Taryn Vian and William Bicknell from Boston University recently published and article called Good Governance and Budget Reform in Lesotho Public Hospitals: Performance, Root Causes, and Reality (Pre publication version is available at http://www.u4.no/recommended-reading/good-governance-and-budget-reform-in-lesotho-public-hospitals-performance-root-causes-and-reality/downloadasset/3141).
In the article they assess the detailed form and basic functionality of the reform, using the following table. This is an application of an evaluation method I proposed in 2006 and is the kind of mechanism that all reformers should use when introducing complex interventions. Notice the form- function gap that is evident in results:
* plans and budgets kind of exist in form
* data collection and reporting mechanisms needed to make the plans and budgets matter don't really exist
* no one uses the new reforms.
Great work and what I think should be a pathbreaking study on evaluating reforms in developing countries.
Table 3: Reform Implementation Progress, Case Study Hospitals
| Dimension/ Measure | Hospital | Average | |||
| A | B | C | D | ||
| Dimension 1: Evidence that Performance Plans Exist | |||||
| Availability of plan | ●● | ●● | ●● | ●● | Modest |
| Organization of plan | ● | ●● | ●● | ●● | Modest |
| Accountability structure | ●●● | ●● | ●● | ●● | Modest |
| Defined activities/outputs | ● | ●● | ●● | ● | Modest to little |
| Participation | ●● | ● | ●● | ● | Modest to little |
| Baseline data | ○ | ○ | ○ | ○ | None |
| Institutionalization | ○ | ○ | ○ | ○ | None |
| Acceptance | ● | ○ | ● | ○ | Little to none |
| Dimension 2: Evidence that Performance-based Budgets Exist | |||||
| Availability of budget | ●● | ● | ●● | ●● | Modest |
| Organization of budget | ● | ●● | ●● | ●● | Modest |
| Output/activity costing | ○ | ● | ● | ○ | Little to none |
| Institutionalization | ○ | ○ | ○ | ○ | None |
| Acceptance | ○ | ○ | ○ | ○ | None |
| Dimension 3: Evidence of Performance Monitoring & Reporting | |||||
| Data systems oriented to PBB | ● | ● | ○ | ● | Little |
| Performance reporting | ●● | ○ | ○ | ● | Little |
| Financial reporting | ○ | ○ | ○ | ○ | None |
| Dimension 4: Evidence that Performance Information is Used | |||||
| ...To make or change work plans | ● | ○ | ○ | ● | Little to none |
| ...To develop budgets | ● | ○ | ○ | ○ | Little to none |
| ...To monitor efficiency and effectiveness | ○ | ○ | ○ | ○ | None |
| ...To communicate within hierarchy (internal accountability) | ○ | ○ | ○ | ○ | None |
| ...To communicate to the public (external accountability) | ○ | ○ | ○ | ○ | None |
Key: ○ = no progress; ● = little progress; ●● = modest progress; ●●● = strong progress. Refer to Table 5 for criteria used to evaluate.
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