CJPSM-Volume XII

ANGUILLA . ANTIGUA & BARBUDA . ARUBA . BAHAMAS . BARBADOS . BELIZE . BERMUDA . BRITISH VIRGIN ISLANDS . CAYMAN ISLANDS 

. . . . . 

DOMINICA DOMINICAN REPUBLIC GRENADA GUADELOUPE GUYANA HAITI 

Management Institute for 

National Development 

Training for Public Service Excellence 

Caribbean 

Journal of 

Public Sector 

Management 

Volume 12 Number 1 

January 2017 

. . . 

JAMAICA ST. VINCENT & THE GRENADINES TURKS & CAICOS US VIRGIN ISLANDS 

JAMAICA . MARTINIQUE . MONTSERRAT . ST. KITTS & NEVIS . PUERTO RICO . ST. LUCIA . ST. MARTIN . ST. MAARTEN . SURINAME

Management Institute for National Development 

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Designed and Published by the Management Institute for National Development 

Kingston Jamaica 2017

Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017 


Caribbean Journal of 

Public Sector Management 

The Caribbean Journal of Public Sector Management (CJPSM) is an annual publication 

of the Management Institute for National Development (MIND) aimed at promoting 

research through the sharing of information on matters pertaining to governance, public 

policy and public sector management, engaging the widest possible audience both 

locally and regionally. The CJPSM takes a multi-disciplinary approach and is the main 

plat-form for analysing and discussing public sector issues in the Caribbean. The main 

objectives of the CJPSM are to: 

1. Serve as a forum for the exchange of information on public sector 

management practices throughout the region. 

2. Provide an avenue for the dissemination of multi-disciplinary research 

on a wide range of topics relating to the Caribbean public sector. 

3. Contribute to the professional growth and development of policy makers, 

managers, researchers, trainers and stakeholders with an interest in the 

Caribbean public sector. 

4. Educate its audience on achievements, innovations, developments and 

experiences, in management throughout the Caribbean public sector. 

5. Explore influencing factors in policy formulation, implementation and 

monitoring of the Caribbean public sector. 

Since the first publication in 1999, the MIND has collaborated with several agencies 

including the Caribbean Center for Development Administration (CARICAD), the 

University of the West Indies (UWI) St. Augustine and the Caribbean Leadership 

Project (CLP). 

The publication of the CJPSM will disseminate original research on public sector 

issues, thus stimulating new ideas, through fundamental and applied research, identify 

critical problems, provide solutions, and assess possible roadmaps for future trends. 

i


EDITORIAL STAFF 

Editor-in-Chief: 

Managing Editor: 

Associate Editor: 

Line Editor: 

Copy Editor: 

Graphic Design: 

Dr. Ruby Brown 

Mr. Kirk Frankson 

Mr. Christopher Thomas 

Ms. Janet Morrison 

Ms. Marlene Campbell 

Mr. Shawn McEwan 

REVIEW BOARD 

The current issue was edited by a prestigious panel of reviewers, representing 

a multiplicity of disciplines. They are well-known and respected academics 

and practitioners engaged in the field of governance, public administration, 

sociology, health economics and research. 

• Professor Neville Duncan 

Professor Emeritus and former Director of the Sir Arthur Lewis Institute 

of Social and Economic Studies 

University of the West Indies, Mona Campus 

Jamaica 

• Professor Edwin Jones 

Professor and former Head of the Department of Government 


Jamaica 

• Dr. Aldrie Henry Lee 

Senior Research Fellow and Director of the Sir Arthur Lewis Institute of 

Social and Economic Studies 


Jamaica 

• Dr. Stanley Lalta 

Research Fellow 

Center for Health Economics 

University of the West Indies, St. Augustine Campus 

Trinidad and Tobago 

• Mr. Peter Stoyko 

Chief Social Scientist and Information Designer 

Elanica, Ottawa 

Canada 

ii


THE PUBLISHER 

MIND was established by Cabinet Decision 32/93 of 6 September 1993 and 

became operational February 1, 1994, with a mandate “to provide effective 

leadership development programmes and management training appropriate to 

all levels, and in line with the demands of a modern and competitive public 

service”. In 1999, MIND was accorded Executive Agency Status in keeping 

with the Public Sector Modernisation thrust. This decision was aimed at raising 

the level and capacity of the public service to implement and fast track the 

modernisation programme. 

MIND’s vision is, “to be the pre-eminent and preferred public service training, 

organisational and leadership development institute in Jamaica, serving the 

Caribbean”. Bolstered by our mandate and vision, our mission is, “to provide 

public servants with quality leadership development options, management 

training, supporting services and outreach that sustain a culture of enterprise, 

efficiency and responsiveness to the publics they serve”. The mission is undergirded 

by our core values of: Customer-focus, Professionalism, Integrity, Results 

Oriented and Teamwork. 

MIND and its predecessor organisations have been providing training since 

1975 and MIND is registered with the University Council of Jamaica (UCJ) as a 

tertiary level institution. MIND’s suite of learning products, including its special 

learning initiatives (Forums, Conferences, Workshops, Public Lectures and 

Consultancy Assignments), demonstrates the Agency’s commitment to develop 

an effective, competent and forward looking public service equipped to undertake 

the necessary reforms of government. Our training programmes/courses are 

offered at the Certificate, Diploma, Associate of Science Degree and Post 

Graduate Diploma levels. On an annual basis, we deliver over one hundred and 

forty (140) programme/course offerings, with an average enrolment of over four 

thousand five hundred (4500) participants in Scheduled and Customised training 

formats. MIND’s training programmes/courses encompass all areas of human 

resource development with an emphasis on Leadership and Management. 

Over the years MIND has forged and or leveraged critical partnerships and 

collaborations with local, regional and international learning organisations and 

donor agencies, to strengthen its capacity to provide a coordinated and integrated 

approach to deliver first class leadership development and management training 

to the public sector and allied sector professionals. 

iii


Table of Contents 

Preface 

Kirk Frankson 

V 

State of Governance and Governance of the 

State of Jamaica 

Professor Edwin Jones 

1 

Governance and Safeguarding Institutions in 

Small Islands: A Case of Aruba (2009-2011) 

Dr. Carolien Klein-Haarhuis, Dr. Monika Smit, Dr. Anton Weenink 

and Roelof-Jan Bokhorst 

13 

Free Healthcare in Jamaica. 

Frontline Workers: Walk a Day in our Shoes 

Shanise Allen 

39 

Accountability of Executive Agencies: To Whom? 

Dr. Valoris Smith 

59 

iv


Preface 

The Management Institute for National Development is pleased to present this 

issue of the Caribbean Journal of Public Sector Management, with a focus on 

Governance and Accountability: Good Governance is important as governments 

grapple with balancing effective allocation of resources, exercising power, 

allowing participation by the citizenry, deliver services to its stakeholders 

while undertaking meaningful reforms. The main thrust globally is to reform 

public sector institutions in order to overcome several common problems such 

as bureaucracy, corruption, the concentration of power and ineffective institutions. 

The United Nations further notes that Good Governance is anchored 

on eight major pillars; accountability, consensus, participation, transparency, 

responsiveness, efficiency and effectiveness, equity and inclusiveness and reduced 

corruption. 

Foremost Caribbean Scholar and authority figure on governance, Edwin Jones 

elucidates that Governance and Accountability are important variables that may 

be negatively affected by favours and notes that Governance and Accountability 

in Jamaica have focused on the reform of public sector institutions and policies 

as they contend with the problems in Jamaica which include but are not limited 

to: 

1. Entanglement in bureaucratic red tape. 

2. Featherbedding; overstaffing the state with political appointments 

through nepotism and patronage. 

3. The absence of creativity and bad business decisions. 

4. Clientelism due to the capturing of the state by special interests that 

use the state for their purposes. 

He posited the view that the Jamaican state must stick to reform process as the 

long term solution. He further opined that over the last twenty years corruption 

has become a major challenge for governance and accountability. He provides 

at least two other necessary but insufficient conditions excluding constitutional 

reform by concluding that Jamaica is currently on the best pathway to achieving 

governance and accountability since independence. Most importantly, he identifies 

the need for the construction of a leadership infrastructure. 

In the second article Klein-Haarhuis et al. from the Research and Documentation 

Centre in The Hague provide empirical data to conclude that favours extended 

in a dynamic of close relationships in small states, negatively affects governance 

v


and accountability. The authors postulate that public sector employees share the 

responsibility for safeguarding governance and therefore policy and guidance 

must be both relevant and useful for all those involved. In the case of Aruba the 

Authors outline several principles and best practices that provide guidance to 

employees operating within an acceptable ethical framework, without consideration 

for favour, in order to ensure good governance and accountability. 

Shanise Allen, Doctoral Student and Physiotherapist, addresses the perception that 

the desire to appeal to political emotions could adversely influence the decisions and 

behaviours of actors in the public sector as opposed to consultation, preparation and 

planning. In her contribution the removal of user fees and its concomitant perceived 

increase in health care while supporting the larger strategic goals: Millennium Development 

Goals, Sustainable Development Goals and Vision 2030 was hampered by 

the exclusion of key stakeholders in the decision making process. Empirical research 

by the author indicates that issues of governance made on the basis of favour will 

result in negative externalities, in this case economic and operational consequences 

including longer waiting times and reduced quality of service. Thus the author 

concludes that favour induced decision making without regard for adequate consultation 

and planning resulted in increased frustration by all stakeholders and lower 

quality of services at several health care facilities. 

Valoris Smith, Lecturer and Chartered Accountant makes the case that lack of 

accountability to too few stakeholders or to the wrong group of stakeholders could 

create a myriad of issues resulting in low levels of trust and support among end 

users. In the final article the author examines the impact of public management 

executive reform on accountability amongst small and medium sized enterprises. 

Smith concludes that the accountability framework of public sector agencies needs 

to be expanded to effectuate accountability not just to the few stakeholder but to the 

larger stakeholder group; the end users. 

