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

The implementation of a decentralization policy officially adopted will require the establishment of a decentralized governance strategy supported by an appropriate programme of actions. The government will create an enabling environment for the policy implementation, including the human, material, and financial capacities to carry out this policy. Implementation is a critical juncture of the decentralization process where lack of strong political, administrative (bureaucratic) and social will as well as lack of strong leadership commitment can derail the process. Mechanisms, institutional arrangements, and management systems and tools including capable human resources, logistics and appropriate financial resources should be satisfactorily functional. When a decentralization policy is in on force in a country, decentralized governance will consist first and foremost in establishing functional mechanisms according to the law and to be applied nation wide. These mechanisms encompass (i)administrative local structure including the leadership deemed necessary for its functioning, (ii)the planning and updating regulatory framework, (iii)Human resource management in conjunction with the national development, (iv)financing schemes including fiscal decentralization and funding sources, (v)decentralized cooperation leading to partnerships and resources 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 and economical context. The different cases below outline how diverse the choices are considering each country. What makes the administrative local structure more challenging in decentralized governance is the leadership system attached to it including the way local authorities and leaders are determined (preferably via “Elections”) and how the local governments will be run. France Case The 22 regions and 96 departments of metropolitan France include Corsica. Paris area is expanded. France is divided into 26 administrative regions. 22 are in metropolitan France (21 are on the continental part of metropolitan France; one is the territorial collectivity of Corsica) , and four are overseas regions. The regions are further subdivided into 100 departments which are numbered (mainly alphabetically). This number is used in postal codes and vehicle number plates amongst others. Four of these departments are found in the overseas regions and are simultaneously overseas regions and overseas departments and are an integral part of France (and the European Union) and thus enjoy a status similar to metropolitan departments. The 100 departments are subdivided into 341 arrondissements which are, in turn, subdivided into 4,032 cantons. These cantons are then divided into 36,680 communes, which are municipalities with an elected municipal council. There also exist 2,588 intercommunal entities grouping 33,414 of the

36,680 communes (i.e. 91.1% of all the communes). Three communes, Paris, Lyon and Marseille 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 and cantons 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 by the Four Republic in 1946. Historically, the cantons were also territorial collectivities with their elected assemblies. In addition to the 26 regions and 100 departments, the French Republic also has six overseas collectivities, one sui generis collectivity (New Caledonia) , and one overseas territory. Overseas collectivities and territories form part of the French Republic, but do not form part of the European Union or its fiscal area. The Pacific territories continue to use the Pacific franc whose value is linked to that of the euro. In contrast, the four overseas regions used the French franc and now use the euro. France also maintains control over a number of small non-permanently inhabited islands in the Indian Ocean and the Pacific Ocean: Bassas da India, Clipperton Island, Europa Island, 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), Réunion (since 1946). Italy Case Italy is subdivided into 20 regions (regioni, singular regione). Five of these regions have a special autonomous status that enables them to enact legislation on some of their local matters, and are marked by an *. It is further divided into 109 provinces (province) and 8,101 municipalities (comuni). It is further divided into 109 provinces (province) and 8,101 municipalities (comuni). The regions 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/Südtirol* (Trento), Umbria (Perugia), Sicily* (Palermo), Veneto (Venice).

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 unicameral legislature, devolved from the United Kingdom Parliament, which relates specifically to each 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 from Westminster. However, despite being the largest of the United Kingdom's four constituent countries, England, (with the exception of the Greater London Authority), has no devolved executive; it is ruled directly by the UK government. Each nation is further subdivided for the purposes of local government. The Queen appoints a Lord-Lieutenant as her personal representative in lieutenancy areas across the UK; this is little more than a ceremonial role. The following table highlights the arrangements for local government, lieutenancy areas and cities across the home nations:

Constituent Country Population Subdivisions

England 50,431,700 Regions Metropolitan and non-metropolitan counties Lieutenancy areas

Scotland 5,094,800 Council areas Lieutenancy areas

Wales 2,958,600 Unitary authorities Lieutenancy areas

Northern Ireland 1,724,400 Districts Lieutenancy areas

Historically, the four nations were divided into counties as areas for local government administration. Although these are still used to some extent for this purpose and as geographical areas, they are no longer the sole basis for local government administration. 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 unitary authorities, apart from London, which consists of london boroughs. Although at one point it 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 in England; 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 and Guernsey. 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 also not part of the European Union. However, the Parliament of the United Kingdom has the authority to legislate for the dependencies, and the British government manages their foreign affairs and defence.

