presence in the sectorwith technical expertise and reputation for flexibility, to ensure its intervention can beadapted to upcoming needs and changing environments.

The German Development Cooperation and the Government of the Republic of Zambiahave chosen Southern Province for the implementation of the program parts mentionedpreviously. The rationale for the choice is based in part on history and the long termpresence of German Development Cooperation in that part of Zambia. In fact, a numberof preceding projects of Zambian-German Technical Cooperation operated in SouthernProvince, addressing issues of Land Use Planning, District Development, Agriculture,HIV-AIDS and Reproductive Health.


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A further reason for the selection of Southern Province, with its 85.000 km2 and 1.3million people, is that it is one of the provinces in Zambia prone to dramatic climatechanges with regular droughts, but largely depends on agriculture. Commercialization ofthe agriculture sector holds to date an untapped potential for support to private sectorinstitutions in the context of the value chain approach, which in turn will stimulate localeconomic development.

KfW, with their upcoming Rural Transport for Poverty Reduction (RTPR) Program inSouthern Province, will provide essential complementary services to the longestablished Decentralized Rural Development Program (SDRD), which is jointly built byGTZ and DED, and complemented by CIM with integrated experts. SDRD works in all 11districts of Southern Province with about 15 national, regional and international experts.In addition, KfW will soon start a complementary program on national level, which will betitled Rural Development Fund Zambia and aims at strengthening the LocalDevelopment Fund (formerly known as ZAMSIF) of the Ministry of Local Governmentand Housing with finances and capacity building mainly in the development of conceptsfor decentralized district financing.

The Priority Area Decentralized Rural Development provides significant interventions atall levels ranging from sub-district to the national level. Contrary to the past, when moreisolated projects operated in a wider range of technical areas, it is envisaged that theconcentrated and better focused efforts of the German implementing organizations,together with their Zambian counterparts.

Eventually the Zambian Government and their partners will be able to make use of theseproducts and services for improved efficiency and a stronger client orientation of bothpublic administration and the private sector. In addition, it is expected that theadministration of districts and sector line ministries at grass root level will be enabled tobetter implement the reform policies of government and provide a better environment forfruitful cooperation with the private sector for local economic development.

THEME.6: INFRASTRUCTURE DEVELOPMENT AND SERVICE DELIVERY

The impact of decentralized governance can be seen through the development of localinfrastructure and an easy access of vital services well valued. The infrastructure refersto building, housing, roads and street furniture, including the basic architecture of thewhole local area that shapes and interlinks all development activities with the humanhabitat while increasing the household growth. The more responsive and efficient is theservice delivery as well as the advancement of the local infrastructure, the moresuccessful decentralized governance is considered.

Case Studies:

Towards an Effective Delivery of Public Services in Africahttp://unpan1.un.org/intradoc/groups/public/documents/AAPAM/UNPAN026077.pdf
http://unpan1.un.org/intradoc/groups/public/documents/AAPAM/UNPAN026077.pdfhttp://unpan1.un.org/intradoc/groups/public/documents/AAPAM/UNPAN026077.pdfhttp://unpan1.un.org/intradoc/groups/public/documents/AAPAM/UNPAN026077.pdf


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THEME.7: MONITORING AND EVALUATION BASED ON CLEAR PERFORMANCEINDICATORS

The efficiency of decentralized governance can be appreciated if it is supported by asound monitoring and evaluation system consisting of clear and verifiable performanceindicators. This monitoring and evaluation system should be functional and well known

by all the communities at all levels (national and local) in order to facilitate transparencyand accountability for the management of all the public matters.

Case studies:

Monitoring and Evaluating Support to Decentralization: Challenges and Dilemmashttp://www2.gtz.de/dokumente/bib/00-1236.pdf

Monitoring and Evaluation of support to decentralization and Local governance:Burk ina Faso Casehttp://www.oecd.org/dataoecd/52/48/33741523.pdfTHEME.8: COMMUNITY DEVELOPMENT AND PARTICIPATORY APPROACHES

FOR THE IMPLEMENTATION OF DECENTRALIZATION POLICY AT THE LOCALLEVEL: CASE STUDIES

This theme outlines different concrete experiences some countries put in place ascommunity development and participatory approaches to implement respectfully adecentralization policy.