The MIND anticipates that by sharing information from this Journal it will bring 

awareness to issues of governance, accountability, probity and transparency among 

public bodies in order to contribute to the achievement of a more compliant, 

responsive, efficient and effective public service. 

vi



1STATE OF GOVERNANCE AND 

GOVERNANCE OF THE 

STATE OF JAMAICA 

Professor Edwin Jones 

VII 

1


State of Governance and 

Governance of the State of Jamaica 

Governance & Accountability: Fair or Favour 

INTRODUCTION: A TUTORIAL ON MEANING 

The main issues raised in this address are for the most part still current and 

relevant to the Jamaican political economy situation. Since the original presentation, 

however, the governance issue of corruption has attracted extensive 

debates, institutional reforms and continuing policy-based focus. [See postscript 

p.9]. Even for this audience, we must begin by clarifying the meaning of the 

organizing theme - governance. There is now fulsome agreement among scholars 

and practitioners that governance should be understood as ... a set of processes 

and practices involving multi-agency partnerships; a blurring of responsibilities 

between public and non-public sectors; a power dependence between organizations 

involved in collective action; the emergence of self-governing networks 

and the development of new governmental tasks and tools. 

Practitioners are usually more interested in those dimensions of governance 

that concentrate on its overlapping themes: processes, practices and tasks. As 

process, governance is about winning commitment to a wide range of pluralistic 

institutional structures and arrangements. In a word, the idea of governance is to 

build a culture of political partnerships. 

Promotion of a new set of universal rules and regulative principles is the second 

idea of the governance process. Generally this means establishing frameworks 

of predictability in the policy environment; agreeing on principles to promote and 

guarantee human rights; offering guidance for conflict resolution. Its cementing 

force is social trust. Essentially, trust sharpens recognition of a common future. 

It strengthens resolve to take action in furtherance of collective purpose. It builds 

reciprocity or commitment to invest in one another’s enterprises psychologically 

and materially. Trust is often built on the success of past action. 

Further, the governance process is about problem solving and opportunity 

creation. It therefore requires society to build all-round socio-political capacity 

to solve collective problems. This type of ‘scaling up activity’ at least involves 

improving the organizational capacity of the state to design and implement 

appropriate policies and efficiently deliver policy products. It involves too, 

improving society’s monitoring and auditing capabilities to forestall crises in 

governance. In particular, it involves strengthening the analytical capacities 

of citizen 1 activists. Capacity building for good governance usually involves a 

programme of ‘opportunity creation’ that is universal, collective and equitable. 

2 

1 A Public Address by Edwin Jones delivered at the MIND


Fourthly, a sustainable governance process must focus on a vision of holistic 

development, which is why the World Bank conceptualizes governance as the 

‘management of a country’s economic and social resources for development’. 

So much for process; now we can point to practical tasks and implications of 

the governance agenda. 

• The first principle is collective action, thus implying the need to build 

cross-organizational arrangements of co-strategizing, co-steering and 

co-managing for problem solving purposes. This idea also embraces 

the notion of ‘joined up government’- a seeking after synergy through 

innovative coordination. 

• The second task of governance concerns the search for power sharing; 

social forces working with government, but retaining a degree of 

autonomy from the state. 

• Thirdly, governance is good for nothing without transparency. 

Accordingly, it requires that transparency must walk on five legs: 

voice, representation, information, choice and accountability. 

• In the fourth place, all advocates of governance accept the need for 

society-wide reform; involving changes in structures and methods, 

relationships and purposes, roles and responsibilities. This vision 

of organizational, managerial and relational change is to make 

government, the private sector and the civic realm perform better. 

The implication of meaning is more complicated than that however good 

governance reflects strong ideological roots, in favour of ‘marketization’. It 

embodies major ambiguities and tensions especially evident in a professional, 

technocratic language that is confusing and seductive. The governance 

philosophy underestimates the risks and challenges involved in searching for 

collaborative advantage in a context where the ethic of ambiguity and reticence 

is strong. Jamaica is a case in point. 

State of Governance & Governance of the State of Jamaica 

THE JAMAICAN CONTEXT: PERMISSIVE & RESISTANT 

Jamaica, ambiguity, paradoxes and therefore, contradictory impulses and 

orientations beset the search for a new governance order. The historic sense 

of the majority of a people being wronged and deprived represents a readymade 

foundation on which to build a governance infrastructure. Colonialism, 

lop-sidedness in administering the independence project, and post-adjustment 

experiences consolidated that sense; but because these experiences tended to 

benefit the few and disadvantage the many, they naturally encouraged varying 

degrees of acceptance and rejection of governance initiatives. 

3


Simultaneously, powerful international forces were to help impart push and pull 

effects on efforts to build the governance infrastructure. Architects of the globalization 

movement promoted governance as its instrumental, central doctrine, 

driven by special techniques. Its instrumental value promised a new democratic 

order and ‘marketization’ as catalysts for national economic development. 

It also promised an antidote to corruption and fiscal irresponsibility as well as 

meaningful reform of the state. Its marketing techniques would be as coercive as 

they were seductive. 


The typical coercive content includes ‘conditionalities’ set by the international 

technical bureau, departure from which would be punished as acts of ‘bad 

governance’. Its professional language is both instrumental and seductive. It 

is the language about ‘participatory’, ‘de-regulatory’, ‘inclusionary’ and ‘costeffective’ 

processes. As such, it is appealing to most stakeholders: politicians, 

business people, public administrators, rights advocates and the ordinary man 

in the street. The language employed also conveys little or no meaning to people 

outside the technocratic circle and is, therefore, a source of confusion 

and manipulation for them. So in effect, the policy products of this governance 

ideology are usually distributed lop-sidedly, exciting ambivalent orientations of 

acceptance and rejection. Nonetheless, a dedicated core of independent local 

advocates has been willing to press for a new culture of governance, with or 

without external impetus. 

Moves to politicize the social sphere attract further ambivalence to the 

governance project and norms. By-products of such politicization are evident 

in the triumph of partisan interest over the public interest. Within this politicized 

environment public discourse is typically conducted in partisan frameworks 

and partisan distribution of the public largesse becomes the norm. Thus, the 

sense of public duty and responsibility is effectively stifled. This means that 

governance initiatives requiring social cooperation are easily defeated by the 

tribal self-division of the polity. This too is the breeding ground for low trust, 

which constricts the space for social capital formation and encourages commitments, 

across the board, to ‘beating the system’. In these and other ways, 

clientelic politics shapes the manifesto for public disorder and discord as well as 

social ambivalence about commitment to common governance strategies. 

All these conditions deepen the sense of crises of governance in this deformed 

political order. One expression of such crises may be observed in a turn away 

from political objects and symbols generally. Increasing crime rates and 

unorthodox forms of protest also constitute reliable evidence of chronic crisis. 

Continuing non-transparent governmental transactions reflect other symptoms 

of that condition. Nothing demonstrates ambivalence towards these crises more 

than the failure of collective vision to create and seize opportunities to confront 

them in a determined fashion. 

4


Some incapacity and much incompetence in the public and private domain 

complicate the situation because there is little motivation to experiment. Thus, 

for instance, Westminster-type governmental arrangements that little predispose 

to power sharing continue to encumber the ground because they are viewed as 

“structural obstacles”. Which eyes have not seen or ears heard that the reality of 

social exclusion, cynicism and the systemic nature of corruption are subverting 

the meaning of governance. Skilful leadership is obviously needed to convert 

these deficits into assets? 

Alas, the relevant leadership cohort has obviously not yet managed to bring 

about common understanding of these crises, much less mobilize the appropriate 

problem-solving tools. It seems unable to perform the strategic brokerage 

role that would deliver collaborative advantage. Nor has the available leadership 

collectively evidenced the legitimacy, mastery and craft to effectively umpire 

divergent interests and orientations in society. So this profile disguises a major 

paradox. For when operating in discrete sectors and establishments this same 

community of leaders appears, for the most part, imaginative, creative and 

sensitive to the art of performance. The challenge, then, is to realign the paradoxical 

leadership orientations. 

Realignment though, would require retreat from our strong and continuing 

anti-intellectual tradition. Elements of this tradition are evident in the willingness 

to celebrate uninformed viewpoints in the public discourse and suspicion 

of new ideas. It prefers rumour-mongering to facts. In other episodes, the antiintellectual 

ideology manifests in social expressions of self-doubt, short attention 

span, and cerebral laziness in places where you would least expect it. It predisposes 

to viewing even objective and sincere criticisms as personal attacks. 

This lack of critical tradition creates special difficulties for collective civic action, 

for it makes social learning and unlearning a problematic enterprise. To be sure, 

it has generated and reinforced habits of apathy, quiescence and distraction, as 

well as those of suspicion and ‘grudgefulness’. None of these characteristics is in 

harmony with the vision of good governance. 


STATUS OF GOVERNANCE WITHIN THE DOMINANT REALMS 

It is the case, however, that the principal governance-seeking organizations in 

Jamaica [political, corporate and civil society] have ‘stepped up into life’ within 

the past decade or so. Although their agenda and behaviour have become 

more extensive and sophisticated, in many respects they remain constrained or 

compromised by ambivalence and resource shortage. We can briefly illustrate, 

starting with the status of corporate governance, understood simply as ‘the way 

big organizations are directed and controlled’. 

The Private Corporate Sector 

Once upon a time it used to be said that the private corporate sector was 

organized and functioned as risk-shy, ‘consumerist’, ‘commission agents’. It was 

5


condemned for being inward looking and for avoiding the challenges of ‘social 

responsibility’. Some research scholars also characterized the private corporate 

sector as too slow to learn how markets work and too willing to regard its 

regulatory pillars as unethical, unnecessary and dangerous. 

Others contend that certain representatives of this sector have never been committed 

to meeting standards of corporate governance, for they identify fully with 

a culture of secrecy. They tend to assign board membership on honorific rather 

than on technical-managerial criteria. They are often insensitive to the interests 

of employees and external stakeholders. With the growing materialization of 

contemporary life, elements within the private corporate sector would be caught 

up in some other well-known ‘bad governance’ practices. 


