Working Paper 82 - Public Sector Management in Africa

Even though the public sector in African countries was expected to spearhead socioeconomicdevelopment to reduce poverty, it has proved largely ineffective in performingthis task. Some of the reasons for this ineffectiveness are excessive politicization, lack ofaccountability and representation, inability to promote the public interest andauthoritarian tendencies. The ineffectiveness has led to the call for a redefinition of therole of the public sector. As a contribution to the debate over the proper role of the publicsector and how it has coped with the New Public Management reforms, this paperassesses the state of public sector management in Africa by focusing specifically on thestrengths and challenges facing the state and its bureaucracy in relation to socioeconomicdevelopment and how the challenges can be addressed.Some of the issues the paper examines include:• the existing and/or evolving theoretical paradigms and their relevance to thepublic sector management;• the inability of the African state to promote development in comparison to theAsian “developmental” state;• various public sector reforms (civil service, decentralization, privatization,deregulation, co-production, public-private partnerships, judicial, tax) initiated toimprove state capacity and their outcomes;• the effectiveness of strategies implemented to promote accountability andminimize corruption; and• the issues and problems in aid management and coordination in Africa.In addition to these issues, the paper also highlights possible policy options for the futureand their relevance in addressing the challenges facing public sector management.

Ghana continues to be a beacon for democracy in Africa

Joseph Atsu Ayee provides a comprehensive overview of the 2016 elections in Ghana

The National Electoral Commission is under scrutiny ahead of #GhanaDecides 2016

Joseph Atsu Ayee examines the challenges facing the Ghana Electoral Commission in what could be pivotal elections for the West African country

"Toilet wars" : urban sanitation services and the politics of public-private partnerships in Ghana

There is a continuing debate over the value of public-partnerships in providing public services in poor urban areas. Many policy-makers in the developing countries have been persuaded that the main problem with established direct public service provision lies in principal-agent problems, i.e. the alleged lack of incentive for regularly-employed public servants to provide a good service. They have therefore sought to involve local communities, citizens and the private sector more directly in the management of services. This paper examines the impact of the new forms of partnership between the public authorities and private/citizen-based organisations on urban environmental sanitation in the two largest cities of Ghana – Accra and Kumasi. It traces the history of public toilet policies in the two cities and analyses the factors that contributed to their relative failure in poor neighbourhoods. Toilets consistently have been poorly managed and have been the site of local political conflicts – toilet wars – despite efforts at franchising them and involving communities in their management. This is attributable to the politics of patronage at the urban level, the relationship between city government patronage and community level groups, and the failure of regulation. Public-private partnerships have not worked. The provision of reasonable sanitation facilities may require: full public provision of basic infrastructure; transparent, independent and rigorous regulation of any contracts for service provision given to non-state agencies; and the enforcement of “conflict of interest” laws applying to elected local representatives

Social inclusion and service delivery in a fragile and post-conflict environment in Africa

The post-colonial state in Africa has attracted great interest from scholars and development partners because of the recognition that no development can take place without a proper functioning state. The state is expected to provide and deliver goods and services to its citizens in order to promote its legitimacy before its citizens. However, in fragile or post-conflict states, the capacity of the state to deliver services to all citizens is not possible because of weak infrastructure, weak public service delivery and weak state institutions which lack the capacity to deliver service and thereby become illegitimate. This has led to the increasing recognition that service delivery interventions or initiatives in fragile states should aim to ameliorate the negative effects of social exclusion of marginalized and vulnerable groups. Against this backdrop, this paper discusses how social inclusion can be promoted and improved by service delivery in fragile states in Africa in the light of the fact that their different contextual variables (such as history, politics, culture and geographical location) affect their ability to develop their capacity to deliver services to their citizens. In other words, why is social exclusion in service delivery in fragile states challenging and what are the reasons for it? The paper shows that a combination of the inability of fragile states to perform their governance functions as a result of their peculiar circumstances and the adoption of the “one-size-fits-all” strategies to deliver services have largely contributed to social exclusion in service delivery. It ends with some policy recommendations. KEY WORDS: social inclusion; service delivery; state legitimacy and fragility; state capacity; fragile/post-conflict countries; governance functions; Africa

Les Sociétés Civiles du Sud: Un état des Lieux Dans Trois Pays de la Zsp, Cameroun, Ghana, Maroc

The report challenges this culturalist approach to civil society. It defends a dynamic notion of civil society in the Southern countries, free from cultural preconceptions

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Reforming the African Public Sector : Retrospect and Prospects

Reforming the African Public Sector: Retrospect and Prospectsis an in-depth and wide-ranging review of the available literature on African public sector reforms. It illustrates several differing country experiences to buttress the main observations and conclusions. It adopts a structural/institutional approach which underpins most of the reform efforts on the continent. To contextualize reform of the public sector and understand its processes, dynamics and intricacies, the book examines the state and state capacity building in Africa, especially when there can be no state without an efficient public sector. In addition, the book addresses a number of theories such as the new institutional economics, public choice and new public management, which have in one way or another influenced most of the initiatives implemented under public sector reform in Africa. There is also a survey of the three phases of public sector reform which have emerged and the balance sheet of reform strategies, namely, decentralization, privatization, deregulation, agencification, co-production and public-private partnerships. It concludes by identifying possible alternative approaches such as developing a vigorous public sector ethos and sustained capacity building to promote and enhance the renewal and reconstruction of the African public sector within the context of the New Partnerships for Africa's Development (NEPAD), good governance and the Millennium Development Goals (MDGs)

Civil Service Reform in Ghana: A Case Study of Contemporary Reform Problems in Africa

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