The UK also has fourteen overseas territories around the world, the last remaining territories of the Brtish Empire. The overseas territories are also not considered part of the UK, but in most cases, the local populations have British citizenship and the right to abode 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 mechanism focusing primarily on development growth and on the way of regulating the commonly used public services or a vital resource such as drinkable water. To be more effective whatever the local entity (local governments, cities, etc.) the planning exercise will be characterized by the following considerations:

(i) Being consistent with the national development pan and policies, (ii) Being fashioned according to the solutions found from the priority needs and problems local communities are experiencing, (iii) Developing peace sensitive, accommodating and participatory approaches that enable greater involvement and engagement of local communities especially marginalized and vulnerable groups, (iv) Matching planned activities with available resources, (v) Access to additional funding and need for partnerships including technical support, (vi) Technology in place and capacity to be developed, (vii) Outlining current identified areas set aside for public good and interests and for 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 translate them into performance indicators to be reviewed during monitoring and evaluation phase.

In addition to planning regulatory frameworks should be outlined for a sound management 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) drainage and public lighting (contributing for more security safety and better running of some services); (e) refuse collection and sewerage; (f) water supply, sanitation and public convenience; (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.

Ethiopia Case http://www.mdpafrica.org.zw/Publications/Ethiopia%20Strategic%20Planning%20Report.pdf Malawi Case http://www.mdpafrica.org.zw/Publications/Strategic%20Planning%20Malawi.pdf Décentralisation et Développement urbain http://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 resources management at national and local levels. Assuming that the civil service is regulating the civil 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 human resources management systems in a decentralization realm. A sound thinking should be made on the following:

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

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

• How to transfer the files and records related to decentralized functions including attached 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 and communication facilities, amenity areas, cultural events, local communities well known for their welcoming tradition, etc..)

The Tanzanian experience below is illustrative in this regard.

Tanzania Experience http://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 Hospitals In line with its Strategic Plan, the Christian Social Services Commission identified an urgent need to address specific constraints adequately in order to prevent further degradation of the health services in the rural areas. The CSSC prioritised in 2005 the development of a Motivation Package (MP) for health workers working in the VA hospitals in the rural areas. Assessment of Health Personnel Management and Cost Recovery Mechanisms Related to Capacity Building in Church Hospitals This study is meant to enable the Christian Social Services Commission to strengthen the coordination of the health personnel hired by church hospitals. On the part of the administration of the hospitals, the study is meant to harmonize the criteria and principles 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 the production of a Health Personnel Management Policy Manual for the church hospitals coordinated by the CSSC. Teaming Up in Tanzania: Supporting the National Response to HIV In [Tanzania’s] response to HIV, the Ministry has deemed its shortfall in human resources for health (HRH) as an emergency. To begin to address this gap, the Ministry is expanding antiretroviral therapy services through an Emergency Hiring Program that will bring 365 new health workers to 25 underserved districts in two phases. The first phase, now underway, will place 176 new hires in 19 districts. Evaluation of Knowledge, Attitudes, and Practices of Health Care Providers toward HIV-Positive Patients in Tanzania This study conducted structured interviews with 204 health care providers in three public hospitals in Dar es Salaam, Tanzania, to evaluate the prevalence of stigma and discrimination among providers toward people living with HIV/AIDS (PLWHAs) and the factors associated with stigmatizing attitudes. Information on HIV/AIDS-related knowledge, perceived risk of infection, willingness to care, and availability of protective gear was also obtained. Assessing the Impact of Educational Intervention for Improving Management of Malaria and Other Childhood Illnesses in Kibaha District Tanzania The study was carried out to evaluate short term effects of one to one educational intervention approach, conducted with 40 drug sellers in order to improve the private sector's practices, compliance and performance in using the national treatment guidelines 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 Challenge: Addressing the Gap in Human Resources for Health The focus of McKinsey’s research effort is on the HRH constraint, faced by many developing countries, in absorbing development aid and scaling up urgently needed health programs. HRH in this context is defined as the health workers at the front line of healthcare service delivery. The field work necessary to diagnose the problem and identify possible solutions has been initiated in Tanzania. We believe these findings,