Which is why a new corporate governance order is still being negotiated on 

bases of corporate self-restraint and better regulatory and monitoring frameworks. 

Moreover, for the cultivation of a complete governance culture in society, 

corporate self-denying ordinances must be strengthened. Existing regulatory 

systems must be harmonized and refined. Enforcement mechanisms must be 

better resourced, and consumer society must be better organized and educated. 

Yet, there is balm in Galahad. A better sense of sound corporate governance is 

emerging. It is reflected in abandonment of some old patterns of behaviour and 

underlying beliefs. Commitment to the idea of progressive partnerships appears 

to be taking root. Observe too, a growing willingness on the part of business 

people to invest in research and human capital development. Equally positive 

is the trend of integrating young, qualified, external stakeholders as board 

members. All this portends a new determination to lay the foundations for better 

corporate governance. What is happening in the civic realm? 

Governance Orientations within the Civic Realm 

No one can deny the growth of civic activism in favour of good governance 

principles and practices. Nor can anyone deny their determined and continuing 

struggle especially against corruption, abuse of rights and public power, party 

tribalism and government ineffectiveness. Their advocacy has won ‘victories’, 

stimulated needed change, and raised social consciousness but practice has 

been contradicted by ambiguities. We concentrate on the last theme as a way of 

pointing to alternative approaches to opportunity creation and problem solving. 

Resource problems in money, leadership and analytical capabilities as well as 

social reach are some powerful sources of ambivalence in the civic realm. These 

problems reflect in remarkably urban-centred engagement. Notice too, that 

under-funding has exposed the so-called network of civil society partners to real 

and potentially compromising reliance on various forms of official and external 

sponsorship, and herein reside possible risks: some already manifest in intense 

internal competition for sponsorship, others likely to incline commitment to the 

sponsors’ own agenda. 

6


Additionally, these resource problems account for lopsided and unorthodox 

forms of protests that often inconvenience society and alienate sympathizers. 

Moreover, they evince a pattern of social advocacy and action that may be read 

to mean, protest against abuse of citizens’ rights, but not against abuse of the 

rights of agents of the state. 

Communities should protest bad governance mainly on their own behalf, rather 

than in joined-up, common cause. Trade unions must press governance claims, 

but only on behalf of their members, not on behalf of labour in general and so 

on. So there may be need for a tutorial on demand-making strategy. 

Good advocacy strategy usually obeys the path and sequence of issue identification, 

serious research or mobilization of evidence negotiation or bargaining 

around the evidence petitioning and claim making – then agitation and demonstration 

as actions of last resort. Here, however, the dominant style often proceeds 

differently. It tends to skip stages, often starting with agitation and demonstration. 

The approach is largely adversarial and threatens to devalue itself because 

a significant portion of public opinion considers it irrational, lopsided, insincere 

and partisan. How strategies are packaged and marketed therefore remains a 

major challenge to our governance-seeking organizations, in this place and at 

this time. Perhaps, however, the greatest sin besetting the expansion and maturity 

of civic activism in Jamaica is the retreat from investment in real, rather than 

symbolic coalition formation. Commitment to collaborative approaches is the 

greatest asset that civic formations can bring to the democratic governance 

process. For the simple logic of coalition building hangs on experience that 

it can deliver at least four benefits. First, it is the best way to solve complex 

problems and the best way to attract socio-political attention and response. 

Additionally, it helps to promote and consolidate legitimacy and shared learning. 

Thirdly, collaborative institutional arrangements carry opportunities for joint 

sharing of best practices, costs and risks. Moreover, civic collaboration is 

instrumental because it makes society more informed, more intelligent, more 

involved and therefore more defensive of governance principles. Yet, there 

is reticence to exploit the benefits of coalition building. Much of this tutorial 

applies to the state. 


The State-Governance Nexus 

On the shoulders of the Jamaican state should rest the burden of leading the movement 

towards democratic governance, but we already know its record of shortfalls 

and under-performance. Perhaps then, there are three basic challenges at this time. 

First is the need to revitalize and extend the overall programme aimed at reforming 

the state. Among other things, that task involves opening wider the relevant gates 

so that transparency in official transactions may walk on its five legs; further 

de-bureaucratizing the administrative machinery; effectively controlling corruption 

and committing fully to the “De-Donification” of our politics. 

7


The second challenge concerns retiring structural inadequacies and the ‘bullyriding’ 

tactics of police, bureaucrats and other agents of the state that now 

devalue human rights and frustrate the administration of justice. In the third 

place, the state must offer stronger leadership to consolidate the idea that power 

best serves its social purpose when it is shared. Power centers other than the 

executive and the political party are what drive democratic governance. Society 

must collectively build such centers itself, as shared responsibility. 


Our Shared Responsibility & Conclusion 

The starting point toward improving the overall governance infrastructure therefore 

involves new ways of thinking: Thinking upside down; thinking inside out; 

thinking in frameworks of positives, not negatives. These forms of thinking 

require radically different modes. They involve drawing on the range of 

available technical knowledge and on the cultural wisdom from below. They 

involve concentrating on what elevates rather than what undermines the national 

interest. Of course, a new habit of reading literature far beyond that of the Holy 

Bible is central to these forms of thinking. 

We may add that these forms of thinking involve both reflective and futuristic 

styles, styles that focus on major historical forces that affect the governance 

agenda, styles that contemplate the medium and long term and better techniques 

for opportunity creation and problem solving. 

Meaningful coalition building on the basis of trust is the next collective 

responsibility. A lively spirit of voluntarism, much training, and civic education 

are central to that enterprise. Equally necessary are the sense of interdependence, 

the sense of a common future as well as the sense of equality, where no one partner 

is too strong or too weak. Remove any one of these conditions and the stage is set 

for disrespect of differences, jealousy and opportunism. 

Self-evidently then, all modern societies need a governance programme to help 

ensure that the life of man and woman escapes the traps or becomes ... “solitary, 

poor, nasty, brutish and short”. We must all be willing to perform a guardianship 

role in order to insure that our project survives. 

So I conclude with five basic observations that may stimulate action and debate. 

First: Although there are many surrounding problems, our governance project 

has perhaps never been in a better, more promising state since the colonizers 

arrived in Jamaica. Let the debate begin. 

Second: I suggest that perhaps our sharpest governance deficit resides in the 

absence of a public philosophy focused on building a new moral and leadership 

infrastructure. Without this, society would neither be able to coordinate 

divergent social interests into policy nor build the sense of civic responsibility, 

8


social restraint and mutual obligation implicit in the governance idea. Let the 

building of that public philosophy begin. 

Third: Notice that women now appear to form the activist core of the contemporary 

struggle for good governance. That activism has served us well, but it 

must now be combined with deeper and wider masculine inputs. Let us hasten 

that social formation. 

Fourth: Do you not agree that public scrutiny of the corporate governance 

arrangements is the least developed part of our programme? Left in that state, the 

continued ‘marketization’ process would become more risky, more unbalanced 

more unethical and more dangerous. Let us balance the scales and avoid those 

awful possibilities. 

Finally: Even the best organized collective approach must contemplate the longterm 

nature of the struggle for reform of Jamaica’s governance arrangements 

for in reality such reforms require cultural shifts, which are the most difficult 

processes to realize. Let us make the time available and invest greater effort to 

secure that change. 

I thank you, and God bless. 

POSTSCRIPT 

Corruption has many facets and nuances. It has been defined as “a transaction 

between the public and private sectors such that public goods are illegitimately 

converted into private-regarding pay offs”. In this jurisdiction it generally 

represents lack of moral commitment and integrity among public and private 

actors. Here too, political and administrative corruption tend to co-exist and 

reinforce each other. It is a problem of governance. Its most common forms 

involve the award of government contracts; conflicts of interest on the part of 

those directly involved in making decisions; partisan distribution of land and 

implementation of public works projects; weak government monitoring and 

auditing systems; non-transparent campaign financing associated with the 

leveraging of kickbacks; and inadequate funding of the civil service. Domestic 

corruption has also taken on a ‘cross border’ dimension, especially positioning 

organized crime to use the profits of illegal enterprise to bribe public officials 

and infiltrate legal businesses and political parties. 


We emphasize three dominant motivations that appear to propel corrupt 

practices throughout the region. Self-interest and greed are a powerful motivator. 

Commitment to ‘market fundamentalism’ seems to strengthen these impulses. A 

permissive environment of social tolerance, weaknesses in public administration 

and decline in the probity of public and private actors also enable the exercise 

9


of corrupt motives. Secondly, the relatively unequal bargaining power of 

public and private organizations and individuals spawns another motive. 

Arguably, the incentive for ‘grand’ corruption is heightened because of unequal 

relations between ‘powerful private interests’ and ‘underpaid and undermotivated 

public officials’. Of course, ‘grand corruption and petty corruption’ 

co-exist. Third, the privatization of state-owned enterprises region-wide has also 

increased opportunities and stirred motivations towards corruption – through nontransparent 

private treaties. 


Domestic corruption imparts negative effects on the society. Overall, it 

undermines the quality of democratic institutions and public policy. Equally, 

it undermines revenue collection capacity, contributing to fiscal weaknesses 

and macroeconomic difficulties. It tends to lower investment and economic 

development, thereby retarding the poverty alleviation drive. Corruption reduces 

efficiency and imposes additional tax on business and society. It leads as well 

to the expansion of the informal economy. Widespread corruption also brings 

government into disrepute and encourages cynicism about political objects and 

public policy. 

