MattAndrews

Governance, outcomes, and attribution

Last week Natalia Adler made an important comment in response to my post on using birth registration rates as a governance indicator. Hopefully I will do it justice in the following summary: How can you use an indicator that governments have so little influence over?

Natalia notes that governments can supply all the processes and offices they want to in places like Nicaragua and Mozambique, but the rates will still stay low if the people don't have an incentive or desire to register their kids. The demand side kills any chance at better performance. She notes further that Unicef (where she works) and others find this demand side limitation extremely difficult to work with. It is a real constraint on many things.

I love the comment, and in many ways it gets us to the limits of prevailing governance indicators and of the thinking behind these indicators.

• So many of the indicators center on things governments produce--directly--like drivers license tests, regulations, or schools, or budgets, etc. The supply side, if you will...what we can 'attribute' directly to the administrators, bureaucrats and politicians in what we call 'government'.
• These things only account for a small fragment of the solution to most complex problems in developing countries. So we end up with 'good governance' governments that cannot solve the problems their citizens face.
  • Delhi has great drivers license regimes that very few citizens take (having worked out other ways of getting a license).
  • Georgia has deregulated but still finds its economy languishing (partly because there is still limited creativity in an economy dominated by monopolies). 
  • Many countries have built schools for students to attend, but have not been able to ensure that teachers actually teach or that children actually learn.  
  • Afghanistan has a budget process that donors like DFID (the British government) compare with 'middle  income countries' but that falls short of fostering effective service delivery or fiscal stability.

In all of these areas--and in all areas where problems are complex--'good governance' involves using authority to do things that are not only within the direct production authority of a government. Achieving change requires that politicians. adminsitrators and others exercise facilitative authority and political and social authority as well. They must, by necessity, engage on the demand and supply sides of social  problems. This means working on incentives, social and cultural constraints, etc. Just doing the supply side stuff makes governments that look better...but are not necessarily better at doing what they were authorized to do.

In the birth registration domain, I would venture that developed countries that now have high rates of birth registration also faced demand side problems. I would venture that governments in these contexts used their authority to address these issues--engaging with religious and traditional groups, building coalitions, etc. This is good governance in my book: When those given authority use it to facilitate or produce the changes needed to move their people forward. (don't hold me to the quote as a definition, but my understanding of good governance is emerging along these lines).

Natalia closed her email asking if anyone out there had ideas about how to deal with demand side issues. My recommendation: PDIA. Problem Driven Iterative Adaptation.

• In places like Mozambique or Nicaragua, start  constructing the problem in a way that garners attention. Point to the low rates of registration and show how this limits access to services, for instance. This is an effective way to bring people into a 'governance coalition'.
• Break the problem down at the same time, identifying demand and supply constraints to producing the output or outcome in question. Identify where the best entry points are for action and craft the problem message to draw people around this. If, for instance, parents are resistant, show them how the failure to register for birth registration limits their kids' access to services.
• Construct some experimental interventions to address specific entry point issues. Think of changing the access rules to schools, for instance, or procedures for accessing early innoculations. Experiment, get quick feedback on responses, and adjust. When looking for feedback, ask about the things you are interested in: When we made school enrolment contingent on being registered, did parents come and register?
• Forget the idea of easy or generic or best practice solutions across all the places we are working in. If we define the problems and pursue solutions iteratively, with clear goals, we will find solutions that work. It just takes time and energy.But that, too,  is an often forgotten rule of the 'good governance' agenda.

Thanks to Natalia for the question, and for the inspiring work she and others at UNICEF do to make the world a better place.

 

 

Birth registration rates as a governance indicator

Some people have asked me offline how I think a birth registration rate could be a governance indicator. They prefer thinking about indicators of what governments look like: Is the budget balanced? Is the political funding transparent? Are civil servants hired on merit?

These measures are interesting, and get to the structures that determine how governments exercise authority (which is governance). But my concern with many of them is simply that they are open to isomophic mimicry--governments can use them to signal good governance without being well governed. Think about the way Greece re-stated its budget balance last year to 'correct' its deficit statistics from around 3% of GDP to something like 12% of GDP. The EU had been watching the numbers, and the Greek government had been reporting, but this stuff is not that hard to fudge.