Case study 1: The Kecamatan Development Project (KDP), Indonesia.

The Kecamatan Development Program (KDP)is a national Government of Indonesiaprogram, implemented by the Ministry of Home Affairs, Community Development Office,

and funded in large part by the World Bank. The Project began in 1998 and its objectivesinclude alleviating poverty, strengthening local government and community institutions,and improving local governance. The program is funded through government budgetallocations, donor grants, and loans from the World Bank. It provides block grants ofapproximately Rp. 500 million to 1.5 billion (approximately US$50,000 to US$150,000) tosub-districts (kecamatan) depending upon population size. Villagers engage in aparticipatory planning and decision-making process to allocate those resources for theirself-defined development needs and priorities. KDP focuses on Indonesias poorest ruralcommunities. Figure 3.1. shows the KDP activity cycle. Notice that the project adopts avillage-level, community-demand driven (CDD) approach, whereby projects are selectedat the village level based on the localitys particular needs and priorities. Though eachproject must address the overall policy objectives of the national government, enough

flexibility and autonomy is accorded to the lowest levels of the administration to designand implement specific project according to local priorities. Even the technical team andproject implementers are selected after consultation with the project beneficiaries. Thedepth of community participation in this project promotes ownership by the stakeholdersand sustainability.
http://www2.gtz.de/dokumente/bib/00-1236.pdfhttp://www2.gtz.de/dokumente/bib/00-1236.pdfhttp://www.oecd.org/dataoecd/52/48/33741523.pdfhttp://www.oecd.org/dataoecd/52/48/33741523.pdfhttp://www2.gtz.de/dokumente/bib/00-1236.pdf


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Figure 3.1. Kecamatan Development Project (Indonesia) Activity Cycle. Source: TheWorld Bank.


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Models of Inter-sectoral Collaboration for Community Development1

This section presents examples of two models of inter-sectoral collaboration for theimplementation of a decentralization policy provided by M. Jae Moon of KoreaUniversity. The general concept is based on the Snavely and Desai (2000) idea that

partnerships between civil society and the public present a preferred strategy tomaximize the social functions of politics, policy, and the economy, as demonstrated intable 3.1.The table shows the interactions and complementarities of the public sector and civilsociety in policy formulation and implementation.

First, the potential partners in the process are the public sector (i.e., the government),the non-profit sector, and other social partners cutting across sectors. Second, thepolitical context in which policy is being formulated in important. A grassroots democracywhich allows for civil society to flourish, and promotes competitive political action basedon the social capital of the country sets the stage for more successful policy formulationand implementation. A multiple-party grassroots democracy creates the dynamic for

policy dialogue to take place across relevant actors, allowing for a more sustainableagenda setting. Finally, policy implementation is likely to be most effective when there iscomplementarity and collaboration between the private sector, the public sector andlocal authorities.

The two models described by Moon (2007) are the New East Side EconomicDevelopment Community Development Corporation (NEWSED) model, implemented inDenver, Colorado (USA), and the Fundacion Communitaria del Bajo (FCB) model,implemented in Irapuato, Mexico.

Nonprofit Sector Intersectoral

Collaboration:

Complementary

Public Sector

Politics Civil Society

Democratic/

SocialMovement

Social Capital

ContentiousPolitical Action

GrassrootsDemocracy

Partisan

Policy

Formulation

Policy Agenda

Setting

Policy Dialogues Grassroots

Democracy

Partisan

PolicyImplementation Innovation/Experimentation

Private

Joint ServiceDelivery(Partnership)

Contracting-out

Decentralization/Local Autonomy

Source: Adopted from Snavely and Desai (2000), p. 250.