While the need to combat widespread corruption is recognized, public attitudes 

have been ambivalent and reform measures accordingly piecemeal. In reality 

there are no quick fixes, but experience suggests a manifesto for reform. Its 

underlying strategy focuses on ‘prevention, enforcement, public awareness and 

support, as well as institution building.’ Thus, certain authorities (e.g., Rondinelli 

and Cheema 2003) recommend that the following approaches may be tried, viz: 

• Create strong political will as the basis for effective anti-corruption 

programmes 

• Focus on prevention and changing systems through changing values, 

creating a culture of professionalism and training, providing adequate 

pay and ensuring deterrence 

• Identify government activities most prone to corruption and review 

both substantive law and administrative procedures 

• Enforce accountability mechanisms and learn from good practices 

and examples of others. Enact comprehensive anti-corruption legislation. 

• Establish broad ownership of reforms, among others, by creating 

strong partnerships with civil society and the private sector 

• Make corruption high risk and low profit 

10


Strategy should guide these reform actions. Credible reform requires that 

politico-administrative and private institutional leadership stand, in every way 

possible, above the taint of corruption. Nor is reform possible without fundamental 

change in the way public policy is made and administered. Logic dictates 

too that reform be directed at creating new beneficiaries who will defend the 

anti-corruption drive. To avoid institutional shelter it must be discussed openly. 

Timing also matters. Corruption will not wither away because of reform or 

because of economic growth. Effective reform is most likely in time of great 

crisis and dissatisfaction with the status quo. Sustainability of effort often 

requires a permanent anti-corruption commission. All the issues discussed so 

far appear to have implications for all citizens of Caribbean states including 

those living abroad. 


11

Values 

Customer-focused 

Integrity 

The core values that guide the actions, 

transactions and behaviours of the MIND Team 

Vision 

Statement 

To be the pre-eminent and preferred 

public service training, organisational 

and leadership development institution 

in Jamaica serving the Caribbean 

Professionalism 

Teamwork 

Results-Oriented 

Mission 

Statement 

To provide public servants with quality 

training and leadership development 

options, supporting services and 

outreach which sustain a culture of 

enterprise, efficiency and responsiveness 

to the publics they serve 

12

Caribbean Journal of Public Sector Management, Vol. XI No. 1, March 2016 

2GOVERNANCE AND SAFEGUARDING 

INSTITUTIONS IN SMALL ISLANDS: 

A CASE OF ARUBA (2009-2011) 

Dr. Carolien Klein-Haarhuis, Dr. Monika Smit, 

Anton Weenink and Roelof-Jan Bokhorst 

13


Governance and Safeguarding 

Institutions in Small Islands: 

A Case of Aruba 

Abstract 


This contribution examines the quality of governance in microstates. It contains 

the report of an empirical study into the practice of Aruba. According to the 

literature, realizing counterweights to public administration is a challenge in 

small-scale settings: human capital is limited and people regularly encounter 

each other in various social roles. Two important safeguarding institutions were 

studied: the Staten (Parliament) and the Aruban Audit Office (ARA). Next, two 

fields of administrative decision-making were studied: public procurement and 

the granting of residence permits. The findings support the hypothesis that the 

interplay of capacity problems and closely knit social relations complicate the 

administration’s impartiality and also render it difficult to safeguard it. 

Keywords: checks and balances, governance, microstates, public procurement, 

residence permits 

14


1. Introduction 

This contribution examines the quality of governance in small islands. The 

practice in Aruba constitutes the case study. Aruba enjoys an autonomous status 

within The Kingdom of the Netherlands. This Caribbean island with a surface 

area of 193 square kilometres has approximately 108,000 inhabitants. This 

situates it on the dividing line between a microstate and a mini-state (Oostindie 

and Sutton 2006, 10). 

Aruban public administration has been set up according to the Dutch organizational 

model of public administration, as is shown by the Aruban Staatsregeling 

(‘constitution’). This constitution prescribes a parliament elected according to 

proportional representation (the Staten), an Advisory Council, and the Aruban 

Audit Office (ARA). When the aim of a full Aruban independence was abandoned, 

a Protocol was drawn up in 1993 between Aruba and the Netherlands. 

It included, among other things, a focus on good governance. It also contained 

agreements to institutionalize legitimacy, transparency and accountability as 

major features of the governance structure. 

From 2009 to 2011, the Research and Documentation Centre (WODC) of the 

Ministry of Security and Justice in the Netherlands carried out a study on the 

‘state of governance and on the maintenance of ‘law and order’ in Aruba. The 

study was commissioned by the Minister of the Interior and Kingdom Relations 

and the Aruban Prime Minister. The major reason was the idea that ‘concerning 

good governance (…), there is still much room for improvement’ in Aruba. The 

problems mentioned pertained to alleged corruption or conflicts of interest; a 

poor functioning of the Staten and thus of democracy; and the failure to 

operationalize a number of the agreements set down in the 1993 Protocol, 

including establishing a procedure for the funding of political parties. The chain 

for maintaining law and order was alleged to show several weak links, also 

because of a shortage of staff at the Public Prosecution Service and the Criminal 

Investigation Bureau. Furthermore, a number of high profile cases were alleged 

to heavily over-burden the prosecution of other criminal cases. Shortly before 

the final signing of the research commission in November 2009, a change of 

government took place. The AVP (the Aruban Popular Party) took over from the 

MEP (Movimiento Electoral di Pueblo) as the majority party. 

In many parliamentary democracies, the functioning of checks and balances 

such as parliaments and audit offices are taken for granted. Yet, for small islands 

the realization of such counterweights to public administration constitutes a 

continuing challenge. People do encounter each other daily in various social 

roles, which serve to compromise the administration’s impartiality and make it 

difficult to guarantee it. These circumstances make it more necessary to have 

effective safeguards which are scrupulously implemented. 

Governance and Safeguarding Institutions in Small Islands: A Case of Aruba (2009-2011) 

15


Based on the findings of the afore-mentioned study (Weenink, Klein-Haarhuis, 

Bokhorst and Smit 2011), this paper focuses on the extent to which the important 

independent safeguarding institutions – the Aruban Staten (parliament) and the 

ARA – succeed in performing their monitoring and correcting roles. This paper 

also seeks plausible explanations for the extent to which these tasks have been 

adequately executed. This will be supplemented with a description of some 

practical experiences in two important fields; the interaction between society 

(citizens and companies) on the one hand and public administration (procurement 

and immigration policy) on the other. 

Relevant theoretical and empirical literature on good governance in small-scale 

contexts is examined to establish a suitable explanatory framework. 

2. Good governance in small (island) states: a concise review of the literature 


2.1 Good governance 

The multidimensional concept of ‘good governance’ has been interpreted, in 

more detail in various ways, in an international context, for instance by the 

World Bank and the United Nations (UN) (see, among others, UNESCAP 2010). 

The dominant interpretation emphasizes economic management supported by 

an efficient bureaucracy, based on a transparent, participatory and accountable 

decision-making process. ‘Good governance’ is a product of the body of thought 

on the neo-institutional economy (Coase 1937; Williamson 1981; North 1990). 

Neo-institutionalists start from the assumption that governments and their 

constituent parts have and pursue their own interests (see also criminologist 

Felson 2009). How any organization performs strongly depends on the way 

in which both the internal relations and the relations within the organization’s 

environment have been arranged. With regard to the quality of governance, the 

literature often discusses problems of limited integrity and serious corruption 

pertaining to breaches of moral or legal norms (Fijnaut and Huberts 2002, 4). 

In this context, the World Bank refers to the work of neo-institutionalist 

Robert Klitgaard, who has summarized this insight into a simple formula: 

‘C = M + D – A. Corruption (C) equals monopoly power (M) plus discretion 

(D) by officials minus accountability (A)’ (Klitgaard 1988, 75; 1998, 6; cf. Jain 

2001; Sung 2002). Since, in Aruba’s case, the variable to be explained is the 

quality of governance, in this paper the reversed Klitgaard-formula is used: 1 

Good governance = A - (M + D) 

Monopoly power (M) represents the power of officials to portion out favours, 

for instance when jobs, subsidies, permits and contracts are allocated. The D 

stands for the discretion exercised by these officials, their headroom to let their 

16 

1 

The assumption thus is that good governance is the precise opposite of corruption (central to Klitgaard’s formula), 

while good governance actually comprises more. Klitgaard is President and University Professor, Claremont 

GraduateUniversity, Claremont. The formula for corrupt systems is C = M + D – A, where C = Corruption, 

M = Monopoly, D = Discretion and A = Accountability.


own interest (or that of potential followers, relatives or others) prevail over the 

public interest without violating the law. Complex regulations and unclear 

competences may encourage less transparency and thus lead to an increase in 

discretion. Whenever power and discretion go together, this provides officials 

with the opportunity to hand out favours for their own benefit or that of friends 

and relatives – practice corruption. In this context, Croes et al. (1997) 

consider the issuing of permits and exemptions and the granting of subsidies and 

government contracts to be fertile areas for such practices. This opportunity is 

contained when institutions such as parliament and the audit office – the A in the 

formula – are able to exercise effective supervision on the government. To sum 

up, good governance is the upshot of limitations placed on the exercise of power 

and the reduction of discretionary headroom, on the one hand, and effective 

safeguarding of institutions, on the other. 

Aruba’s safeguarding and other institutions have been modelled after the Dutch 

system, yet the circumstances under which they function are quite different. The 

most notable and unchangeable difference is that of scale – a small face-to-face 

tiny island state versus an infinitely larger and more complex country. 

2.2 Governance in a small scale society 

Based on empirical data from the World Bank, Oostindie and Sutton (2006) 

have shown that, worldwide, non-sovereign (is)lands ‘score’ above average 

on all criteria of good governance, 2 but always below the level attained by their 

‘metropolis’. Nauta (2007; 2011) has affirmed this for Aruba and the former 

Netherlands Antilles which, in his view, are unable to attain the Dutch level of 

good governance. The global image of governance in the small-scale overseas 

territories is therefore neither ‘negative’ nor simply ‘positive’. 

Quantitative empirical research into the effects of scale on corruption has not 

yielded any unequivocal outcomes. According to Knack and Azfar (2003), there 

is no clear empirical connection between population figures and the extent of 

corruption, while theoretical explanations allegedly point in different directions. 