I'm looking for an indicator that measures something that is hard to fudge, where evidence of achievement is reflected both in new processes and in new outputs--and progessively in outcomes. I am also interested in indicators that capture the way governments use their authority to increase engagement and interaction in society (which is probably as close to my personal definition of 'good governance' as I can think of right now).

I think that birth registration fits this bill pretty well. Governments actually have to do a bunch of things to increase registration performance, which we can see in terms of the new processes and activity as well as the outputs (numbers of birth records) and within short periods of time we should see (according to those who investigate the impact of birth registrations) increased enrolments of kids in health programs, school, etc. etc. So there are waves of impacts that we can look to to see if the performance is real. We can also expect these impacts to reflect a meaningful way governments facilitate interaction, and we can expect knock on effects that promote more endogenous governance change (the more people who are registered, the more who can engage in political and social and economic processes).

Lastly, some ask if the problem is really a large one. Here are some data showing the number of people under 14 years of age in twenty countries, the current birth registration rate, the number of children under 14 who are not registered (given this rate) and some idea of the number of kids that could be registered if we had a global goal to bring all countries up to modestly better levels (the adjusted level I propose, which is a maximum 15% increase in registration).

 

The first thing this kind of data shows is that many many people are not registered in their countries. When I examined 100 countries I found that as many as 50% of the children under 14 were probably not registered. Wow. This is so disempowering. And it is such a basic and unfortunate constraint on their participation in the educational, economic,  social and political life of their country. If most people are not registered in places like Liberia, don't we think that governance is limited as well: we might promote democracy but many are not registered to vote; we might provide schooling, but many are not in the system to attend; we might think that good governance involves having a formal rule of law, but if people are not registered how do they access and engage with the formal legal system?

In essence, there are outrageous numbers of people who are not formally registered, and if we were to focus on getting them registered we could improve access to many parts of the good governance agenda we otherwise promote. If we focused on the modest improvements I suggest, measuring across the 100 countries I have data for, we bring about 150 million children under 14 into the formal social, political and economic conversation in their countries. Imagine the way this could spark change in the way authorizing structures function in countries?

My colleague Arvind Nair notes that the other governance knock-on effect of this kind of indicator relates to the way it forces interaction amongst agencies today.

• If countries up their birth registration rates it will be because a number of agencies start engaging and coordinating.
• This is itself a way of improving the interaction of agents in society (which, again, I think good governance should focus on) and the potential for learning and creativity is seriously high. Change is iterative, and sometimes you need to find the entry point that sets it off.

A systematic approach to governance indicators

Yesterday's blog postings have me thinking. What approach is a valid approach to governance indicators? I am going to propose a way of developing and thinking about the indicators here, using an example I proposed yesterday--birth registration rates.

First, explain the theory behind your indicator:

I think governance is about the way authority is exercised in society. The goal is to get authority exercised in a way that it fosters improved capability, well being and growth. In developing countries, I think this also involves exercising authority in a way that promotes creative interaction--required to address the complex problems these countries face.

So, I am proposing indicators that assess the way those exercising authority open up interaction, engagement and participation in society--politics, economics and other areas. Essentially, the ones given authority need to be empowering interaction of others which I believe will yield adaptive processes of development.

I think that birth registrations are a good measure to think about in this respect.There is a growing literature that notes the way increased birth registrations increases the potential people have to engage in their societies, especially as these societies become more formal. Without registrations, people struggle to engage politically, benefit from medical care, access schooling, etc. etc. (see unicef's paper on this...http://www.unicef.org/esaro/Technical_paper_low_res_.pdf).

This is my theoretical perspective on the issue, and I am sure others have their views. The key thing is to ensure you can say that there are theoretical foundations for your indicator choice.

Second, make sure the proposed indicator matters in development, and addresses a key problem:

If we hope that the indicators we introduce are going to affect behavior, we should be sure that those who have to act on them care enough. In our pdia work we note that people and organizations care enough to change when they face problems. So: Is the indicator capturing some problem that matters, where we really believe there might be enough political will to move?

