Public Sector Capacity Research Articles

Approaches, enablers and barriers to govern the private sector in health in low- and middle-income countries: a scoping review

IntroductionThe private sector plays a substantial role in delivering and financing healthcare in low- and middle-income countries (LMICs). Supporting governments to govern the private sector effectively, and so improve outcomes...

Public leadership meta-skills in the 2020s

IMPACT Looking at public leadership from a meta-skills point of view is a new way to make visible what matters in public leadership in the 2020s. The significance of this topic lies in the contribution it makes to understanding and improving public leadership in the age of prevailing public policy complexities and austerity. This article explains why investing in leadership meta-skills is not only crucial for employees and organizations but also directly impacts the public sector's capacity for renewal, the quality of public policy and the ability of the public sector to deliver good services to citizens. The article provides directly applicable results for public leaders regardless of administrative branch; the findings can be applied anywhere where public value is created. The four categories of leadership actions and practices presented in this article help the public sector to succeed in the transition towards people-centred, cross-sectoral and future-driven policy outcomes.

Mapping bureaucratic overload: Dynamics and drivers in media coverage across three European countries

AbstractBureaucratic overburdening has emerged as an important theme in public policy and administration research. The concept signifies a state where public administrators are overwhelmed with more tasks and responsibilities than they can effectively handle. Researchers attribute this phenomenon to several key factors, such as an increasing assault on the public sector, a growing volume of policies to enforce, and “external” shocks. These studies converge on the perception that the public sector's capacity to effectively implement policies and to address societal problems is progressively diminishing. However, there is a clear knowledge gap regarding the breadth, dynamics, and pervasiveness of this issue, as existing research often narrows its focus on the implementation of specific policies or policy sectors. This paper addresses this research gap by mapping the frequency of bureaucratic overload reports in newspaper articles from Italy, Ireland, and Germany, spanning two decades from 2003 to 2022. In the second step, we describe the drivers of overload that we coded in a random sample of articles. Our research reveals that the overburdening of public administration is indeed an escalating problem resulting from an “explosive” cocktail of external and internal challenges that simultaneously affect public authorities.

A proposal to recognize investment in breastfeeding as a carbon offset.

Policy-makers need to rethink the connections between the economy and health. The World Health Organization Council on the Economics of Health for All has called for human and planetary health and well-being to be moved to the core of decision-making to build economies for health. Doing so involves valuing and measuring what matters, more and better health financing, innovation for the common good and rebuilding public sector capacity. We build on this thinking to argue that breastfeeding should be recognized in food and well-being statistics, while investments in breastfeeding should be considered a carbon offset in global financing arrangements for sustainable food, health and economic systems. Breastfeeding women nourish half the world's infants and young children with immense quantities of a highly valuable milk. This care work is not counted in gross domestic product or national food balance sheets, and yet ever-increasing commercial milk formula sales are counted. Achieving global nutrition targets for breastfeeding would realize far greater reductions in greenhouse gas emissions than decarbonizing commercial milk formula manufacturing. New metrics and financing mechanisms are needed to achieve the health, sustainability and equity gains from more optimal infant and young child feeding. Properly valuing crucial care and environmental resources in global and national measurement systems would redirect international financial resources away from expanding carbon-emitting activities, and towards what really matters, that is, health for all. Doing so should start with considering breastfeeding as the highest quality, local, sustainable first-food system for generations to come.

Factors influencing fever care-seeking for children under five years of age in The Gambia: a secondary analysis of 2019–20 DHS data