Based on corruption figures from research among companies, Amin (2011) 

argues, however, that corruption occurs less often in countries with low population 

figures than in countries with large populations. This would fit in with the 

argument that a small scale generates better results and therefore leads to less 

corruption. In order to achieve economic stability and success, the nation’s 

limited resources must be used as efficiently as possible. 


According to several authors, a small scale influences administrative decisions 

and acts directly, through the often more intimate social relationships, as well 

as indirectly, through the effectiveness of formal (safeguarding) institutions 

(Oostindie and Sutton 2006; Croes et al.1997). Two ways in which this happens 

according to the theory are examined. 

2 

The control of corruption, rule of law, voice and accountability, regulatory quality, political stability and the 

absence of violence and government effectiveness. 

17


Less capacity and a low level of specialization 

In a small community, fewer people have to carry out all the tasks expected of 

a government, causing relatively high recurring costs to burden the community 

(Briguglio 2003). In addition, the pool of suitable officials in relation to the 

number of public tasks to be accomplished is small. This also goes for small 

islands (e.g. NAO 2007; AUSAID 2009). For these reasons the chances increase 

that a post will remain vacant or will be taken up by people with a lower 

education or less expertise than would be the case in a more populous country 

(Amin 2011; Knack and Azfar 2003). A practical aspect of a small scale 

influencing the quality of governance is the relatively low level of specialization 

(Munneke 1994; Nauta 2007; Oostindie and Sutton 2006). Small countries 

frequently have only one administrative layer (cf. Borman 2011). Different 

competences are often concentrated in one hand, while they are spread over 

different administrative levels and positions in larger societies (see also World 

Bank 2001). 


The lack of staff and low level of specialization also affect the safeguarding 

institutions. A bicameral system, for example, is not feasible in many small 

countries, and it is also difficult in a small-scale context to find enough qualified 

personnel to staff the safeguarding institutions (see, among others, Oosting 

2011). 3 An advantage of limited manpower and specialization may be that it will 

become clear more quickly which official is responsible for a specific decision or 

action, and therefore who is accountable for it (Oostindie and Sutton 2006). 

Social and physical proximity 

The smaller a community is, the greater the likelihood that citizens and officials 

will be acquainted, not only formally, but also informally. Because social 

relations are more often multiplex (Verbrugge 1979), an official’s formal 

performance may result in informal sanctions or rewards from his social 

surroundings (World Bank 2001). An official who decides negatively about an 

application for a building permit, for example, may encounter opposition in 

his role as brother or neighbour. In other words, multiplexity complicates the 

impartial execution of public duties (cf. Croes et al. 1997, regarding Aruba). 

A small scale society also leads to physical proximity. Contactability provides 

the opportunity to reach agreements, whether these constitute a transgression 

of norms or not (Felson 2009). Moreover, having only one administrative layer 

increases the power (M) of the individual official; in a manner of speaking, the 

minister not only decides on part of the national budget but also on individual 

applications for permits, which involve private interests. In addition, in a smallscale 

society, each vote carries relatively significant weight during election time. 

This may tempt administrators even more to give specific voters preferential 

treatment. Since the yield of personal attention paid to individual voters is 

comparatively large, voters and candidates will maintain a more direct and 

sustained relationship than they would have in large-scale societies. Such 

18 

3 Research conducted by the Australian Ministry of Development on ‘governance’ on islands in the Pacific shows 

that financial monitoring is in bad shape, partly because of a lack of sufficiently trained accountants in the region 

(AUSAID 2009, 33, 46).


relationships may hamper the impartial execution of formal duties. This easily 

generates at least the appearance of a conflict of interest. Yet, whether this 

actually happens also depends on the degree of effectiveness of safeguarding 

institutions. 

The relatively great power monopoly (M) of administrators combined with the 

‘discretion’ (D) and ‘proximity factors’ mentioned earlier, means that safeguarding 

institutions have an even more important task in effectuating ‘accountability’ 

(A). As Oostindie and Sutton conclude on the basis of their literature review 

(2006, 20): ‘[g]overnmental pervasiveness in small states, where anonymity 

is not possible and pressures towards partisanship are considerable, means that 

special attention must be paid to mechanisms ensuring impartiality of administration 

and justice’. 

Again, the aforementioned aspects of social and physical proximity will also 

affect the safeguarding institutions. Any member of the Audit Office who 

assesses the administrative decision-making process to have been ineffective, 

may expect to encounter disapproval in another social role (World Bank 2001). 

With regard to small islands in the Pacific, Duncan and Toatu (2004) have argued 

that: ‘various measures can be taken to reduce agency problems, such as through 

supervision (…) and auditing (…). However, collusion can occur between the 

agents and the supervisors or auditors (...)’. It is possible that the same goes 

for members of parliament who are critical of the actions of administrators. 4 

Similar to limited manpower, social and physical proximity may also work to 

the advantage of safeguarding institutions: it becomes clear more quickly who is 

responsible for any possible slips. 

3. Study design 

The research period runs from the second half of the 1990s to the moment of the 

study’s commission (Autumn 2009); for reasons pertaining to validity – most of 

all to prevent memory effects – the study has focused on the years prior to the 

commission. 

We began by studying written material related to aspects of good governance 

on Aruba. It included studies and evaluations by (either ‘mixed’ or ‘unmixed’ 

Dutch-Aruban) fact-finding or advisory committees of international organizations 

such as the IMF (on government finances) and studies by individuals. 

We also studied sources from both checks and balances and enforcement 

institutions, such as annual reports and annual surveys, or research reports 

that dug deeper, such as studies by the ARA and the Central Auditor’s Service 

(CAD), the Advisory Council, or studies carried out on behalf of political 

parties. We have also obtained material from the Criminal Investigation Bureau 

and the Public Prosecution Service. We have used the studied material for the 


4 The Australian study mentioned earlier revealed: ‘[e]ven where external audit is improving and uncovering poor 

practice, mechanisms such as parliamentary committees may not be effectively holding executive bodies to account’ 

(AUSAID 2009, 46). 

19


preparation as well as the validation of (findings from) a large number of semistructured 

interviews. 5 The interviewees were, among others, representatives 

from safeguarding institutions, politicians – including members of the Staten 

and the government; officials, representatives from enforcing institutions and 

immigration services; representatives from the business world and civil society; 

and several former functionaries. The interviews lasted more than two hours 

on average. The combination of data collecting techniques helps to obviate the 

weaknesses of individual methods. Variable recall of events among respondents 

constitute a threat to the validity of data. We have counteracted this as much as 

possible by confronting the respondents with information from written material. 

This ‘multi-method approach’ is often applied in research in the fields of social 

science and the science of public administration (see, among others, Brewer and 

Hunter 2005). 


Now, we will first discuss the functioning of two important safeguarding 

institutions: the Staten and the ARA. Next, we will focus on two fields of 

administrative decision-making: public procurement and the granting of residence 

permits. 

4. Safeguarding institutions: the performance of parliament (the Staten) 

and ARA 

4.1 The Staten: Aruban politics 

Capacity and independence 

Not much seems wrong with the Staten’s formal authority. As Nauta (2007, 7, 40) 

has argued: ‘[t]he state powers have been strictly separated and the authority 

of the Staten provide it with ample opportunity to monitor the government.’ 

Similar to the Dutch system, the Aruban Staten have the right of initiative, of 

amendment, of inquiry, of demanding changes in the Budget, of interpellation 

and of moving a motion. The Rules of Procedure for the Staten prescribe the way 

in which the Staten assembles, while the Staten Chair sees to their observance. 

The plenary sessions of the Staten are public and, since 2010, the minutes can be 

consulted online (Staten van Aruba, 2011). The sessions of the central committee 

and the standing and special committees are not public. 

In some respects, however, the authority of the Staten members is confined by 

procedures. FESCA (2003a), for example, mentioned: the limited autonomy of 

the Staten when drawing up their own budget: 6 limitations on the speaking time 

allotted to Staten members which do not apply to ministers; and the appointment 

of the Staten Chair by the government, even if this happens on the Staten’s 

recommendation. The government also appoints the staff of the Secretariat. 

Staten members, however, can appoint their own party staff (cf. Koolman 2011). 

20 

5 From December 2009 to March 2011, we have conducted 86 interviews with (anonymous) key figures on Aruba 

and in the Netherlands. 

6 Since 2000, the Staten and also the Advisory Council (RvA) and ARA can officially submit their own Budget. 

The Staten Budget is presented to the Minister of General Affairs, who can make changes to it.


Roles played in practice 

Just as much as the government is required in small-scale Aruban society to 

assess all legislation and policies not falling under the Kingdom’s tasks, it is 

also required of parliament. This requires the 21 Staten members to possess a 

high level of expertise. To be sure, the Staten’s committee system causes a 

certain amount of specialization of the activities, but even then, each Aruban 

Staten member is part of several committees, while the one-man party Partido 

Democracia Real (PDR) participates in all of them. 7 The broad knowledge this 

requires is not everyone’s asset. During the past decade, the workload of Staten 

Members has increased, while the technical support for party specialists and 

the secretariat with regard to legislation is said to be insufficient (Fesca 2003a; 

Swaen 2011). 

The role of the Staten in the budgetary process has been limited since Aruba 

gained its autonomous status. Up to 2012, governments structurally presented 

their budgets late and budget overruns were sometimes approved afterwards. 

The Advisory Council has repeatedly denounced the practice of retroactive 

adaptation of budgetary laws. 8 To this day, annual accounts have never been 

discussed in the Staten. The goal of the Staten, formulated at the end of the 

1990s, to deal with the annual accounts pertaining to the 1987-1996 period 

has not been realized. 9 Aruba’s CAD 10 issued negative audit certificates for the 

annual accounts of 1997 and 1998 (cf. ARA 2005b). Since 1998, the annual 

accounts have not been audited. The CAD considered them to be impossible 

to check. The Land’s Expenditure Committee, established in 1998, seems to 

have been dormant for a long time. In 2011 it was involved in a catch-up effort 

to finally be able to discuss the annual accounts, with support from the Dutch 

Lower House. 