In this case, I would argue 'yes'. According to a growing literature on birth registrations, there are may interested groups. First, those in the health sector find it hard to offer care when many kids are not registered (how do you budget, monitor, etc.). Second, those working on education struggle for the same reasons. Third, those working in the justice sector need this information. etc. etc.

One can also see the problem when looking at the countries that have low birth registration rates. It is mostly poorer countries (see chart below). One can also see that countries where growth and development occured tended to improve their registration rates at the same time (the USA began in earnest in the first decades of the 20th century, and increased registration went hand in hand with increased state capacity, engagement, political participation, etc.).

I'm not saying conclusively that there is causal linkage from registration to development, but I am saying that the less developed countries lack this...and more developed countries promoted this in their process of development. So it seems this is a problem worth addressing in poor countries.

Third, make sure the indicator focuses on an output that cannot be a meaningless signal:

I don't think it is useful to focus countries on developing birth registration systems. Many will do this and it won't matter because they won't function. But if the indicator asks countries to ensure that the % of births that are registered increases, one is focusing on an output of a system that has potentially vast change implications. If countries do better on the indicator, one can expect real changes--more engagement, more interaction, more participation as an outcome.

Fourth, make sure the indicator allows flexibility on the process and is contextually iterative:

All indicators are preseciptive in some sense. It is important to precribe some kind of goal (register the kids!) not a means to get there. It is also important to ensure that the goals we prescribe are meaningful and can be done in the contexts we are working.

So, with this example I would say we are not prescribing a specific process of registering children. Indeed, you would want to say "Let's choose some methods, and some areas, that give us the bst strating point...and then let's learn." In places like Ethiopia (where registrations are lower than 15%) we would probably have some targeted manual registration measures in place, learn how they work, then diffuse them and experiment with more advanced mechanisms. In places like Ethiopia the goals would also be contextualized: Let's try to get the rate up to 30% by 2020 (imagine the change this would imply for people who live in that country?). In a country like South Africa the challenge would be going from 90% to 95%, which would entail a struggle to register kids in rural areas.

Fifth, make sure the indicator is stretching but has a low chance of doing harm:

If we are going to take the time of getting those in authority to do things differently (ie. challenging changes in governance) it is important to push the envelope. It is also important to be careful about doing harm. In this respect we should always think about the downside of the measure: What risk is there of isomorphic mimicry? what risk is there that some countries just won't be able to do this? what risk is there that higher rates of birth registration will lead to 'bad' governance?

I am not going to go into my answers in reaction to birth registrations, but I think the discussions would be important. The example here shows that we could have key indicators, I think, that measure ways in which governance could be improved to improve society.

Still revisiting governance indicators

I got a couple of comments on facebook about the earlier post. I wanted to address an issue off the bat. The issue centers on the relevance of current process-based indicators. A comment noted that these are valid indicators, given that they measure step-by-step changes. So, it is valid to say that governance is improving where the law requires less time to get a drivers license. Or, it is valid to say that governance is improving where the law requires fewer documents to start a business. Or, it is valid to say that governance is improving where PEFA scores are getting better (a country has moved from a C to a B on the procurement measure, for instance).

Now, I don't want to be understood as saying these are all worthless measures. I use PEFA data, for instance, and find it helps build narratives about governance that strike me as useful and real. But I would say strongly that these kinds of process improvements often measure nothing about governance at all. The more we insist that they do, the more we crowd out a real conversation about what governance is and how it can be measured.

I would suggest that folks listen to Lant Pritchett's presentation on 'Folk and the Formula'. http://www.wider.unu.edu/events/annual-lecture/en_GB/27-09-2012/ In it, he cites a range of examples that suggest these kinds of process improvements do not yield better governance outcomes -- improved capability from those exercising authority:

• In Delhi, for instance, researchers found that most people who get their drivers licenses do not sit the test. It does not matter how long it takes (formally) to get a license. The real problem is whether anyone takes the test at all...or if the city streets are safe. The process measure distracts one from this more complex and functional problem.
• In other studies, Lant points to evidence that many firms bypass the formal rules for starting businesses as well. My own work in Georgia shows also that cutting regulations to start businesses does not mean you have more businesses or more jobs or more functional economies. If momopolies fester, and small firms lack access to markets and money, it does not matter how long the formal process of registering a business is. The process focus distracts attention from real problems of social and economic organization.
• Lant also speaks of the PFM work I have been doing. Here, the finding is regularly that countries adopt new procurement, budgeting etc systems but the product of these systems does not improve. The number of formal procurement systems that yield terrible contracting results is staggering (often procurement is slower, more labored, more costly, and sometimes even less transparent after rules). This is partly because the systems exist formally but are not used practically (sometimes because capacity and political realities make them less than practical). The process indicator again distracts from attention to the real, more complex problem.

I would say that advocates of process indicators as governance indicators need to make extremely strong arguments showing why they believe the improved processes will actually yield better governance (authority structures that yield greater capabilities). I am happy when I hear people make this argument, but we need to make sure the arguments are made. We can't just take a 'Field of Dreams' argument--build the new formal systems and the users will come.  Few institutionalists believe that rules of the game change in this way: Actually, most believe that change is driven by adjustments in norms and cultural cognitive dimensions (the base of the iceberg I spoke about a few weeks  ago).

Given this, I speak of focusing on outputs and outcomes. If we see actual changes on the ground, then there is a chance that norms and cultural cognitive schematics are being shifted. It is also why I speak about focusing on expanded interaction and participation: the more people engage, the more they get to see the ambiguity of their systems, and imagine new ways of engaging, which can foster new ways of seeing.

Here are some ideas I would have for output indicators related to the input indicators above:

• Instead of how many days does it formally take to get a driver's license, let us use measures of the saftey of a country's streets (how many accidents per 1,000 cars? how many pedestrians are killed per year?).
• Instead of measures of the number of days it takes to start a business, how about asking about the number of new businesses showing profit three years after opening doors.
• Instead of asking about whether countries have competitive procurement regimes, why not ask about the number of new firms who successfully carried out government contracts in the past year (under the argument that more firms suggests more participation, competition, etc.).

I understand that these measures are not all available. I'm trying to think of measures that would capture what I think is a product of governance that makes countries function better, however. The other process measures may in fact be means to achieving some of these goals, but they may also not be the starting measures, and are almost guaranteed not to be sufficient measures (new procurement rules does not mean new vendors capable of competing). Focusing on the outputs and outcomes causes us all to pay more attention to the complexities of the problems, and emphasis on the real things we care about.

If we are going to have governance represented in the post-MDG measures, we must have these kind of capability-enhancing measures. Or we should not have measures at all. First, do no harm.

Governance indicators revisited

Alan Hudson at ONE has been jogging my brain about governance indicators again. We have been trying to talk about the issue but connections are hard when everyone is moving around. So, I thought it might be best to re-ignite the conversation here in blog-space.

A while back I wrote a series of posts on indicators, and Alan and others engaged in the discussion. If you click on the  category links you will see these engagements.  I have been thinking a lot about the issue in recent days, particularly as various people note that some kind of indicator will probably be included in the post-MDG development indicators.

In offering some thoughts on this, let me start by defining what I understand as governance: the way authority is  exercised in society/sector/organization. When we refer to this in a development sense we are usually thinking about democratic governance and/or administrative governance by governments.

Given these starting points, it is important to point out that any use of the term 'good governance' introduces a normative, value laden perspective into the discussion. And it is here that we need to start being really careful. Because we are developing indicators for a broad swathe of countries in very different situations and with different histories, we need to be clear that the norms we introduce are generally applicable and are useful to use in comparing different places.

Further, given that we hope to use indicators to push countries in specific directions, we need to ensure that we think all countries can go there and that it is a generally useful direction. In this sense I want to emphasize the distinction between form and function and the observations in recent work (see Looking Like a State) that indicator-based reform agendas foster changes in form that often do not equate with improved functionality. Indeed, "Looking Like a State" argues that indicator-based reforms often promote signaling that crowds out reforms promoting improved functionality.