BackgroundMalaria contributes to excess child mortality in The Gambia. Children under five are at risk of severe malaria and death if not treated promptly and appropriately. It is crucial that a child with fever receive appropriate care from a trained provider. The aim was to identify influences on child fever care-seeking in The Gambia to inform malaria control strategies.MethodsThis cross-sectional analysis of The Gambia 2019–20 Demographic and Health Survey used logistic regression analysis to identify associations between source of care for a child with fever (public or private healthcare provider, other, or no treatment) and mother, child, and household characteristics.ResultsOnly 52.0% of mothers sought care from a trained healthcare provider for a child with fever—45.1% from a public facility and 7.0% from the private sector. 35.2% of mothers did not seek treatment. Mothers in urban households were 2.67 times as likely (aOR, 95% CI 1.504–4.736) as mothers in rural households to seek care from an informal source (e.g., pharmacy) versus not seeking treatment, and 0.29 times as likely (aOR, 95% CI 0.165–0.515) as mothers in rural households to seek care from a public provider versus informal source. Mothers in wealthier households were 2.30 times as likely (aOR, 95% CI 1.274–4.164) as mothers in poorer households to seek care from an informal source versus no treatment and half as likely as mothers in poorer households to seek care from a public provider versus informal source (aOR 0.53, 95% CI 0.291–0.959).ConclusionsMaintaining The Gambia’s malaria control achievements will require the active engagement and oversight of private pharmacies along with continued integrated community case management to reach mothers who do not seek care for a child with fever, and remove challenges to seeking appropriate care from trained providers. Whether influenced by convenience, costs, perceived urgency, or other factors, given the likelihood of urban mothers and mothers in wealthier households to seek care from private pharmacies, it will be necessary to incorporate private pharmacies into malaria control strategies while building public sector capacity and workforce, and initiating more effective attitude and behavioural change among mothers and households.

New development: Is it time for New Public Service Bargain?

IMPACT Governments should realize that public sector organizations are no longer the employer of choice. Public sector organizations face the challenge of attracting, recruiting and retaining skilled, competent and talented personnel. The public sector now competes with other sectors in a digital economy often offering better remuneration and working conditions. Decades of neoliberal public sector reforms and austerity measures have eroded the extent to which public sector organizations are attractive as a potential employer. The article suggests the idea of a New Public Service Bargain between politicians and civil and public servants as a more effective and sustainable approach to building public sector capacity to deliver services.

Co-design and evaluation of a youth-informed organisational tool to enhance trauma-informed practices in the UK public sector: a study protocol

IntroductionA trauma-informed approach (TIA) means working with awareness that people’s histories of trauma may shape the way they engage with services, organisations or institutions. Young people with adverse childhood experiences...

The Capacity Building and Public Service Delivery in Mogadishu Municipality, Banadir Region, Somalia

This study focused on capacity building and public service delivery in Mogadishu Municipality,Banadir region, Somalia. The study objectives were to assess the current practices of capacity building conducted in Mogadishu Municipality (Banadir region), to identify the identify stakeholders involved in capacity building in Mogadishu Municipality (Banadir region), to identify successful factors in public sector capacity building program in Mogadishu Municipality(Banadir region) and to examine the constraints to effective public sector capacity building in Mogadishu municipality. The researcher used a combination of both qualitative and quantitative approaches of research to collect and analyze text and numeric data respectively. The researcher used descriptive research design, which has helped to investigating the current practices of capacity building and public service delivery in Mogadishu City.For the purpose of this study, the sample size was 52. It was stratified through the various groups. The data collected was coded first. After coding there was data entry and analysis using content analysis. The study concluded that citizen participation in the design and implementation of capacity activities for better public service delivery in Banadir region building are being practiced and implemented and Banadir regional administration has made good progress towards promotion of capacity building for better public service delivery in Mogadishu Municipality, Banadir region, Somalia, but there are problems and shortcomings in applying and practicing as well as promoting the theory and principles of capacity building.Based on the findings, the study recommended that as part of the capacity building effort,providing training without assessing the needs of the offices and or sectors results in wastage of resource. Therefore, training needs analysis should be undertaken before conducting training activities and the training has to be linked with performance, capacity created and developed would imply a huge waste of resources if it is not effectively utilized. Brain drain is often the byproduct of non-capacity utilization, involving non state actors during capacity need assessment and development and formulating local government capacity building framework.

Cost and outcomes of routine HIV care and treatment: public and private service delivery models covering low-income earners in South Africa