Through the years, Staten members have made use of the right to pose questions 

to the government, yet in the decade before 2009 more than half of the questions 

submitted in writing remained unanswered. As of yet, there is no information on 

the ratio of answered and unanswered questions after 2009. In 2011, however, 

the Staten did criticize some ministers for their failure to provide answers. 

To date, the Staten has made use of its right to inquiry once, as a result of the 

‘Racetrack’ affair. 11 It has never voted against a member of the government. 

............................................................................................................ 

7 

From the end of 2009 on, thirteen standing and five special committees have been established (www.parlamento. 

aw). 

8 

This happened nine times in 2006 (RvA 2007). In the previous year, unauthorized expenditures or retroactive 

authorization were also concerns (RvA 2006). 

9 

Repeatedly, the ARA found considerable problems in the annual accounts. Government services and agencies, 

especially the Finance Directorate, were heavily criticized for the many gaps in their administrative organization 

and their lack of internal monitoring. See ARA (1997; 2001); Croes et al. (1997) and the Aarts Committee (1998). 

10 

The CAD is the internal accountant of the Nation of Aruba (Article 9 CV 1989), and in accordance with article 

24 paragraph 3 of the LARA (National Regulation regarding the Aruban Audit Office, in Dutch: Landsverordening 

Algemene Rekenkamer Aruba) (LARA) it is the executing expert for the ARA. The CAD detects and gives 

advice, but it cannot enforce its recommendations 

11 

A parliamentary inquiry into financial promises and actions of the AVP government during the 1999-2000 

period related to the realization of an international racetrack on Aruba. The committee’s conclusions were, among 

others, that the government ‘had completely sidelined’ the Staten and that the role and task of the ARA ‘had been 

completely ignored’ (Commissie Racetrack 2005, 122). Incidentally, the racetrack has never materialized. 

21 

Governance and Safeguarding Institutions in Small Islands: A Case of Aruba (2009-2011)


The foregoing suggests that, during the past decade, the Aruban Staten has made 

limited use of its supervisory authority and also had little grip on the executive 

branch. Various respondents characterized political relations through the years as 

essentially monistic, to such an extent that the Staten has insufficiently fulfilled 

its supervisory task. As such, monism and parliamentary supervision are not 

incompatible, but according to several observers, on Aruba, it obstructed a sound 

functioning of parliamentary democracy. Bakker (2000), among others, has 

alleged that when a majority of the Staten supported the government, members 

of the opposition bypassed the Staten in taking their issues directly to the Public 

Prosecutor and the Dutch government. In this respect, since 2009, a change 

seems to have set in. The governing party has regularly posed questions to its 

own members of government. 12 


Polarization and patronage 

According to all respondents who commented on Aruban politics, since its 

Separate Status, the island has constantly suffered from a polarized political 

situation (cf. Fesca 2003a; 2003b). The two largest parties, the AVP and the 

MEP, represent the two poles, while smaller parties usually find it hard to obtain 

electoral support. According to Croes et al. (1997), polarization has caused an 

uncompromising attitude towards the other party and has interfered with an 

objective discussion of subjects that could not be deemed truly controversial. 

This is still the current situation. Polarization is thought to harm parliamentary 

work. One informant stated: “no real account is given in any way (…) politics 

is solely focused on the electorate”. Party discipline may rob Staten members 

of an incentive to criticize their ‘own’ ministers concerning political content, 

thus eroding the Staten’s supervisory function. The consequences become most 

clearly noticeable if one party holds an absolute majority, as was the case after 

the last three elections on Aruba. In Fesca’s view, the ‘vote getters’ system has 

contributed to the docile attitude of the government parties in the Staten. 13 

That a single vote can carry a lot of weight in small-scale societies increases the 

importance of campaigning (Fesca 2003a). The considerable amount of money 

raised externally for political campaigns – without any legal regulation – 

reinforces the impression that donations have not been made selflessly. Whether 

unsolicited or after being asked, several respondents confirmed this image of a 

clientelistic political culture. By the middle of 2011, still no bill on party funding 

had been passed, although there were plans at the beginning of 2011 to present a 

new bill to the Staten. 14 

22 

............................................................................................................ 

12 

For that matter, there were also signs at the start of the period of government of the MEP that some new Staten 

members planned to steer a critical course. They backed down, however, after pressure from their party. 

13 Usually, the vote getters become government members (Fesca 2003a). The candidates who ‘moved up’ in the 

Staten were those who had received only a limited mandate from the electorate, which made their position within 

the party relatively weak. 

14 

For that matter, the Dutch regulations regarding party funding have also been the subject of criticism (GRECO 

2010).


4.2 The Aruban Audit Office (ARA) 

An important supplier of information to the Staten is the ARA. According to the 

Aruban constitution, the ARA is entrusted with the investigation of the efficiency 

and legitimacy of the country’s receipts and expenditures. The Land’s Regulation 

regarding the ARA (LARA) specifies this in more detail. To exercise its duties, 

the ARA is to receive surveys from every ministry and every other official 

body that administers the Land’s means; it may demand books, bills, accounts 

and such. This authority also extends to state companies, statutory bodies and 

institutions subsidized by the government. Ministries and other official bodies 

are legally liable to supply these items. The ARA can use the investigative 

results of the CAD (Article 24 paragraph 3, LARA). 

The ARA also checks the Land’s annual accounts, as well as those of government 

enterprises, institutions and budgetary funds (Article 24 paragraph 1 and 

2, LARA). The Accountability Regulation obliges ministers to draw these up 

once every year and send them to the ARA. The subsequent task of the ARA is 

to report detected deficiencies or irregularities to the Staten and the Governor, 

if prior consultation with the Minister of Finance has not yielded satisfactory 

results (Article 26, LARA). To conclude, the ARA is obliged to produce its own 

annual report. 

Capacity and independence 

Despite the ARA’s authority, at least up to 2006, proposals have circulated 

to adapt the LARA for the purpose of accentuating the checking tasks and 

competences of the ARA (ARA 2005a) without any result to date. Aruba does 

not, for instance, have a procedure to deal with services that disregard the ARA’s 

advice. In addition, the privatization of the ARA with regard to its finances, staff 

and planning, which was recommended by a governance committee (Croes et al. 

1997) still seems not to be effective (ARA 2005a). In practice, the ARA is unable 

to appoint its own staff, even though the selection procedure is done by the 

ARA’s Board and the staff is accountable to this Board. For the realization 

of the remainder of its budget, the ARA is also dependent on the cooperation 

of the government (ARA 2005a). Officially though, the ARA can draw up this 

budget itself, just like the Advisory Council and the Staten. According to the 

interviewees, there was no Board at all for half a year during the 2008-9 period, 

and it was still short of a third Board member in 2011. Furthermore, the research 

staff of approximately six people needs to be expanded. 


The role played in practice 

The ARA checks the annual accounts, produces annual reports (which include 

shorter sub-investigations) and conducts a study into a designated subject on 

average every three years. During the past decade, the ARA did not always 

succeed in completely carrying out its plans (see, for instance, ARA 2005a). 

Between 2007 and the end of 2010, no new reports have been published. 15 

15 A report on the accountability of publicly funded organisations was released by the ARA in 2011. 

23


A faulty registration made this checking difficult or even impossible, as had been 

proven in the case of the non-examination of the Aruban annual accounts by the 

CAD. However, in 2005 and 2007, study results did get published on the various 

systems for the granting of permits. 

In general, the ARA reports have a good reputation in terms of quality and 

objectivity. They focus on the facts and when irregularities have been found, 

the responsible members of government are called to account for them. Our 

respondents cast doubt, however, on the question, whether the reports focused 

on the most urgent aspects of the quality of governance. 16 The ARA has sometimes 

also been accused of inertia. 


To work for the ARA easily leads to tensions in a small community, as three 

people involved have stated. Close social relations make it hard to voice any 

criticism as regards content without this being considered a personal attack. As 

several respondents stated, members of the ARA repeatedly had to endure public 

criticism by the government, which they learned from the media, among other 

channels. 

Response by the government and the Staten 

The response of the government and the Staten to studies by the ARA can be 

called limited, to say the least. The ARA presents its findings to the responsible 

minister(s) before sending them to the Staten. The ARA takes three months to 

listen to both sides, yet in general the reactions are too late (ARA 1998; 2005a, 

b). In three cases, the ARA considered the responses incomplete and unsatisfactory. 

Only a part of the responsible government members responded, for example, 

or the response pertained to only a part of the report (ARA 2005b; 2007). 

According to the ARA, the reactions it received were often insufficiently 

specific. Contact with the ministers from the MEP government was minimal. 

Through the years, Staten members, responded inadequately to the ARA 

reports also. In 2005, the ARA stated that ‘reports are not discussed in public 

assemblies of the Staten. This is a deficiency, yet also a failure to appreciate the 

duties of the Aruban Audit Office (…)’ (ARA 2005a, 39). Contacts between the 

ARA, the government and the Staten have been intensified after 2009. At the 

beginning of 2010, in consultation with the Dutch National Audit Office, the 

Prime Minister, the Minister of Finance and the Staten Chair laid down their 

pursuit of an Operation Accountable Order in a memorandum. In May 2011, the 

ARA presented a strategic policy plan, with the intent to conduct its investigations 

more productively and independently in the future. 17 

5. Two integrity-related cases: public procurement and residence permits 

Since the extent to which good governance exists has to primarily be shown by 

the decisions made in concrete cases, we have examined the practice of different 

24 

16 Yet, two reports (ARA sa, and ARA 2004) did actually come about after questions had been posed by the Staten 

about the legitimacy of the use of public means. 