So: What is there we can measure that relates to the way authority is exercised, by government, that is broadly relevant across highly different developing countries, that does not impose too rigid a 'form' based agenda, and may even promote more functionality and development?

Whew. That was a long sentence. And it is a tall order. I'm still not convinced we can get there, and worry that any measure will promote signaling, be biased against some places, and impose some set of not-so-useful norms on some countries.

But here are some starting ideas:

• Outcomes: First thing anyone who has read my work will know is that I think governance is best assessed on the basis of outcomes. The Vietnamese government has done something right in ensuring that more children live past age five than was the case a few decades back. I call this improved governance, given that the improved outcome suggests that a system of players has taken the authority given to them and organized social abilities and political influence to perform better. If people feel safer in Kenya in a decade I will say that authority is being better used to deliver a key public good. Note that I am not focusing on the processes by which these outcomes occur, partly because I think there are many ways to govern and produce results and relevant solutions depend on contextual realities.
  • The challenge here is thinking about which outcomes we might say are generally relevant in development...and which ones are about form and not function...and which ones are not already in the MDGs. The question I ask in answering this is simple: What are the major problems that hinder development that are about the way authorizing structures function and that don't yet feature in the MDGs?
  • Also, it is important to think about the potential that one or other outcome focus might produce incentives to adopt particularly heinous processes (I don't think we should focus on processes in these indicators but I don't think all processes are equal or that good ends justify all means).
  
• Key outputs: We can't always measure outcomes given timing issues and other factors. But we can measure outputs with more certainty. Outputs can have some of the functional characteristics of an outcome as well (where processes are more like form). The key thing is to think about the outputs we measure and ensure that they relate to the outcomes we care about.

Some specific ideas, where I will betray my normative views on development (and depending on your response, you should think about your own biases as well):

• I propose looking at outcomes that speak to social, political and economic participation.  I am sold on the idea that development demands adaptive change in response to complex problems. I am also convinced that one of the reasons this adaptation is not observed enough (and hence developing countries are struggling to survive) is that the states are not fostering enough engagement in the face of the complexity they face. I thus believe that any 'good governance' is one in which authority mechanisms are used to foster interaction and engagement across society, that pushes for creative problem solving, and that supports participation.
  • I will propose a few measures of this, without going into the drawbacks or details of each here (as I only have a few more minutes to write...we can argue about the ideas as they emerge): Labor force participation and employment (assuming that the more people who participate, the better); Civic engagement in political processes; Child survival rates (the more there are, the more to engage); Some measures of social mobility (people moving around the country and people moving in and out of the country); new products emerging (or new exports produced).

• I propose looking at outputs that also speak to social, political and economic participation.  Some of these outcome measures are not available, but we can look at outputs that lead to the outcomes. My argument is that countries producing these outputs have a beetrr chance of fostering interactions that generate creative responses to complex problems.
  • Here are a few measures of this, again without going into the drawbacks or details of each here: Measures of public and private sector transparency (arguing that information sharing fosters interaction, which fosters creativity and complexity); Birth registration stats (given that social, political and economic engagement is undermined where people are not registered); Measures of complexity in public and private sector governing structures (variation in composition of boards, cabinets, etc.); Education participation by girls and minorities (assuming that more girls and minorities leads to more variation). More to be added.

Note my bias toards creative governance, as opposed to a defensive stance that promotes 'accountability' promoting processes. I don't think many of the 'accountability enhancing' processes in current indicators actually promote accountability in many developing countries (because they are regulative interventions without normative and cultural-cognitive foundations...which are required to make icebergs stand...see former posts). I also think social, political and economic accountability mechanisms need to develop endogenously as the society emerges. The key is to foster emergence and adaptation, which requires shifting authorizing mechansims (aka governance structures) towards fostering open engagement.

I realize this has its own normative problems in some places, where the idea of openness and participation and engagement is difficult because societies are closed and/or participation is limited by culture or other factors. I would argue that these countries are equally affected by the implications of fitness, and that the failure to promote complexity will undermine fitness and harm survival of these countries. So, I understand that there are some places where this idea may be met uncomfortably...but I don't think it is not broadly applicable to all countries.

