Performance-Based Financing: Report on Feasibility and Implementation Options Final September 2007

This study examines the feasibility of introducing a performance-related bonus scheme in the health sector. After describing the Tanzania health context, we define “Performance-Based Financing”, examine its rationale and review the evidence on its effectiveness. The following sections systematically assess the potential for applying the scheme in Tanzania. On the basis of risks and concerns identified, detailed design options and recommendations are set out. The report concludes with a (preliminary) indication of the costs of such a scheme and recommends a way forward for implementation. We prefer the name “Payment for Performance” or “P4P”. This is because what is envisaged is a bonus payment that is earned by meeting performance targets1. The dominant financing for health care delivery would remain grant-based as at present. There is a strong case for introducing P4P. Its main purpose will be to motivate front-line health workers to improve service delivery performance. In recent years, funding for council health services has increased dramatically, without a commensurate increase in health service output. The need to tighten focus on results is widely acknowledged. So too is the need to hold health providers more accountable for performance at all levels, form the local to the national. P4P is expected to encourage CHMTs and health facilities to “manage by results”; to identify and address local constraints, and to find innovative ways to raise productivity and reach under-served groups. As well as leveraging more effective use of all resources, P4P will provide a powerful incentive at all levels to make sure that HMIS information is complete, accurate and timely. It is expected to enhance accountability between health facilities and their managers / governing committees as well as between the Council Health Department and the Local Government Authority. Better performance-monitoring will enable the national level to track aggregate progress against goals and will assist in identifying under-performers requiring remedial action. We recommend a P4P scheme that provides a monetary team bonus, dependent on a whole facility reaching facility-specific service delivery targets. The bonus would be paid quarterly and shared equally among health staff. It should target all government health facilities at the council level, and should also reward the CHMT for “whole council” performance. All participating facilities/councils are therefore rewarded for improvement rather than absolute levels of performance. Performance indicators should not number more than 10, should represent a “balanced score card” of basic health service delivery, should present no risk of “perverse incentive” and should be readily measurable. The same set of indicators should be used by all. CHMTs would assist facilities in setting targets and monitoring performance. RHMTs would play a similar role with respect to CHMTs. The Council Health Administration would provide a “check and balance” to avoid target manipulation and verify bonus payments due. The major constraint on feasibility is the poor state of health information. Our study confirmed the findings of previous ones, observing substantial omission and error in reports from facilities to CHMTs. We endorse the conclusion of previous reviewers that the main problem lies not with HMIS design, but with its functioning. We advocate a particular focus on empowering and enabling the use of information for management by facilities and CHMTs. We anticipate that P4P, combined with a major effort in HMIS capacity building – at the facility and council level – will deliver dramatic improvements in data quality and completeness. We recommend that the first wave of participating councils are selected on the basis that they can first demonstrate robust and accurate data. We anticipate that P4P for facilities will not deliver the desired benefits unless they have a greater degree of control to solve their own problems. We therefore propose - as a prior and essential condition – the introduction of petty cash imprests for all health facilities. We believe that such a measure would bring major benefits even to facilities that have not yet started P4P. It should also empower Health Facility Committees to play a more meaningful role in health service governance at the local level. We recommend to Government that P4P bonuses, as described here, are implemented across Mainland Tanzania on a phased basis. The main constraint on the pace of roll-out is the time required to bring information systems up to standard. Councils that are not yet ready to institute P4P should get an equivalent amount of money – to be used as general revenue to finance their comprehensive council health plans. We also recommend that up-to-date reporting on performance against service delivery indicators is made a mandatory requirement for all councils and is also agreed as a standard requirement for the Joint Annual Health Sector Review. P4P can also be applied on the “demand-side” – for example to encourage women to present in case of obstetric emergencies. There is a strong empirical evidence base from other countries to demonstrate that such incentives can work. We recommend a separate policy decision on whether or not to introduce demand-side incentives. In our view, they are sufficiently promising to be tried out on an experimental basis. When taken to national scale (all councils, excepting higher level hospitals), the scheme would require annual budgetary provision of about 6 billion shillings for bonus payments. This is equivalent to 1% of the national health budget, or about 3% of budgetary resources for health at the council level. We anticipate that design and implementation costs would amount to about 5 billion shillings over 5 years – the majority of this being devoted to HMIS strengthening at the facility level across the whole country