BackgroundWhile South Africa’s national HIV program is the largest in the world, it has yet to reach the UNAIDS 95–95-95 targets. To reach these targets, the expansion of the HIV treatment program may be accelerated through the use private sector delivery models. This study identified three innovative non-governmental primary health care models (private sector) providing HIV treatment, as well as two government primary health clinics (public sector) that served similar populations. We estimated the resources used, and costs and outcomes of HIV treatment across these models to provide inputs to inform decisions around how these services might best be provided through National Health Insurance (NHI).MethodsA review of potential private sector models for HIV treatment in a primary health care setting was conducted. Models actively offering HIV treatment (i.e. in 2019) were considered for inclusion in the evaluation, subject to data availability and location. These models were augmented by government primary health clinics offering HIV services in similar locations. We conducted a cost-outcomes analysis by collecting patient-level resource usage and treatment outcomes through retrospective medical record reviews and a bottom-up micro-costing from the provider perspective (public or private payer). Patient outcomes were based on whether the patient was still in care at the end of the follow up period and viral load (VL) status, to create the following outcome categories: in care and responding (VL suppressed), in care and not responding (VL unsuppressed), in care (VL unknown) and not in care (LTFU or deceased). Data collection was conducted in 2019 and reflects services provided during the 4 years prior to that (2016–2019).ResultsThree hundred seventy-six patients were included across the five HIV treatment models. Across the three private sector models there were differences in the costs and outcomes of HIV treatment delivery, two of the models had results similar to the public sector primary health clinics. The nurse-led model appears to have a cost-outcome profile distinct from the others.ConclusionThe results show that across the private sector models studied the costs and outcomes of HIV treatment delivery vary, yet there were models that provided costs and outcomes similar to those found with public sector delivery. Offering HIV treatment under NHI through private delivery models could therefore be an option to increase access beyond the current public sector capacity.

Value-for-Money Drivers in Public-Private Partnerships in Affordable Housing in Indonesia: An Analytic Network Process Perspective

This study aimed to identify the factors expected to drive value-for-money (VfM) when using public-private partnerships (PPPs) for affordable housing in Indonesia. Utilising economy, efficiency and effectiveness as the VfM criteria, the study employed the analytic network process to determine the relative importance of 13 factors compiled from the literature review. The factors were then grouped into five clusters: private sector capacity, transparent and competitive procurement, risk and reward allocation, public sector capacity and the nature of the long-term contract. The data were gathered through a survey of 20 experts with hands-on experience in Indonesia’s PPPs. Effectiveness was identified as the most critical VfM criterion, implying that bringing other VfM aspects into public decisions is indefensible if the outcome, providing low-income customers with suitable housing at rents they can afford, is not achieved. The justified scope and size of the project, clear output-based specifications, quality project planning and preparation and long-term service delivery emerged as the most critical factors enhancing VfM, each with a different focus on a specific VfM criterion based on local weights. At the cluster level, risk and reward allocation ranked the highest. This study also acknowledges several limitations and provides directions for future research.

What are the Priorities of Bureaucrats? Evidence from Conjoint Experiments with Procurement Officials

A well-functioning bureaucracy is a precondition for efficient public goods provision. However, bureaucratic decision-making is still largely seen as a black box. We provide novel insights into the preferences of bureaucrats regarding their work outcomes. We focus on a major public sector activity and survey more than 900 real-life procurement officials in Finland and Germany. The questionnaire includes hypothetical choice experiments to study the relative importance of multiple features in tender outcomes. First, bureaucrats state to have substantial discretion at work but no important incentives. Second, our experimental results show that procurers are particularly worried about avoiding negative risks concerning prices and supplier reputation. Third, an avoidance of bidders with prior bad performance appears to be an extremely important factor. Fourth, procurers value a certain degree of competition, while litigation concerns and regional favoritism play only a small role. The striking lack of heterogeneous effects points towards the role of intrinsic motivation among public buyers in countries with high public sector capacity.

Role of Public-Private Partnerships in Primary Healthcare Services Worldwide: A Scoping Review

Background: The public health system is currently facing a shortage of resources, and the demand for healthcare has increased, indicating the need to use the capacities of other sectors through public-private partnership (PPP) strategies to improve the quantity and quality of health services. Objectives: The purpose is to identify PPPs' role in providing primary healthcare worldwide. Methods: This study was conducted in 2020. The Arksey O’Malley framework was used, along with a systematic literature search on five databases, including Web of Science (ISI), Scopus, Pubmed, ProQuest, and Google Scholar. Data were gathered from 2000 to 2020. Results: The findings presented in this study are reported based on 16 selected studies. The findings point to the positive impacts of cooperation between the public and private sectors in health care systems on matters of provision, coverage, and performance of services, as well as improvements in responsiveness to providers towards enhancing health referral systems. The provision of participatory services in countries varied according to their level of development, and further interactions between the government and the private sector resulted in better coverage and reduced inequality in service delivery. Conclusions: Public-private partnership is an effective way to achieve sustainable development goals. Public-private partnerships can be strengthened by integrating public and private sector facilities and aligning the interests and motivations of service providers with public health goals. Also, awareness of the plans and capacity of public and private sectors, along with conscious and mutual interaction, can strengthen health on a larger scale. Scientific approaches and correct participation can also relieve the part of governmental responsibilities to focus on more primary measures so that it can carry out its core tasks, including stewardship, policy-making, and supervision, with greater focus and power to facilitate the achievement of goals.