I would, however, suggest that we should be aware of where countries start in measuring these things: For instance, instead of measuring Ethiopia's birth registration rate...let's ask about the improvement in the rate relative to a starting point or relative to an equivalent country (accepting that the idea of  'equivalent' is also variable). Let's make the indicators sensitive to the iterative nature of change; if a country is still at a low level but it is improving gradually, that surely is good governance?

I also realize that the assumption here is that governments can promote complexity, in all contexts. I think this is a fine assumption, in that I think governments control many rules that impact how people interact politically, economically and socially. I am hesitant to prescribe which rules would be good ones to change, however, as I think the space for change is different in different places.

These are my thoughts on what I think is a really tough topic. I want to emphasize that this kind of approach to governance indicators would, I think, be really different to that of the past. I also want to emphasize that the discussion is intended to provoke response...not as any prescription.

Looking Like a State

I am back from Mozambique now and will blog more about the work there in coming months. In the meantime, the Kennedy School just launched an interview I did in support of our article "Looking Like a State". http://www.hks.harvard.edu/news-events/news/articles/looking-like-a-state

The interview picks up on some of the important ideas we are toying with in the Building State Capability program at the Center for International Development. These include:

• Many developing country governments do what they are advised to do..and end up looking better...but are not better. The new forms they adopt do not yield more functionality.
• The forms that developing countries are encouraged to adopt come from more developed countries, where they are seen to foster functional states.
• The lessons we need to learn are not what the developed countries did, but rather how they did these things. The process of change--and adaptation capability--is what needs to be transported to developing countries.

As an example, many countries were encouraged to adopt Swedish style public budgeting mechanisms in the past fifteen years. Really smart people have made great presentations on  the whatof these reforms (like the shape of fiscal rules in recent IMF documents and government presentations http://www.imf.org/external/pubs/ft/wp/2012/wp12187.pdf ; http://www.rgs.mef.gov.it/_Documenti/VERSIONE-I/RGS-comuni/Eventi/WORKSHOP--2/Bergvall---Svezia.pdf).  There is very little work on howthese rules came to be, however, even though the story of the evolution of Public Financial Management reforms in Sweden holds many secrets about why this kind of change heppens, how it emerges, and what kinds of conditions make it possible.

If one starts to look at this evolution, a few key observations can be made. See a bunch of references...

• http://books.google.com/books/about/Proposal_for_a_reform_of_the_Swedish_bud.html?id=1wwmAQAAMAAJ ;
• http://www.ingentaconnect.com/content/mcb/042/1995/00000008/00000002/art00003;
• http://books.google.com/books/about/Controlling_Public_Expenditure.html?id=HTcICDVoaOUC; http://books.google.com/books?id=K6nPva2piB4C&source=gbs_similarbooks).

 First, reforms began way back  (like in the 1950s...)

Second, reforms emerged largely in response to particular problems (like the need for costing specific expenditures in the 1960s, and the need to get a medium term policy view in the 1980s, and the need to bring spending down in the 1990s)

Third, reform teams emerged in all these periods and spent a number of years just constructing the problems so that they could make a case for reform (in the 1990s, for instance, the teams used data from von Hagen's work to show that Sweden's budget system was weak and convince broad groups that these weaknesses were a primary reason for the crisis).

Fourth, reform teams tended to draw on ideas from a variety of sources in all periods--including international practices like US program budgeting in the 1960s, and new Zealand fiscal rules in the 1990s). They did not jump on any one idea, however, but pursued incremental processes of finding and fitting the right models to their context. This generally involved experimentation (through strategies like piloting). In these processes, the reformers built capacity to do reform and political will and support for reform (that were not sufficient at the start of the interventions).

Fifth, the final reform forms were hybrids--blended products of external and internal ideas, shaped by the capacities and needs of the context--and were chosen because they functioned to solve problems (not because they were pure form best practices).

Sweden does not just look like a state. It is a state. Partly because its structures have emerged to make it functional. The process of emergence is what developing countries really need to learn about.

Building State Capability in Mozambique's Judicial Sector

I have been in Mozambique over the past week, in an exercise related to the Harvard Building State Capability (BCS) initiative. One of my focal points has been the Judicial sector, where the government is pursuing exciting initiatives that could enhance their capability to function.