accounting for certain differences, will be broadly applicable to several developing countries. Infectious Disease Surveillance (IDS) in Tanzania In Tanzania, the PHRplus project developed and tested a set of training materials and tools 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 for district training of trainers, facility training of trainers, district and facility level IDSR training materials and other supporting training tools. Traditional Health Practitioner and the Scientist: Bridging the Gap in Contemporary Health Research in Tanzania Traditional health practitioners (THPs) and their role in traditional medicine health care system are worldwide acknowledged. Trend in the use of Traditional medicine (TRM) and Alternative or Complementary medicine (CAM) is increasing due to epidemics like HIV/AIDS, malaria, tuberculosis and other diseases like cancer. Despite the wide use of TRM, genuine concern from the public and scientists/biomedical heath practitioners (BHP) on efficacy, safety and quality of TRM has been raised. This paper discusses global, regional and national perspectives of TRM development and efforts that have so far been directed towards bridging the gap between THPs and scientist/BHP in contemporary health research in Tanzania. Tumaini Home-Based Care Program: a Case Study This case study was conducted to impart a thorough understanding of the Tumaini Home-Based Care Program model and to document lessons learned that could be applied to other initiatives. While the Tumaini program addresses the needs of both people living with HIV and AIDS (PLHA) as well as OVC, the case study focuses particular attention on specific services and program impact for OVC. The program goals were 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 provide sustainable HBC services. Motivating Tanzanian Primary Health Care Workers While decent salaries for health workers are important, other issues also matter if workers are to remain motivated. The study recommends that health workers: are properly supervised and supported. Supervisors will need to be trained to do their job effectively; have their work assessed and receive regular feedback; and are given a clear career structure with straightforward procedures for promotion. Recognition of High Risk Pregnancies and Referral Practices Among Traditional Birth Attendants in Mkuranga District, Coast Region, Tanzania A cross-sectional study was carried out in Mkuranga District of Tanzania with the aim of comparing the ability of trained and untrained traditional birth attendants (TBAs) in identifying women with danger signs for developing complications during pregnancy and childbirth 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 knowledgeable on danger signs during pregnancy and childbirth and were more likely to refer women with complications to a health facility, compared to untrained TBAs. The authors recommend that in resource constrained countries like Tanzania and especially in remote rural areas, TBAs should be trained on early identification of mothers with obstetrical complications and on their prompt referral to health facilities that can provide emergency obstetric care. HIV and Infant Feeding Counselling: Challenges Faced by Nurse-Counsellors in Northern Tanzania

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 in national/international guidelines, are faced with a number of challenges. This study aims to explore the experiences and situated concerns of nurses working as infant feeding counsellors 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 Motivation Package 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. It discusses the human resources for health situation in Tanzania in general, and specific findings from the Lake zone in terms of health workers in church health institutions. The author proposes options for a motivation package to address the issues of retention for these 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. It introduces geographic information systems (GIS), human resource information systems (HRIS) and the Christian Social Services Commission (CSSC). It outlines the progress made in creating the systems, the benefits and reasons to have GIS and HRIS and presents the preliminary results in terms of health infrastructure, human resources and programs 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 the second section it will review the National Health Insurance Fund Act requirements for accreditation and the current means of registering and evaluating health providers. What is needed in accreditation, the options for Tanzania, and the potential problems there may be with accreditation. The final section provides practical guidance for implementing a short-term and longterm strategy for accreditation of NHIF providers and more broadly for all Tanzanian providers. Appendix A provides a practical tool: An Accreditation Survey Instrument for Hospitals. Does the Integrated Management of Childhood Illness Cost More than Routine Care? Results from the United Republic of Tanzania The Integrated Management of Childhood Illness (IMCI) strategy seeks to reduce [childhood] deaths through three main components: improving the skills of health workers, improving health systems an improving family and community practices. IMCI has been shown to be associated with improved quality of care, which should result in improved health outcomes. However, concern about the costs of implementing IMCI had been given as a reason why some countries have not adopted it on a large scale. It is important, therefore, to assess whether IMCI does, in practice, cost more than routine care for children who are less than 5 years old, and if so, by how much…Here we present results from the cost components of the MCE study in the United Republic of Tanzania.

