Basic health care in Punjab, Pakistan’s largest province with a population of 101 million, falls short of its citizens’ needs and international standards. In 2014, only 59% of deliveries were assisted by skilled midwives, while the under-five mortality rate stood
at 104 out of 1000 (nearly double the South Asian average of 55).
Not surprisingly, satisfaction with public health care is low.Amendments to the Constitution in 2010 aimed to decentralise political power further in Pakistan. They transferred the responsibility for managing resources from the federal government to provincial
governments. Provincial governments are closer to the communities and, therefore, considered to be better placed to meet their service delivery needs. This decentralisation process opened up new opportunities for the reform of basic service delivery in the provinces. The Sub-National Governance (SNG) programme aims, among other things, to improve the planning and management of public finances in Punjab, and needs-based budgeting in the primary health care sector is a key component of the programme.
In Pakistan, public confidence in the state is undermined by poor service delivery and opaque governance arrangements. In 2014, Pakistan ranked 117 out of 168 countries in Transparency International’s Corruption Perception Index.
For the people of Pakistan, greater insight into the structure and functioning of government finances, as well as decisions on tax and spending, would enable them to better hold their elected representatives to account. Such accountability can result in better quality of
services, including health and education, at provincial and local levels. Budget transparency also acts as a powerful disincentive for corruption or financial mismanagement, and can foster greater trust in government.
The provision of basic services in Pakistan has for a long time fallen short of acceptable international standards, with marginalised and vulnerable groups struggling to access basic health and education opportunities. As such, the country lags behind on a number of key social indicators: Pakistan ranks 23rd in the world for under-five deaths and, at 60%, has one of the world’s lowest literacy rates.
Oxford Policy Management (OPM) is implementing the DFID-funded Sub-National Governance (SNG) programme in Punjab and Khyber Pakhtunkhwa (KP) provinces of Pakistan. The SNG programme aims to support lasting improvements in the quality of, and access to, basic
services in these two provinces (which have a combined population of over 125 million), by strengthening their governance and the management of public finances.
Strong public financial management (PFM) systems underpin inclusive state institutions that generate trust, promote innovation and enable societies to flourish. Capable, transparent and accountable institutions that use effective systems for managing public funds are more likely to deliver public services, promoting long-term poverty reduction and economic growth.
This paper traces the introduction of public financial management (PFM) processes and systems in the Occupied Palestinian Territories since they came under the control of its current government, the Palestinian Authority (PA). A number of factors combined make for an extremely challenging context for external actors to catalyse change – these include: non-existent formal central government functions at the time the PA was established, major restrictions in the movement of goods and people, ill-designed donor budget support and a very asymmetric distribution of power between the PA and the Israeli government that favours the status quo.
The ACT on Knowledge leaflet series focuses on key emerging issues related to climate change and how they affect South Asia. Each of 10 leaflets synthesizes existing knowledge on a topic and aims to stimulate discussion. Suggestions for further reading are provided at the end.
This working paper provides an analytical contribution to our overall study on the actual and potential use of social protection systems to respond to environmental, social and political crises in the Sahel region of West Africa. Populations in the Sahel have long established informal mechanisms for providing support to needy households, showing solidarity based on kinship, faith or community. Many have also adapted their livelihood strategies to accommodate extremes of drought and resource limitations, notably through pastoralism. This paper asks how well these mechanisms may withstand the increasing intensity and frequency of climate shocks, and considers how their existence affects the likely effectiveness of formal humanitarian aid interventions and national social protection programmes in the Sahel. The working paper is a preparatory document for a broader case study on the Sahel, due for publication in late 2016.
A growing body of literature and evidence demonstrates that conventional aid interventions focused on technical issues and capacity building alone are not sufficient to deliver developmental impact. In view of the growing interest in ‘doing development differently’ and ‘thinking and working politically’ to deliver more effective development assistance, there is a need for operational models that illustrate what this can mean in practice. This note describes a problem-driven iterative adaptation (PDIA) approach to donor-supported health efficiency reform in the challenging context of the Occupied Palestinian Territories (OPTs). Focusing on the management of external medical referrals, which emerged as a political problem, the note highlights how a flexible logframe allowed a series of small, gradual interventions to be introduced, in sharp contrast to the traditional pre-planned ‘projectised’ approach that has been the standard in the development industry to date.
Dans le cadre du recherche sur les systèmes de protection sociale réactive aux crises, le présent document vise à fournir un état des lieux des connaissances et des questionnements sur ces questions dans le contexte spécifique du Mali. Il a été écrit sur la base d’une revue documentaire couplée à des échanges menés avec différentes parties prenantes par email et Skype et/ou en personne à l’occasion de la Conférence nationale sur la protection sociale qui s’est tenue à Bamako les 19 et 20 octobre 2015. Ce travail marque le point de départ de l’étude de cas du Mali. Il entend fournir aux chercheurs un document préparatoire à leur première mission de terrain et, d’une manière plus large, offrir une première base pour la rédaction d’un document de référence et d’orientation pour les parties prenantes travaillant au (ou pour le) Mali autour de ces questions en clarifiant le cadre conceptuel de la recherche.
This is the first in a series of papers from the ongoing research. Together, the set of papers will develop theoretical perspectives about the interface between social protection, humanitarian assistance and disaster risk management (DRM), review the latest literature and generate insights from new case studies across sub-Saharan Africa and Asia.
It is now recognised that institutional incentives are critical to the successful reform of public financial management (PFM) systems. However, there is relatively little guidance on how to identify and manage these issues. The Medium Term Budgetary Framework (MTBF) reform programme in Pakistan provides a good example of how political and organisational factors play a critical role in shaping the pace and success of PFM reforms. This note uses current thinking on PFM reform to understand the factors that led to a successful outcome for the Pakistan MTBF, against the odds.
Zimbabwe is emerging from a period of macroeconomic instability, and has adopted cash budgeting to manage prevailing revenue uncertainty. This briefing note examines the experience with cash budgeting in three sub-Saharan African countries: Malawi, Uganda and Zambia. It considers what lessons might guide Zimbabwe in developing its cash budgeting systems, avoiding the difficulties others have experienced, and ensuring that future macroeconomic stability is not dependent on the continuation of this emergency measure.