17 Algemene Rekenkamer wil weer in centrum staatsbestel’ [‘Aruban Audit Office again aspires to a place in the 

centre of the political system’], Amigoe, 7 May, 2011.


government actions that are vulnerable with regard to integrity. In the following, 

we will present cases in two fields in which the integrity of those involved has 

been compromised: public procurement and the granting of residence permits. 

5.1 Public procurement 

In general, the integrity of decisions made regarding public procurement is 

vulnerable because of the interaction between the government and private 

enterprise. With regard to government contracts, integrity problems occur when 

an official allows his choice to be influenced by something done in return by a 

company that benefits him personally, instead of focusing on criteria of efficiency. 

Rose-Ackerman (1999, 28) noticed ‘[c]orruption in contracting occurs in 

every country – even those at the high end of the honesty index such as the 

Scandinavian countries, Singapore, and New Zealand’ (cf. Croes et al. 1997). 

This vulnerability makes an effective legal framework absolutely necessary 

(CAD 2010.04). 

Regulatory framework 

According to the Aruban Audit Service (CAD), the aim of the regulation of 

procurement is ‘to have control over the costs and to encourage the transparency 

of the decision-making process’. The Aruban rules for procurement are included 

in the Accountability Regulation of 1989 (CV 1989). Article 25 of the CV 1989: 

• Public contracts with a value of less than Afl. 10,000 can be granted out 

of hand, 18 

• Contracts with a value between Afl. 10,000 and Afl. 100,000 can be put 

up to either public tender or private tender (when a limited number of 

companies are asked to submit a tender), 

• Contracts with a value of more than Afl. 100,000 must be put up for 

public tender. 

The Land’s Decree on Public Contracts (AB 1996, no 58) prescribes the 

procedure according to which work must be put up to public tender. A Land’s 

Decree on private contracts does not exist. In addition, with regard to public 

contracts, the WTO decrees that it is prohibited to discriminate against foreign 

bidders (ARA 2005b). The WTO rules also apply to governmental Public 

Limited Companies and foundations according to an internal overview of 

legislation (dated May, 18, 2010), whereas the contracting procedures of the 

Accountability Regulation of 1989 do not. 19 The Finance Directorate is in charge 

of checking whether the Accountability Regulations are observed. Article 26 

CV 1989 provides the reasons that may justify a deviation from the prescribed 

procedure. When a contract of more than Afl. 100,000 is not put up for public 

tender, it must in principle be put up for private tender. Only if the latter is 

impossible or inefficient, may the contract be granted out of hand. A deviation 

from a public tender must be motivated in the Ministerial Order that generates 


18 1.00 Afl. is 0.56 US$. 

19 The WTO rules start from higher threshold values. See www.wto.org/english/docs_e/legal_e/gpr-94_01_e. 

htm#articleIV. 

20 This Order has to be signed by the minister involved as well as the Minister of Finance; if the latter turns out to be 

the minister involved, the signature of the Prime Minister is required. 

25


the deviation. 20 Article 26 leaves unresolved whether this must be done before 

or after the granting, but in 2005, the ARA pointed out the desirability of getting 

approval beforehand (ARA 2005b). To grant a work in breach of the CV 1989 

results in nullity of contract (article 31). A member of government who 

knowingly violates the rules commits a malfeasance and is liable in both civil 

(CV 1989, article 31 paragraph 2) and criminal law (articles 372a and 372b, Penal 

Code). 21 


Practice: The Fondo case and beyond 

During the ‘Fondo case’, famous in Aruba, a deviation from the rules for public 

procurement occurred. The case resulted in a lengthy lawsuit, in which members 

of government and officials had to account for alleged criminal violations of the 

public procurement rules. A number of building contractors were prosecuted for 

fraud. As a result, members of the AVP-OLA Cabinet who had actually made 

the rules stricter in response to the aforementioned committee report by Croes 

et al. (1997) ended up on trial. Fondo refers to the decision-making process 

regarding the Fondo Desaroyo Nobo San Nicolas (FDNSN). The suspicion was 

that, during the AVP period of 1999-2001, officials and politicians had accepted 

contributions to the campaign war chest of individual politicians from companies, 

in exchange for contracts for building and maintenance projects. 

The lawsuit, which took place from 2002 until 2008, was accompanied by much 

political commotion, to the extent that the Public Prosecution Service, the ARA 

and the Court of First Instance (GEA) were accused of partiality, while the 

government was accused of attempted influencing. In the heavily polarized 

Aruban context, such accusations did not appear out of thin air. In the years 

preceding the lawsuit, both the Truth Commission (2002) and the ARA carried 

out an investigation into the Fondo issue. The Truth Commission concluded, 

among other things, that corrupt acts had been committed, in particular in 

connection to public contracts in the context of a redevelopment plan for the 

borough of San Nicolas (Comision di Berdad 2002). The ARA (2004), investigating 

at the request of the Staten, chiefly focused on the ‘Sasaki Fund’, in which 

25 million Aruban Florins had been deposited for payment of the costs of the 

property developer PDN San Nicolas, who financed projects under the flag of 

FDNSN. According to the ARA, a violation of the procurement rules of 

CV 1989 (articles 25 and 26) had occurred. There was no Ministerial Order, and 

therefore a deviation from the rules had taken place without any apparent 

motivation. 

Other procurement issues 

In a letter dated April 17, 2008, a month after judgement had been passed on the 

Fondo case, the acting AG urged the Staten Chair to start a parliamentary inquiry 

into procurements. He based this request on the ARA’s Annual Report 2000- 

2004 (2005b, 84-85) in which 369 decisions to abandon public procurement 

were examined. 22 The number of Ministerial Orders drawn up by the various 

26 

21 Budget overruns that were entered into without authorization caused the Court to sentence a former minister of 

the OLA party to the payment of Afl. 670,000 damages. 

22 In the Fondo case, the Public Prosecution Service also came across contracts with a value of more than Afl. 

100,000 for which no Ministerial Orders were found.


ministers turned out to be very different (ARA 2005b). 23 The ARA then checked 

these decisions against four criteria: the mention of a budget item, the mention 

of the financial scope of a project, a clear project description, and the additional 

signing by another minister. The majority of the decisions did not meet these 

criteria. It thus turned out that the problems regarding procurements and 

Ministerial Orders were not over during the period of MEP government following 

the FDNSN. Even after the publication of the so-called ARA report (2005b), 

the Public Prosecution Service came across ‘a practice of many years of 

exceptions to the Accountability Regulation’. 24 The Public Prosecution Service 

mentioned, for example, observed contracts awarded out of hand without any 

attempt to follow a private procedure; missing motivations for deviations in 

accordance with article 26 CV 1989 in approximately 20% of the cases; and the 

use of literally the same motivations in 50% of the cases. According to the 

Public Prosecution Service, “the motivation of urgency was surprising, since the 

procurement pertained to an annually returning activity. It was also surprising 

that for two identical cases, the special qualities of one candidate were called 

upon, while two other candidates possessed the same qualities but were nonetheless 

not invited to submit a tender (…)”, as the acting AG reported in the aforementioned 

letter to the Staten Chair. 

The Public Prosecution Service was of the opinion that, in the first instance, it 

was the task of the Staten to check the government’s procurements and applied 

its line of policy to prosecute or investigate a ministerial malfeasance only if it 

had been committed in combination with a general offence such as forgery. Yet, 

the acting AG did not receive an answer to his letter; even after it had been made 

public, the Staten failed to respond. 

The procurement cases on which similar doubt was cast sometimes involved 

large sums. A problematic procurement trajectory in 2005 regarding a refuse 

depot at Parkietenbos, for example. It was alleged to have cost Aruba 20 million 

florin in bureaucratic and judicial red tape against an estimated project size of 7 

million florin – while the actual refuse depot had still not been realized in 2010. 

After 2004, the ARA stopped taking stock of procurement issues. In 2010, the 

CAD took a random sample of N=100 (more than 5%) from 1,990 invoices of 

the financial year 2008 (CAD 2010.04). The results confirmed the impression 

that, in most cases, the procurement rules had not been observed: in none of 

the 44 cases in which contracts had not been put up for private tender was a 

Ministerial Order drawn up. A Ministerial Order had been formulated in only 

4 of the 21 cases in which a contract had not been put up for public tender. In 

three-quarters of the cases, contracts had not been put up for tender in agreement 

with CV 1989 articles 25 and 26. 


............................................................................................................ 

23 In addition, in an investigation into the government investments in 2002 and 2003, the CAD concluded: ‘[t]he 

abandonment of putting contracts up for public tender is more often rule than exception’. The CAD also observed 

that the procedure for inviting tenders was frequently ignored and that the regulations of the WTO agreement 

regarding government contracts are not included in Aruba’s regulatory framework (CAD 2005.04, 3). 

24 

‘Tussenstand inzake de Namdar-zaak’ [‘Situation so far regarding the Namdar case’], press communiqué issued 

by the Aruban Public Prosecution Service, 17 April, 2008. 

27



Threats to integrity 

Two aspects relating to the rules for procurement provided officials with the 

discretion (‘D’) which in principle enabled them to favour close relations without 

placing themselves outside the law: 

1. The possibility to deviate from the procurement rules through a 

Ministerial Order without any sound motivation, since the reasons for a 

deviation described in article 26 were not precise enough. As the CAD 

has stated: “Precisely because of the lack of clarity, these arguments are 

often (…) not used as intended when the procedure of putting up a 

contract for public or private tender is abandoned. In fact, this abandonment 

is no more than a formality. It is peculiar that the law has created 

these simple possibilities” (CAD 2010.04, 7-8). 

2. The lack of a procedure for private procurements. According to the CAD, 

this is the reason why tenders did not have to meet any technical requirements, 

for instance, which made it impossible to compare them (CAD 

2010.04). 