Crowdsourcing geospatial data for Earth and human observations: a review

The transformation from authoritative to user-generated data landscapes has garnered considerable attention, notably with the proliferation of crowdsourced geospatial data. Facilitated by advancements in digital technology and high-speed communication, this paradigm shift has democratized data collection, obliterating traditional barriers between data producers and users. While previous literature has compartmentalized this subject into distinct platforms and application domains, this review offers a holistic examination of crowdsourced geospatial data. Employing a narrative review approach due to the interdisciplinary nature of the topic, we investigate both human and Earth observations through crowdsourced initiatives. This review categorizes the diverse applications of these data and rigorously examines specific platforms and paradigms pertinent to data collection. Furthermore, it addresses salient challenges, encompassing data quality, inherent biases, and ethical dimensions. We contend that this thorough analysis will serve as an invaluable scholarly resource, encapsulating the current state-of-the-art in crowdsourced geospatial data, and offering strategic directions for future interdisciplinary research and applications across various sectors

Incorporating stakeholders in policy assessment: Generating a framework for system analysis and data driven policy making

In this thesis, we explore the use of social media in assisting in decision making and present a case study of the development and implementation of an open data framework in a small organization. We analyze the role of social media data for providing policy insight and prioritization of initiatives among citizens in particular we explore the sentiment analysis application in data mining in twitter. Data related to poverty and basic income was collected for 24 days in 2019, cleaned and prepared for natural language processing. A subset of the data was manually labeled for sentiment analysis in order to inform and train the AI. This analysis of public opinion on poverty is situated within the sustainable development goals and support for poverty reduction policies. We also explore the case of study of the district of Squamish in the development and application of an open data framework aligned to the strategic values and with a look into the continuous improvement and correct documentation of the system. We develop a policy, guidelines and framework tailored to this organization with small communities in mind. We use the open data case of study of Squamish as a model for the framework, we feed the framework with information based on the strategic direction and meeting with the district working group to better direct the development and application. We finally explore a joint solution for the progress of equality policies and targeted governmental initiatives while exploring the interactions of external and internal stakeholders. We present the social media case as a component to support the overall framework and to empower citizen with valuable data and potential for information analysis for other stakeholders

The Global Risks Report 2016, 11th Edition

Now in its 11th edition, The Global Risks Report 2016 draws attention to ways that global risks could evolve and interact in the next decade. The year 2016 marks a forceful departure from past findings, as the risks about which the Report has been warning over the past decade are starting to manifest themselves in new, sometimes unexpected ways and harm people, institutions and economies. Warming climate is likely to raise this year's temperature to 1° Celsius above the pre-industrial era, 60 million people, equivalent to the world's 24th largest country and largest number in recent history, are forcibly displaced, and crimes in cyberspace cost the global economy an estimated US$445 billion, higher than many economies' national incomes. In this context, the Reportcalls for action to build resilience – the "resilience imperative" – and identifies practical examples of how it could be done.The Report also steps back and explores how emerging global risks and major trends, such as climate change, the rise of cyber dependence and income and wealth disparity are impacting already-strained societies by highlighting three clusters of risks as Risks in Focus. As resilience building is helped by the ability to analyse global risks from the perspective of specific stakeholders, the Report also analyses the significance of global risks to the business community at a regional and country-level

The implementation and sustainability of pro-poor local economic development initiatives in the King Cetshwayo district municipality.