Human Resources for Health in Tanzania: Challenges, Policy Options and Knowledge Gaps NORAD commissioned this study in order to learn how the human resource challenge currently is being addressed in Tanzania. Over the last few years, awareness has increased among policy makers in Tanzania that the country is facing a health worker crisis, 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 for similar efforts in other countries. A second aim of the study was to identify knowledge gaps for the development of evidence-based human resource strategies in Tanzania. By structuring available evidence within a strategic policy framework, and by identifying key knowledge gaps, this study may serve as an input to the further efforts to strengthen the health workforce in Tanzania. Team Players: Building the Skills of Local Health Care Planners Training and innovative tools were key to the success of the Tanzania Essential Health Interventions Project, along with small funding increases. The tools and strategies allowed the districts of Rufiji and Morogoro to target their new resources on the largest contributors to the burden of disease and on health care delivery. The most dramatic result, among many, has been an average decline in child mortality of more than 40%. Technical Review of Health Service Delivery at District 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 Health Management Teams (CHMT) and LG. The report presents a short general appraisal of district 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 available at council level to develop a comprehensive council health plan (section 2.2). Issues related 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 Joint 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 key issues, 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 major components that was undertaken as part of the 2002 joint MoH/Partners review of the health sector as a follow up of the 2001 joint review. The main objective of the terms for the human resources review was to propose strategies and approaches for developing a new and implementable long term plan which should address current health sector and local government reform needs and requirements. Supporting the Retention of Health Resources for Health: SACD Policy Context This report presents a review of issues in the regional policy context that are of relevance to the retention of human resources for the health sector (HRH) within the region, based on a rapid appraisal in selected countries and at regional level. This work specifically focussed on the actions needed to stem the flow of international migration by encouraging the retention of health staff within countries. A particular concern raised across countries is staff retention in the public and rural services that preferentially serve the poorest populations. Importantly, policy documents and national

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 of assistant medical officers and clinical officers to address the shortage of doctors in rural areas. It contains short interviews with health workers and administrators on how these substitute 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 Development website. Investing in Tanzanian Human Resources for Health Using Tanzania as a case study, this report advocates that the only effective means of really addressing the HRH challenge inpoor countries is to begin to immediately scale up training 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 the Tanzania Mainland The study documents the concerns of [People Living with AIDS] PLWHA, Community Health Workers (CHWs), primary care providers, and other stakeholders to inform Pathfinder’s support to national efforts to scale-up [Community Home-Based Care] CHBC. The proposed project aims to replicate Pathfinder’s successful CHBC model for PLWHA 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 on the promotion of Public Private Partnership (PPP) for equitable provision of quality health services in Tanzania. Improving Motivation Among Primary Health Care Workers in Tanzania: A Health Worker Perspective The aim of this study was to explore the experiences of health workers working in the primary health care facilities in Kilimanjaro Region, Tanzania, in terms of their motivation to 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 at primary care level was undertaken in Tanzania and South Africa in 2003. The main factors identified by respondents as underlying poor health worker performance and motivation in the public sector were: staff shortages and low salaries; poor working conditions; favoritism and lack of transparency in human resource management practices; limited supervision and monitoring; weak disciplinary procedures; limited and slow opportunities for promotion; differential salary levels; rigid employment management policies; slow decision-making across the public service; and conflicting lines of accountability at district level.

Community-Based Distribution in Tanzania: Costs and Impacts of Alternative Strategies to Improve Worker Performance Donor funds may be inadequate to support the growing demand for services provided by community-based distribution (CBD) programs. One solution may be to reduce the remuneration of CBD agents, but this approach may lower their productivity. Programs also need to consider reducing other costs, including those for supervision and training. The cost per agent visit—including costs associated with payments to agents and to supervisors and the costs of training—was calculated for three CBD programs in Tanzania. The output measure was visits in which contraceptives were provided or referrals made for family planning services.

THEME.4: Financing Schemes and Funding Sources Financing schemes are developed to support the decentralization process and finance local development activities. Financing instruments include transfers, grants, subsidies, and sharing of tax revenues between central and sub-national governments, and the ability of local governments to pursue alternative sources of funding for development projects. Starting with fiscal decentralization to special funding bodies the various financing schemes become operational through a budgeting process.

Fiscal decentralization Fiscal decentralization consists of the alignment of the fiscal functions among different levels of government. The responsibilities of which level of government sets and collects what taxes, or which tier undertakes what expenditures must be clearly spelled out. The central government must adopt a delicate balance between trying to improve the efficiency of service delivery at the local level and maintaining a fiscal discipline at the national level. A fiscal decentralization program must, in a straightforward way, delineate whether and on what basis local governments can self-finance or recover costs through user charges. It must clearly set out: the nature of intergovernmental transfers; whether municipalities can expand local revenues through property taxes, sales taxes or indirect taxes; whether there is to be any type of co-financing arrangements between central government and local government; and whether municipalities have the authority to borrow and mobilize funds from local, national or international sources. If local administrations obtain the ability 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 when the 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. In this situation, the burden of local service provision is shared vertically (between levels of government) and horizontally among the local jurisdictions. Under revenue-sharing arrangements characterized by automatic intergovernmental transfers of resources, or total (no local co-funding) funding, or unconditional funding of local spending, the central government may have difficulties dealing with the common pool problems.