Table 3.1. Interactions and complementarities of the

public sector - civil society in policy formulation andimplementation

1The two approaches presented in this section draw on the work by M. Jae Moon, Department of Public

Administration Korea University, titled: Good Governance for Public Service Delivery in Local Communities:Lessons from Two Cases. (May 2007)


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Case Study 2: The NEWSED Model: An Expansion Model

Established in 1974, NEWSEDs objective is to promote and develop economic andcommunity programs and projects that raise the income, educational, and political levelsof West Denver residents (NEWSED, 2001). According to the organizations website,

NEWSED's primary focus has been to solve long-term economic problems indisadvantaged communities by securing and coordinating resources for neighborhoodrevitalization, developing needed shopping areas and services, fostering minority andneighborhood business ownership, job retention and creation, increasing homeownership and affordable rental opportunities, [promoting] neighborhood organizing, andhosting cultural events and activities that showcase the neighborhood's predominatelyChicano/Mexicano population. NEWSED promotes holistic social and economicdevelopment opportunities.

According to Moon (2007), the NEWSED model is an Expansion Model, which is basedon an in-house programmatic design approach. Figure 3.2 shows the elements of thismodel. As the figure shows, the NEWSED approach is to secure resources from various

sources in the community, which the organization

Figure 3.3. The Expansion Model: NEWSED In-house

Program Design Model (Moon, 2007)

NEWSED

Community

Organizations

Resources

programs

Resources

programs

programs

Government

Organizations

Business

Organizations

utilizes to develop and design its in-house programs. This model secures theinvolvement of the various strata of the community: including government, civil societyand business, in supporting and funding the organizations programs. These programsinclude affordable rental housing programs; home ownerships programs; local economicdevelopment initiatives; and local business support programs. NEWSEDs fundingoriginates from the following sources:


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The Mayors Office of Economic Development (MOED)-Youth Opportunities The Mayors Safe City Program-School to Work The Annie E. Casey Foundation

In terms of representation, NEWSEDs Board Members are drawn from the communityethnic representation; the PODER Advisory Council (PAD); and the Community

leadership programs (e.g. the Youth Opportunity Movement). PODER is a LeadershipDevelopment, and school-to-work transition Program, which provides counselingservices for Mental Health, Drug and Alcohol Abuse, and Domestic Violence. The YouthOpportunity Movement (YO!), targets young people between the ages of 12-24 yearswith such programs as General Education Diploma (GED) preparation and job training.PODER, YO! and the Human Services Program (PATCH) are among the institutions incharge of social services delivery (Moon, 2007).

With respect to economic development, NEWSED adopts a private-public approachwhich relies on the Santa Fe Drive Redevelopment Corporation (SFDRC) incollaboration with the City of Denver; the Neighborhood Business Revitalization District(NBRD)/ Santa Fe Art District; and the Housing Development Authority; and local

businesses.

Case Study 3: The Fundacion Communitaria del Bajo (FCB) Model: A Diffus ionModelThe Fundacion Communitaria del Bajo (FCB) was established in 1997. Theorganizations objective is to raise and channel resources to promote and strengthenlocal development through creating and encouraging ties between, and with theparticipation of, civil society, government, and the private sector [with the aim ofachieving collectively] the well-being of the community (FCB, 2001). To accomplish thisobjective, FCB introduces the idea of Community Foundations, which, the organizationmaintains, ought to become the bedrock of local development and poverty reduction.

Moon (1997) terms the FCB model a Diffusion Model. As figure 3.3 shows, the FCBapproach is to build networks of implementers of local development projects, which itaccomplishes by raising revenues and channeling those revenues to its organizationalpartners.


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Figure 3.4. Diffus ion Model: FCB

Network Design Model (Moon, 2007)

Resources

Resources

FCB

Programs

Community

Organizations

Programs

Community

Organizations

FCBs network of support include:The Mexican federal governmentThe Local governmentOther NGOsInternational support

Politically, FCB has gathered interest from various strata of the community, including,universities, NGOs, governments, business, and other NGOs such PADIC, Proyeto San

Juan, People Kitchen Program. FCBs economic development projects include, forexample, PADIC-San Juan Project, and job training programs linked with multi-nationalcorporations (Moon, 2007).