Doctoral Degree. University of KwaZulu-Natal, Durban.The main aim of the study was to critically explore the implementation and sustainability of pro-poor Local Economic Development in the KCD municipality. The secondary objective of the study was to determine how the implementation and sustainability of LED initiatives are organised, assessed, strategized and reviewed in the KCD. The implementation of economic development policies seemed to be a persistent problem hindering Local Economic Development (LED) in South Africa. Local government is a sphere of government that is closest to local communities and is so placed to identify, drive and implement programmes aimed at addressing unemployment, poverty alleviation and developmental challenges facing local communities in South Africa. The King Cetshwayo District (KCD) is not excluded from these challenges, which include the challenges of stimulating pro-poor LED by creating jobs and promoting the growth of small and medium business enterprises (SMMEs). The need to address poverty and unemployment is one of the most critical issues in this municipality. This research study was founded on the theoretical framework of the World Bank Local Economic Development model that involves several stages of LED strategic planning. A qualitative approach was adopted whereby eight in-depth interviews were conducted to interview municipal officials which included the mayor, the municipal manager and LED officials in two local municipalities in the KCD. The study further conducted 14 focus group discussions with community members which included co-operatives. Thematic analysis through an interpretive approach was used to analyse and present data for this study. The findings have shown that LED in the KCD is conceptualised generally as a form of partnership or coalition undertaken between the key players in a local municipality and involves the development of partnerships between the private sector, government and civil society. Moreover, the Richards Bay Industrial Development Zone (RBIDZ) together with other stakeholders, including the municipality, have put measures in place to assist SMMEs to benefit from the RBIDZ activities. LED initiatives in the uMhlathuze local municipality are intended to stimulate both the enhanced growth of the local economy (pro-growth) and to address concerns of persistent poverty (pro-poor). The study also noted that both local municipalities have adopted the LED strategy but they are not sufficiently guided by the strategy to respond to the people’s needs. Pro-poor LED initiatives allow community members to showcase their skills and their desires and at the same time they can earn a living. Both municipalities are, however, not adequately monitoring and reviewing the LED strategies and initiatives, hence most of the pro-poor LED initiatives in the KCD are not sustainable. From the discussion of the findings the study concluded that LED initiatives that are established in different communities, particularly the KCDM, lack uniqueness and face stiff competition. There is also a lack of skills to manage LED initiatives, a lack of knowledge about the processes and the procedures of implementing and sustaining pro-poor LED initiatives. Moreover, there is inadequate funding to facilitate and implement LED and there is a need to involve the people from the planning stage and a request for more community participation

An Analysis of the role of governance on effective programme management - A case of Namibia Mass Housing Development Programme Management - A case of Namibia Mass Housing Development Programme

Namibia has been praised for having rigorous policy frameworks that address various national development challenges. Over the years, the country has introduced various policy initiatives to address the housing challenge in the country. However, implementation of such policies and programmes faced various challenges resulting in suboptimal outcomes and consequently, a situation where such programmes are abandoned, and new ones are introduced with little learning from past experiences. This paper, analysed the role of governance on effective programme management using a case study of Namibia’s Mass Housing Development Programme. The findings highlight governance challenges, as one of the key contributing factors to failing programmes. A qualitative approach was employed in gathering data using face to face in-depth interviews with the informants who represented the target population in the study. The paper contributes to the body of knowledge on the importance of governance which public policy and programme makers can draw lessons from for effective programme implementation

The Implementation of Governance to Counter Islamist Militancy in Pakistan\u27s Khyber-Pakhtunkhwa Province

Militancy inspired by Islamists is escalating globally, and government action is necessary to protect vulnerable populations. Security professionals generally agree that governance may complement the use of force to defeat militants; however, current doctrine does not address the concurrent integration of governance in a comprehensive strategy. This interpretive case study explored Pakistan\u27s application of governance during the 2009 Khyber operation in Swat Valley, code-named Operation Rah-e-Rast. The central research question focused on how governance activities were integrated with military operations to subdue militancy. Data were collected through interviews with 6 planners, Pakistani secondary source survey data, and government artifacts. Data were inductively coded using a progressive axial coding process and validated through methodological triangulation. Data were then analyzed using a case study analytical model, grounded in neo-Clausewitzian theoretical principles, to derive key themes. Key findings indicate that an interministry collaborative approach to regain the public trust was more effective in placating violence than was solely using military action. Sound governance, enabled by strategic communications and intelligence, fostered tribal relationships that promoted confidence and undermined the militant support base. The civil-military planning protocols were successful, but mainly ad-hoc and suboptimized. Formal training, standing civil-military planning forums, and planning process improvements stemming from the Pakistan experience could instill social change by assisting national leaders in developing a cogent countermilitancy strategy to defeat the global Islamist movement