Transfers of financial resources from the central governments are necessary, at least in the first stages of the process, until newly formed sub-national governments have acquired the capacity to raise their own funds. However, if local government leaders fail to use the received transfers for the stated purposes or if they use the funds to promote political patronage of their own, the macroeconomic consequences may be undesirable because 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” spending responsibilities to the sub-national governments without first devolving enough resources for the local governments to meet the new spending requirements. This should be properly managed to build trust at different levels of the government. China Experience: Growth and equity Tradeoff in Decentralization Policy http://isp-aysps.gsu.edu/papers/ispwp0216.pdf

Participatory Budgeting Participatory budgeting is a democratic planning process as a mechanism of local government in which ordinary local residents within a community participate in deliberation and decide how to allocate public resources to development activities. They become active key decision-makers, active stakeholders and active development agents. They familiarize themselves with the development challenges and priorities as well as the financial constraints and the ultimate benefits resulting from a sound budget execution. In so doing they are well equipped to ask for evaluation and accountability in the future. Since its emergence in Porto Alegre, participatory budgeting has spread to hundreds of Latin American cities, and dozens of cities in Europe, Asia, Africa, and North America. More than 200 municipalities are estimated to have initiated participatory budgeting. In some cities, participatory budgeting has been applied for school, university, and public housing budgets. These international approaches differ significantly, and they are shaped 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 Kingdom have initiated participatory budgeting processes. Participatory budgeting has been implemented in Canada with public housing, neighborhood groups, and a public school, in the cities of Toronto, Guelph, and West Vancouver. Similar budget processes have been used in communities in India and Africa.In France, the Region Poitou-Charentes has launched an experience of participatory budgeting in all its secondary schools.

A guide for Participatory Budgeting http://www.internationalbudget.org/resources/library/GPB.pdf

THEME.5: DECENTRALIZED COOPERATION: PARTNERSHIPS AND RESOURCES MOBILIZATION Decentralized cooperation is instrumental for strengthening governance initiatives at local level whatever the institutions (private sector, public sector, or civil Society). This cooperation 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 poverty reduction, decentralized cooperation has been more and more championed by central government and local authorities even though institutional relationships between different countries still flourish. Some thoughts are going on to see how to increase a direct cooperation between local entities (local governments, local authorities, cities, communes and municipalities, etc..) of different countries. Case Studies: Coopération décentralisée et Développement http://www.diplomatie.gouv.fr/fr/IMG/pdf/366_Int_Coop.decentral_1_.pdf Geman Development Cooperation and Support to Zambia Decentralization In the recent past in Zambia Decentralization has been both, a heated debate and at times a dormant process. Since the decentralization policy was launched in August 2004, development discussions in Zambia have begun increasingly to acknowledge and support the essence of the decentralization policy: This recognizes that Local Government, specifically the district councils, have to be the focal point for development management if significant changes are to be made in terms of poverty alleviation. This is based on the rationale that only when the processes of identifying development needs and orchestrating development programs are brought closer to people, that the quality of programs and the relevance and quality of services can increase significantly. There is a common concern, however, that necessary capacity for organizing horizontal and vertical planning and monitoring mechanisms at local government bodies is still, at best, limited. It is also of particular concern that the general rural population is not yet integrated in the process of formulating development needs nor into the implementation of the resulting programmes. The implementation of the decentralization policy has started, and the long expected implementation strategy was finally developed, published and shared with all concerned development players in Zambia. Though the author of this strategy is the Decentralization Secretariat, which is part of the Ministry of Local Government and Housing, the owners and managers of the implementation processes will have to be all those institutions, which are directly or indirectly participating and affected. This includes Sector Line Ministries at national, provincial and district level, civil society organizations, private sector, and most importantly the 72 district, city and municipal councils of Zambia.. It is expected that with these interventions local government will have more decision making powers and in the long run will be able to coordinate development programs on district level and steer service delivery from private sector and government for local economic development.