Case Study 4. Participatory Budgeting in Porto Alegre, Brazil

a. The Concept: In 1988, the city of Porto Alegre in Brazil began to institute participatorybudgeting which provides an opportunity for citizens to exercise an oversight over theallocation of municipal resources. In a participatory budgeting approach, local citizens orcitizen groups are given a direct voice in all phases of budget preparation. To do this,Porto Alegre regularly relies on community organizers to draw previously marginalizedgroups into the budgetary system, thereby sidestepping the local elite who so often

capture the decentralization process to advance their personal or class interest. Citiesinvolve in participatory budgeting routinely make budget information available to ordinarycitizens and provide regular reports on the status of the implementation of the budget.This direct participation of citizens in the process of budget preparation andimplementation greatly increases conditions for transparency and accountability at thelocal level.

b. Results:


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Between 1989-1996 the number of households with access to water services rose from80% to 98%, and the number of children in public schools also doubled during that time.Tax revenue increased by nearly 50% due to transparency affecting motivation to paytaxes;Participatory budgeting has helped to balance earnings and expenditureOver 80 Brazilian cities now following the Porto Alegre model.

Participatory budgeting has been adopted in countries such as Bolivia, Peru, and theState of Kerala in India, among others.

Case Study 5. Gujarat, India: Participatory Budget Review

The ConceptDevelopment Initiatives for Social and Human Action (DISHA), a 80.000-member NGObased in India, has monitored and reviewed the budgetary process in the state ofGujarat since 1992. DISHA reviews budget documents, disaggregate spendingcategories and studies discrepancies between proposed budget and actual spending,and summarizes its findings to be used in public debate. The concept of participatory

budget review has become part of the way the state of Gujarat conducts business.

ResultsBetter allocation and release of funds to priority sectorsNumeric discrepancies and other errors (around 600 in first year) are detectedMedia has publicized resultsBetter flow of information among ministriesGujarat model replicated in 12 other Indian statesNational budget now analyzed by Peoples Budget Information and Analysis Service(BIAS)

Case Study 6. Uganda Public Expenditure Tracking Survey

The ConceptPublic Expenditure Tracking Surveys (PETS) are used to track down the flows of publicfunds and gauge the degree to which these funds reach their intended beneficiaries. InUganda, PETS were introduced since 1996, when Uganda became the first country tointroduce the system. The purpose was to evaluate actual spending and assess leakageof funds as they are transferred from the government to the Districts and down to theservice delivery level. The Ugandan PETS focused primary on the education and healthsector.

ResultsPrimary school enrollment in Uganda rose from 3.6 million students to 6.9 million

between 1996 and 2001.Share of funds reaching schools increased from 20% in 1995 to 80% in 2001.Based on survey findings central government launched a mass information campaignrequiring published data on monthly transfers of grants to districts in newspapers and onradioPrimary schools and district authorities required to post notices on all inflows of funds.Schools and parents now have access to information needed to understand and monitorthe grant program.


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Case Study 7. Bangalore, India: Citizen Report Card

The ConceptsA citizen report card enables citizens to grade a service provider of their essentialservices. This is a tool to reduce the distance between decision-makers and ordinary

citizens who are customarily not organized or equipped to exert pressure on governmentof service provides to demand better services. Citizen Report Card was introduced inBangalore in 1993, after surveys concluded that the quality of service delivery in the citywas very poor and not responsive to citizens needs.

ResultsFormerly apathetic public agencies now listen and react to citizen concerns.Worst rated agency (Bangalore Development Agency) reviewed internal systems forservice delivery and introduced reforms and public forums to consult on solving highpriority problems.Karnataka Electrical Board formalized periodic dialogues with residence associations toredress grievances.

Public awareness on issues of service quality has substantially increased.Report cards have stimulated civil society activism in Bangalore with many more groupsengaged in citizen monitoring.Report cards have been replicated in other Indian cities and internationally (Ukraine,Philippines and Washington, DC).

Overall, what these cases show is that the most effective results at the local level areobtained when resources are managed through a combination of skills, innovation,flexibility, and accountability.

Addi tional Read ings

Cadena, Cecilia, Martell Christine, R, M. Jae Moon, Decentralization and Non-Governmental Organizations: Comparative US-Mexico Case Study, Documentos deInvestigacon, Mexico, 2003.www.cmq.edu.mx/docinvest/document/DI75284.pdf

Moon, M. Jae, What Drives Good Governance in Public Service Delivery, Korea

University, 2007. Online at: www.kapa21.or.kr/ppc/downfile/.ppt

Schwabe, Craig (Human Sciences Research Council (HSRC)), Citizen Report Cards

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decentralized government

Documents