The public sector and co-creation in turbulent times: A systematic literature review on robust governance in the COVID-19 emergency.

The capacity of public sector of co‐creating with other stakeholders is challenged by the increasing presence of disruptive turbulent events, such as the COVID‐19. At this regard, robustness has been identified as a suitable response to deal with this kind of events. Through a systematic literature review, we analyzed how public sector organizations have co‐created with other actors during the COVID‐19 and what have been the contribution of robust governance strategies. Our findings point firstly to the empirical validity of the robustness concept, providing evidence of the extensive use of robust governance strategies into the co‐creation processes. Second, we identified a configurational approach to robustness, with governments co‐creating by simultaneously employing several robust strategies. Thirdly, we observed a more active involvement of societal stakeholders, with emergence of proto‐institutions and potential threats to the political system.

Obesity and Bariatric Surgery in Australia: Future Projection of Supply and Demand, and Costs

IntroductionThe prevalence of obesity is increasing in developed countries, including Australia. There is evidence that bariatric surgery is effective in losing weight and reducing risk of chronic diseases. However, access to bariatric surgery remains limited in the public health sector.MethodWe modelled population-based estimates of the likely numbers of people eligible for bariatric surgery in Australia using the recent Australian New Zealand Metabolic and Obesity Surgery Society (ANZMOSS) framework and estimated the potential costs that would be incurred from primary and subsequent reoperations in both public and private sector.ResultsThe annual number of newly eligible patients is expected to rise, and hence the gap in demand is increasing relative to current baseline supply. If a 5-year program to treat all currently eligible patients was implemented, the maximum yearly demand is projected to be 341,343 primary surgeries, more than eight times the existing capacity of public and private sector, which can only offer 41,534 surgeries/year. A nine-fold increase is expected if we treat currently eligible patients over a 5-year program and all newly eligible patients as they occur each year.ConclusionOur results highlighted the currently highly skewed distribution of bariatric surgeries between the private and public sectors. Improving access would bring substantial benefits to many Australians, given the demonstrated cost-effectiveness and cost savings. This requires a major increase in resourcing for publicly-funded access to bariatric surgery in the first instance. A national review of priorities and resourcing for all modes of obesity treatment is required in Australia.Graphical abstract

Addressing Adverse Selection in Public-Private Partnership (PPP) Procurement: An Agent-Based Approach

In risky public-private partnership (PPP) projects, governments and public institutions tend to offer private investors certain guarantees for their participation. However, when public sector capacity and institutions are weak, these guarantees can generate moral hazard in the bidding process and lead to contractual renegotiations, resulting in a loss for taxpayers. Drawing on a sophisticated, agent-based model that recreates the complex dynamics of the PPP procurement process, this paper demonstrates public sector competency is crucial for limiting moral hazard when guarantees are offered in PPP projects.

Organizational commitment in local government bureaucracies: The case of Zambia

AbstractWhat drives organizational commitment in local government? Despite the growth of decentralization initiatives in many developing countries and concurrent investments by international donors to build public sector capacity, there thus far has been little consideration of what drives bureaucrats to stay committed to local government service. This paper addresses this question by drawing on original survey data with more than 150 bureaucrats across 16 district councils in Zambia. The findings show that along with education, key factors that shape commitment include alignment with the mission of local government service, clear job objectives provided by supervisors, and placement in a city council. By contrast, extrinsic rewards and political interference play a more important role when examining drivers of job satisfaction. The results underscore the need for nuanced and multi‐modal policy interventions in developing country contexts to retain skilled staff in local government and improve the delivery of services to local communities.