It is against this background that the combined efforts of the four organizations of German Development Cooperation (KfW, GTZ. DED, and CIM) operate in the Priority

Area “Decentralized Rural Development”. The Priority Area is almost entirely housed in the 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 Priority Area 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 the successful implementation of the decentralization policy based on agreed and harmonized strategies. This support is guided and harmonized by the policy statements of the “5th National Development Plan” of the Government of the Republic of Zambia as outlined 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 national level policy formulation and refinement processes, and policy implementation based on lessons learnt from local experiences and a harmonized strategy, which is aligned with all other cooperating partners in the sector. This is intended to help government and its partners clarify roles and processes for the decentralization process and build capacity for it.

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

With the establishment of national forums for sector coordination, policy guidance and monitoring of sector performance (Sector Advisory Group) for the Ministry of Local Government and Housing the Government of Zambia has created a potentially effective mechanisms for making better use of lessons learned from operations on the ground. The Sector Advisory Group and associated Working Groups can be employed to make sure that demands for process support in decentralization implementation voiced at national 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 sector with technical expertise and reputation for flexibility, to ensure its intervention can be adapted to upcoming needs and changing environments.

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

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

KfW, with their upcoming Rural Transport for Poverty Reduction (RTPR) Program in Southern Province, will provide essential complementary services to the long established Decentralized Rural Development Program (SDRD), which is jointly built by GTZ and DED, and complemented by CIM with integrated experts. SDRD works in all 11 districts 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 be titled “ Rural Development Fund Zambia” and aims at strengthening the Local Development Fund (formerly known as ZAMSIF) of the Ministry of Local Government and Housing with finances and capacity building mainly in the development of concepts for decentralized district financing.

The Priority Area „Decentralized Rural Development“ provides significant interventions at all levels ranging from sub-district to the national level. Contrary to the past, when more isolated projects operated in a wider range of technical areas, it is envisaged that the concentrated 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 these products and services for improved efficiency and a stronger client orientation of both public administration and the private sector. In addition, it is expected that the administration of districts and sector line ministries at grass root level will be enabled to better implement the reform policies of government and provide a better environment for fruitful 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 local infrastructure and an easy access of vital services well valued. The infrastructure refers to building, housing, roads and street furniture, including the basic architecture of the whole local area that shapes and interlinks all development activities with the human habitat while increasing the household growth. The more responsive and efficient is the service delivery as well as the advancement of the local infrastructure, the more successful decentralized governance is considered. Case Studies: Towards an Effective Delivery of Public Services in Africa http://unpan1.un.org/intradoc/groups/public/documents/AAPAM/UNPAN026077.pdf

THEME.7: MONITORING AND EVALUATION BASED ON CLEAR PERFORMANCE INDICATORS The efficiency of decentralized governance can be appreciated if it is supported by a sound monitoring and evaluation system consisting of clear and verifiable performance indicators. 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 transparency and accountability for the management of all the public matters. Case studies: Monitoring and Evaluating Support to Decentralization: Challenges and Dilemmas http://www2.gtz.de/dokumente/bib/00-1236.pdf Monitoring and Evaluation of support to decentralization and Local governance: Burkina Faso Case http://www.oecd.org/dataoecd/52/48/33741523.pdf THEME.8: COMMUNITY DEVELOPMENT AND PARTICIPATORY APPROACHES FOR THE IMPLEMENTATION OF DECENTRALIZATION POLICY AT THE LOCAL LEVEL: CASE STUDIES This theme outlines different concrete experiences some countries put in place as community development and participatory approaches to implement respectfully a decentralization policy. Case study 1: The Kecamatan Development Project (KDP), Indonesia.

The Kecamatan Development Program (KDP) is a national Government of Indonesia program, 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 objectives include alleviating poverty, strengthening local government and community institutions, and improving local governance. The program is funded through government budget allocations, donor grants, and loans from the World Bank. It provides block grants of approximately Rp. 500 million to 1.5 billion (approximately US$50,000 to US$150,000) to sub-districts (kecamatan) depending upon population size. Villagers engage in a participatory planning and decision-making process to allocate those resources for their self-defined development needs and priorities. KDP focuses on Indonesia’s poorest rural communities. Figure 3.1. shows the KDP activity cycle. Notice that the project adopts a village-level, community-demand driven (CDD) approach, whereby projects are selected at the village level based on the locality’s particular needs and priorities. Though each project must address the overall policy objectives of the national government, enough flexibility and autonomy is accorded to the lowest levels of the administration to design and implement specific project according to local priorities. Even the technical team and project implementers are selected after consultation with the project beneficiaries. The depth of community participation in this project promotes ownership by the stakeholders and sustainability.