First, the government is focused on developing a database in which they have information about all their cases -- at court house level -- with data about judges, buildings, expenditures and other inputs. The idea is to see the relationships between inputs and results...with a goal of budgeting with more strategic information, the Minister having an information dashboard, etc.

This is a big deal. The government has been trying to develop a 'best practice' case management system for over a decade--with no functionality of the system. So, getting a functional system will be pretty amazing, and the government aims to do some basics within eight months. Wow. This could really change the way Mozambique's judicial sector works. 

Today I saw the Minsiter, Deputy Minister, Permanent Secretary and other senior officials to discuss this (see photo below, bad quality from my blackberry but what great people they are). The group agreed to go 'poco a poco' (little by little). In the language of PDIA, this is like saying 'step by step'. The first step is set for completion on November 1... and then we will all convene to see what was learned and what is next.

The Minister is third from left. She is also a graduate of the Leaders in Development program at Harvard.

We also discussed plans to build two new courthouses in the districts. This does not sound like much, but only 3 new court houses have been built in the past 5 years. Imagine if 2 get built next year, and 2 in the year after, and 2 in the year after. This is how you build the know-how and capability necessary to make justice work for all.

The challenge is,  again, complex--mostly because of the many players involved in the health sector. Right now the government is being ably supported by the World Bank who are using an innovative results based mechanism to inspire results. Government is also being supported by DANIDA.

But again, this is a 'poco a poco' process. I intend to tell you how it goes month by month.

Harvard's public financial management executive education course, and the Swedish case of reform

In January, we will be starting a new executive education program at the Kennedy School.

It focuses on public financial management reform. It does not address 'what' to do in these reforms, however. I think we have many great answers to the 'what' question.  Instead, it focuses on 'how'. This is the big question in many countries:

• How do we find the right solution?
• How do we implement it?
•  How do we sustain it?

We plan on taking these questions seriously for a week of intense engagement with people from all over the world. We will be asking about ways in which reformers can: (i) get in front of contextual complexities that often undermine reforms (the icebergs I speak of in prior postings),  (ii) find and fit solutions that match their context (being politically acceptable and practically possible), and (iii) engage distributed agents across government to make reforms work.

In addressing these questions, we will also be asking about things like sequencing (what should be done first, second, etc.) and about which best practices on should learn from (and how one should learn).

We are trying to make this as practical and rigorous as possible. In this light, we will be drawing from a number of reform cases that shed light on how to make public financial management systems more functional.

The Swedish case

I am preparing the material in regard to Sweden's 1990s reforms right now. While not a developing country, the process by which Sweden reformed since the mid-1990s  is really interesting, and relevant for all countries. We will be discussing it in detail in January, but I thought it might be interesting to throw some material out here.

For some background, consider the following work, that relects on a reform that took a country from high debt, fiscal distress, and major government failure to sustained surplus, fiscal stability and effective government in under a decade.

Wow.

http://193.200.113.93/fileadmin/jvi_files/DG_ECFIN_Conference/Per_Molander_2.pdf

http://blog-pfm.imf.org/files/molander-2001.pdf

http://www.clevelandfed.org/research/policydis/pdp21.pdf

Here also, see Goran Persson -- former Prime Minister -- talking about the lessons of Sweden's reform for current European countries. Note how he does not speak as much about the technical 'what' about the reforms...but rather he focuses on the contextual factors that provoke reform, and the way in which leaders should engage with contexts to make change happen.

http://www.youtube.com/watch?v=TTeQjwao7nA

We will build on this kind of example in January to discuss the way in which problems (crises and even slowly developing disturbances) create space for change. The questions we will address include: What problems do you have? How can you construct these problems to get attention and buy-in needed for change? How can you use the problems as the entry point to overcome contextual constraints (political and otherwise)?

Sweden did it. So can the United States--and Uganda--and Colombia--and Vietnam--and Cambodia--and the Solomon Islands--and your country.

I would love to hear any thoughts you have about the Swedish reforms as you read the material and listen to the audio.