Revisiting Innovations in Governance

Innovations, reforms and reinvention drives are overlapping strategies which arrive during organisational crisis when public sector capacity falls short of addressing a catastrophe. They come as a natural consequence of survival design or a tenacious need to outdo an opponent in a competition. However, some may even come through errors of the past. Innovations shrink both time and budget while becoming an agent for the three ‘Rs’ of recognition, replication and research. Much research, such as studies on administrative innovations at Department of Administrative Reforms and Public Grievances’ (DARPG) best administrative practices research on innovation has been undertaken since the coming of globalisation which brought through a combination of computers and information technology, on one hand, and re-conceptualisation of inter-agency collaboration and network research, on the other. Innovations do not bypass traditional public sector values of equity, fairness and probity to achieve enhanced efficiency as these become elements of sustainability and continuity in them. Government has a role to play in public sector innovations in facilitating freedom to innovate, in generating an environment of scientific curiosity, democratic freedom and decentralised governance. A spirit of entrepreneurship is currently being treated as a gateway to innovations and the mushrooming of startups as unleashing of innovations which may transform the manner in which public administration works in India. However, failed startups set at rest the innovation theory. Innovations need certain essentials for their success and continuity.

Public Procurement in Law and Practice

We examine a new dataset of public procurement laws, practice, and outcomes in 187 countries. We measure regulation as restrictions on the discretion of the procuring entities. We find that laws and practice are highly correlated with each other across countries, and better practice is correlated with better outcomes, but laws themselves are not correlated with outcomes. A closer look shows that stricter laws correlate with improved outcomes, but only in countries with low public sector capacity. We present a model of procurement in which both regulatory rules and public sector capacity determine procurement outcomes. In the model, regulation is effective in countries with low public sector capacity, but not in countries with high capacity because it inhibits the socially optimal exercise of discretion to exclude low quality bidders. (JEL D73, H11, H57, K12, K42, O17)

Children’s Data Network

The Children's Data Network (CDN) is a data and research collaborative focused on the linkage and analysis of administrative records. In partnership with public agencies, philanthropic funders, affiliated researchers, and community stakeholders, we seek to generate knowledge and advance evidence-rich policies that improve the health, safety, and well-being of the children of California. Given our experience negotiating access to and working with existing administrative data (and importantly, data stewards), the CDN has demonstrated its ability to perform cost-effective and rigorous record linkage, answer time-sensitive policy- and program-related questions, and build the public sector's capacity to do the same. Owing to steadfast and generous infrastructure and project support, close collaboration with public partners, and strategic analyses and engagements, the CDN has promoted a person-level and longitudinal understanding of children and families in California and in so doing, informed policy and program development nationwide. We sincerely hope that our experience—and lessons learned—can advance and inform work in other fields and jurisdictions.

Assimilating leaf area index data into a sugarcane process-based crop model for improving yield estimation

The ability to estimate sugarcane yield is an important factor to improving the planning capacity of public and private sectors, and so food and energy security. One way of achieving this is by employing process-based crop models (PBM), which can be coupled to data assimilation (DA) algorithms to correct predictions along the crop season. While the application of PBMs often need careful parameterization or genotype-specific parameters, few studies focus on understanding the impacts of crop parametrization with different crop genotypes with DA. Moreover, dimensioning the number and timing of observations is key to effectively improve predictions with DA. This study assess the performance of a new sugarcane PBM (DSSAT/SAMUCA) coupled to three DA methods, and when the genotype-specific parameters are available or not. Data from 22 field experiments is utilized to compare the performance of using the ensemble Kalman filter (EnKF), ensemble smoother (ES) and weighted mean (WM) for assimilating leaf area index (LAI) to improve yields estimates. We also quantify the impact of using one genotype-specific calibration (cv. RB867515) on yield predictions of four non-calibrated genotypes (cv. NCo376, SP832847, R570, RB72454). Simulations of DA methods had better performance than employing the PBM without DA, so called open-loop (OP). The ES method resulted in the best performance (R² = 0.498 and RMSE = 20.268 Mg ha−1) followed by EnKF and WM. Utilizing a genotype-specific calibration showed substantially smaller RMSE for the three DA methods (EnKF = 16.76, ES = 16.70 and WM = 15.36 Mg ha−1) compared to non-calibrated (EnKF = 21.44–26.23, ES = 21.50–26.27 and WM = 23.38–28.37 Mg ha−1). Nevertheless, we also verified a higher improvement of model performance when applying EnKF and ES method to experiments where the cultivar does not match the genotype-specific calibration employed. While the WM had the opposite results, with the calibrated cultivar showing a higher improvement of model performance. As the number of LAI data assimilation increases, the DA methods tend to outperform the OP, but observations at late crop phenological stage of development showed a higher positive influence on SFY predictions.