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

Models of Inter-sectoral Collaboration for Community Development1

This section presents examples of two models of inter-sectoral collaboration for the implementation of a decentralization policy provided by M. Jae Moon of Korea University. The general concept is based on the Snavely and Desai (2000) idea that partnerships between civil society and the public present a preferred strategy to maximize the social functions of politics, policy, and the economy, as demonstrated in table 3.1. The table shows the interactions and complementarities of the public sector and civil society 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, the political context in which policy is being formulated in important. A grassroots democracy which allows for civil society to flourish, and promotes competitive political action based on the social capital of the country sets the stage for more successful policy formulation and implementation. A multiple-party grassroots democracy creates the dynamic for policy dialogue to take place across relevant actors, allowing for a more sustainable agenda setting. Finally, policy implementation is likely to be most effective when there is complementarity and collaboration between the private sector, the public sector and local authorities. The two models described by Moon (2007) are the New East Side Economic Development Community Development Corporation (NEWSED) model, implemented in Denver, Colorado (USA), and the Fundacion Communitaria del Bajío (FCB) model, implemented in Irapuato, Mexico.

Nonprofit Sector IntersectoralCollaboration:Complementary

Public Sector

Politics Civil SocietyDemocratic/ Social Movement

Social CapitalContentious Political Action

Grassroots DemocracyPartisan

Policy Formulation

Policy Agenda Setting

Policy Dialogues Grassroots DemocracyPartisan

Policy Implementation

Innovation/ExperimentationPrivate

Joint Service Delivery (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 and implementation

1 The 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)

Case Study 2: The NEWSED Model: An “Expansion Model” Established in 1974, NEWSED’s objective is “to promote and develop economic and community programs and projects that raise the income, educational, and political levels of West Denver residents” (NEWSED, 2001). According to the organization’s website, NEWSED's primary focus has been “to solve long-term economic problems in disadvantaged communities by securing and coordinating resources for neighborhood revitalization, developing needed shopping areas and services, fostering minority and neighborhood business ownership, job retention and creation, increasing home ownership and affordable rental opportunities, [promoting] neighborhood organizing, and hosting cultural events and activities that showcase the neighborhood's predominately Chicano/Mexicano population. NEWSED promotes holistic social and economic development opportunities.” According to Moon (2007), the NEWSED model is an Expansion Model, which is based on an in-house programmatic design approach. Figure 3.2 shows the elements of this model. 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)

NEWSEDCommunity OrganizationsResources

programs

Resources

programs

programs

Government Organizations

Business Organizations

utilizes to develop and design its in-house programs. This model secures the involvement of the various strata of the community: including government, civil society and business, in supporting and funding the organization’s programs. These programs include affordable rental housing programs; home ownerships programs; local economic development initiatives; and local business support programs. NEWSED’s funding originates from the following sources:

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

In terms of representation, NEWSED’s Board Members are drawn from the community ethnic representation; the PODER Advisory Council (PAD); and the Community leadership programs (e.g. the Youth Opportunity Movement). PODER is a Leadership Development, and school-to-work transition Program, which provides counseling services for Mental Health, Drug and Alcohol Abuse, and Domestic Violence. The Youth Opportunity Movement (YO!), targets young people between the ages of 12-24 years with such programs as General Education Diploma (GED) preparation and job training. PODER, YO! and the Human Services Program (PATCH) are among the institutions in charge of social services delivery (Moon, 2007). With respect to economic development, NEWSED adopts a private-public approach which relies on the Santa Fe Drive Redevelopment Corporation (SFDRC) in collaboration 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 Bajío (FCB) Model: A “Diffusion Model” The Fundacion Communitaria del Bajío (FCB) was established in 1997. The organization’s objective is “to raise and channel resources to promote and strengthen local development through creating and encouraging ties between, and with the participation of, civil society, government, and the private sector [with the aim of achieving collectively] the well-being of the community” (FCB, 2001). To accomplish this objective, FCB introduces the idea of “Community Foundations”, which, the organization maintains, 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 FCB approach is to build networks of implementers of local development projects, which it accomplishes by raising revenues and channeling those revenues to its organizational partners.

Figure 3.4. Diffusion Model: FCBNetwork Design Model (Moon, 2007)

Resources

Resources

FCB

Programs

CommunityOrganizations

Programs

CommunityOrganizations

FCB’s network of support include: The Mexican federal government The Local government Other NGO’s International 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. FCB’s economic development projects include, for example, PADIC-San Juan Project, and job training programs linked with multi-national corporations (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 participatory budgeting which provides an opportunity for citizens to exercise an oversight over the allocation of municipal resources. In a participatory budgeting approach, local citizens or citizen 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 marginalized groups into the budgetary system, thereby sidestepping the local elite who so often “capture” the decentralization process to advance their personal or class interest. Cities involve in participatory budgeting routinely make budget information available to ordinary citizens and provide regular reports on the status of the implementation of the budget. This direct participation of citizens in the process of budget preparation and implementation greatly increases conditions for transparency and accountability at the local level. b. Results:

Between 1989-1996 the number of households with access to water services rose from 80% 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 pay taxes; Participatory budgeting has helped to balance earnings and expenditure Over 80 Brazilian cities now following the Porto Alegre model. Participatory budgeting has been adopted in countries such as Bolivia, Peru, and the State of Kerala in India, among others. Case Study 5. Gujarat, India: Participatory Budget Review The Concept Development Initiatives for Social and Human Action (DISHA), a 80.000-member NGO based in India, has monitored and reviewed the budgetary process in the state of Gujarat since 1992. DISHA reviews budget documents, disaggregate spending categories 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. Results Better allocation and release of funds to priority sectors Numeric discrepancies and other errors (around 600 in first year) are detected Media has publicized results Better flow of information among ministries Gujarat model replicated in 12 other Indian states National budget now analyzed by People’s Budget Information and Analysis Service (BIAS) Case Study 6. Uganda Public Expenditure Tracking Survey The Concept Public Expenditure Tracking Surveys (PETS) are used to track down the flows of public funds and gauge the degree to which these funds reach their intended beneficiaries. In Uganda, PETS were introduced since 1996, when Uganda became the first country to introduce the system. The purpose was to evaluate actual spending and assess leakage of funds as they are transferred from the government to the Districts and down to the service delivery level. The Ugandan PETS focused primary on the education and health sector. Results Primary 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 campaign requiring published data on monthly transfers of grants to districts in newspapers and on radio Primary 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 monitor the grant program.

Case Study 7. Bangalore, India: Citizen Report Card The Concepts A citizen report card enables citizens to grade a service provider of their essential services. 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 government of service provides to demand better services. Citizen Report Card was introduced in Bangalore in 1993, after surveys concluded that the quality of service delivery in the city was very poor and not responsive to citizens’ needs. Results Formerly apathetic public agencies now listen and react to citizen concerns. Worst rated agency (Bangalore Development Agency) reviewed internal systems for service delivery and introduced reforms and public forums to consult on solving high priority problems. Karnataka Electrical Board formalized periodic dialogues with residence associations to redress grievances. Public awareness on issues of service quality has substantially increased. Report cards have stimulated civil society activism in Bangalore with many more groups engaged 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 are obtained when resources are managed through a combination of skills, innovation, flexibility, and accountability. Additional Readings Cadena, Cecilia, Martell Christine, R, M. Jae Moon, “Decentralization and Non-Governmental Organizations: Comparative US-Mexico Case Study”, Documentos de Investigacíon, 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/문명재.ppt Schwabe, Craig (Human Sciences Research Council (HSRC)), “Citizen Report Cards Survey: City of Tshwame, South Africa, www.ansa-africa.net/uploads/documents/features/Citizen_report_card_survey_Tshwane_Schwabe.pdf UNDP, “World Alliance of Cities Against Poverty: Experiences in the Fight Against Poverty: “Participatory Budgeting”: Increasing Citizen Involvement in Municipal Development Strategy Formulation: A Case From the South: Porto Alegre, Brazil. Online at: http://mirror.undp.org/switzerland/wacap/en/experiences/porto_alegre.htm

Wampler, Brian, “A Guide to Participatory Budgeting”, October 2000. Online at www.internationalbudget.org/resources/library/GPB.pdf Rwanda http://www.minaloc.gov.rw/IMG/doc/goodgov/1/parliament_paper.pdf http://www.devpartners.gov.rw/docs/index.php?dir=H+%26+A%2FH+%26+A+Local%2FDecentralization%2F&download=Fisc