Furthermore, in practice the manifold deviations from the rules did not seem to 

have any consequences. Usually, the deviation was brought about by drawing up 

a Ministerial Order only after the Land had been committed. The contract had 

now been signed and the bypassing of the procurement procedure was adjusted 

by means of a decision, thus side-lining the Staten and the judge. At other times, 

no Ministerial Order was used to deviate from the procurement rules. In these 

cases, the problem turned out not to be too much discretion (D) but ineffective 

safeguarding mechanisms (too little A). This being said, the ARA, CAD (and 

the Advisory Council) have been reporting violations of the CV 1989 and have 

already been making recommendations for improvement for over twenty years. 

The response of the Staten members to these actions, however, left a lot to be 

desired. This confirms the picture of political monism. The fact that, in principle, 

the Public Prosecution Service only swung into action when the violation of CV 

1989 coincided with a general offence and otherwise referred the case to the 

Staten, possibly meant a further weakening of the counterweight (A) perceived 

by administrators. 

The procurement regulations were the subject of debate in the Staten again in 

the spring of 2011. The Minister of Finance responded in April of that year with 

the statement that improvement in this area is desirable and that a study group is 

now examining the rules for procurement. 25 

5.2 Residence permits 

Because of the incessant labour and other forms of migration to Aruba, immigration 

policy is of vital importance to the island. Until the end of the 1990s Aruba 

had a strong net influx of migrants. Between 1988 and 2006, the Aruban 

28 

25 ”Parlement gehinderd door uitblijven beantwoording Statenvragen” [“Parliament hindered by delayed answers to 

Staten questions”], Amigoe, 28 March, 2011; “Overheidsaanbestedingen nog steeds niet goed geregeld” [“Public 

procurement still not regulated properly”], Amigoe, 21 April, 2011.


population increased annually by an average of 3%, from more than 60,000 

to 102,000 inhabitants. In the new millennium, in particular after 2005, immigration 

slackened; and in 2007-2008, the annual population growth amounted to 

only 1%. The result of the migration movements was that in 2007, 34% of the 

Aruban population had not been born on Aruba. In that year, 28% of the immigrant 

population originated from Colombia, 14% from the Netherlands, 13% 

from the Dominican Republic, and 11% from Venezuela. A quarter to a third 

of the immigrants were Arubans who had returned to Aruba. Estimates of the 

number of illegal immigrants on Aruba vary from 4,000 to 20,000 (CBS Aruba 

2008b; DIP 2009; Public Prosecution Service Aruba 2007). 

Varying policy and regulation 

The Aruban policy regarding immigrants has been changed quite frequently. 

The background of this is a tension between concern about the great number of 

immigrants on Aruba on the one hand and the need for foreign workers on the 

other. With regard to this subject the two largest political parties had different 

priorities, which resulted in a changing immigration policy that was translated 

into legislation belatedly. The immigration law, the Land’s Regulation of Admittance 

and Expulsion (Article 7 paragraph 1, LTUV 2008), prescribes that a 

temporary residence permit is granted by or on behalf of the minister in charge 

of immigration affairs for the duration of one year at the most. For persons in 

employment, this period extends to a maximum of three years, during which 

the permit must be renewed annually. In special cases, this three-year period 

can be extended with a year at the request of the employer. This regulation dates 

from before 29 June 2006, but the policy has already been applied since 2002, 

under the Oduber III government. Prior to 2002, the length of stay was not 

bound to a maximum. The alteration in 2002 consisted of the introduction of 

the so-called Swiss Model, which basically meant that immigrants applying for 

a residence permit had to leave Aruba after three years. The aim of this was to 

limit the number of naturalizations and to regulate entry to the labour market. 

Since the middle of 2005, the Swiss Model policy had not been applied to a 

limited number of occupational groups and in 2010 its application was 

completely abandoned. This means that the three-year maximum was dropped. 

Applications are now assessed according to the new policy, which as of the 

middle of 2011 had not yet been laid down in legislation. 

Since 2006, the main organization for the granting of residence permits is the 

DIMAS (Departamento di Integracion, Maneho y Admision di Stranhero), 

which assesses applications of immigrants who want to stay on Aruba. Predecessors 

of the DIMAS were the DINA (2002-2006) and the Directorate Public 

Order and Security (DOOV, until 2002). From 2001 to 2006, residence permits 

were granted by the Minister of Justice. 


Two integrity issues 

Integrity issues constitute a recurring subject in the reports published on the 

29


immigration chain in the past years. These publications refer to actually 

discovered irregularities as well as to the suspicion that permits are obtained 

(more easily) by payment, or that applications are dealt with more quickly after 

payment. Furthermore, several respondents (representing the Public Prosecution 

Service, the immigration chain and tourism) took the view that application 

procedures for residence permits gave rise to abuses. 


According to the Public Prosecution Service, in one case there were sufficient 

indications to start an investigation. It involved a DINA employee who 

allegedly organized residence permits on payment through a consultant for staff 

of an enterprise in the tourist sector. The Minister of Justice had previously 

rejected the applications in question, but granted several residence permits at a 

later stage. According to the minister and the entrepreneur involved, the minister 

had become convinced of the economic importance of not deporting them. The 

employee himself also stated that he had not held out the prospect of money to 

the minister. Yet, one of the minister’s staff members was actually suspected of 

taking money. Ultimately, this case was dismissed because two witnesses who 

were essential in furnishing proof could not be found (Speech of the acting 

Aruban AG, 22 January 2008). 

Another criminal investigation regarding the immigration chain involved fraud 

with immigration cards, which enabled the owner to extend his or her stay on 

Aruba. The fraud was committed by an immigration official, who ‘stamped’ 

five women of Venezuelan and Colombian origin onto the island in this way. A 

Venezuelan woman who stayed on Aruba illegally supplied women on payment, 

who were then helped out by the immigration official, again on payment. She 

stamped a false date of arrival on Aruba on the card that everybody must fill in 

upon arrival and must subsequently always be carried on their person. In this 

way, she concealed the fact that the women’s maximum length of stay had 

already expired. The women got caught when the LTUV was altered and the 

permitted length of stay for Venezuelans was reduced from three months to one 

month. The official was sentenced to fifteen months in prison and discharged 

from office for a maximum of five years. The mediator was sentenced to twelve 

months in prison. The two foreign women were sentenced to terms equal to the 

length of their custody, not for their illegal stay, but for bribery. 

Threats to integrity 

In the empirical study, we encountered a number of integrity risks of a more 

permanent nature with regard to the granting of residence permits. Decisions 

made in the immigration chain are often of vital importance to the applicants 

involved, and according to our informants, applying pressure on Aruban government 

employees does occur. This vital interest may result in integrity risks when 

the officials involved possess the ‘D’ to meet (urgent) demands. That discretion 

was present to begin with, because of the many policy changes. In practice, this 

led to a lack of clarity about the application of the policy and a steep increase 

30


in the number of legal procedures. At the same time, accountability (‘A’) was 

put into practice only to a limited extent. In the past, individual employees were 

allowed to, for example, deal with an application for a permit from beginning 

to end. This meant that functions were seldom separated. In addition, there was 

little supervision at the workplace, which made it possible, for instance, to make 

unauthorized changes to the registration systems. 

An additional problem was the inadequate filing by the then immigration service 

DINA and the Labour and Research Directorate (DAO). Documents frequently 

went missing and registration was faulty. The documents the ARA asked for 

at the DINA often turned out to be untraceable (ARA 2007). This inaccurate 

registration and filing increased the opportunities to issue permits illegally. 

Registration problems not only generate integrity risks, they also make it difficult 

for the ARA or the Public Prosecution Service to unearth the truthfulness of 

alleged breaches of that integrity afterwards. 

The DIMAS struggled with a shortage of personnel, who were not well-educated, 

while no attention had been paid for a long time to in-service training. In 

addition, clear frameworks or working instructions were not always on hand. 

Integrity risks may result from such capacity problems. The throughput times for 

the granting of permits were longer than the period legally prescribed. This may 

be caused by the observed capacity and registration issues. People who applied 

for permits or naturalization got into trouble when they had to wait for a permit 

for a long time, or when they were unable to prove that their stay on Aruba was 

legal or their stay on Aruba had been uninterrupted. The long throughput times 

also generated integrity risks: they increased the temptation to speed up the 

dispatching of specific cases, for example when this was in the interest of 

acquaintances. Recently, the throughput times for the issuing of permits have 

become shorter (to what extent is still unclear), as the result of working 

agreements between the DIMAS and the DAO, the directorate that advises the 

DIMAS about aspects of the labour market in connection with the granting of 

permits. 

At the DIMAS, internal supervision has been improved and a separation of 

functions has been introduced (PWC 2008b). Intake and decision-making, for 

instance, are no longer done by the same person. The process of issuing permits 

has also become more reliable and less susceptible to fraud because of process 

descriptions. A threat to this improvement and its consolidation is the shortage of 

staff (ARA 2007). 


6. Analysis and conclusions 

Our findings regarding the safeguarding institutions support the hypothesis 

that the interplay of capacity problems and closely knit social relations hamper 

their functioning in a small-scale society like that on Aruba. Lack of staff was 

31


a problem we encountered everywhere on the island and the supply of highereducated 

people is small, partly because of the competition from business and from 

abroad. It is probable that the shortage of staff has been the cause of the low 

production of the ARA. Shortage of staff also had its effect on the limited 

specialization among Staten members. 


The findings may also be considered a symptom of an unchangeable social and 

physical proximity. The ARA, for example, was regularly subjected to political 

pressure. ARA research is in danger of easily getting politically charged because 

of the far-reaching polarization among the political parties. This also applies 

to the investigations of the Public Prosecution Service. Furthermore, in the 

ARA’s view, it had insufficient say in the execution of its budget and the appointment 

of its staff, a complaint also based on the idea that a greater say decreases 

the risk of political influencing. Moreover, because of shortcomings in the 

internal registration and supervision, there was little left to check by safeguarding 

institutions afterwards. The Advisory Council and the ARA have carried out 

checks as well as investigations that were more far-reaching. They investigated 

administrative actions in many cases, and they pointed out weaknesses in the 

legislation and regulations or in procedures that generated the risk of loss of 

integrity. 

According to several observers, instead of playing a role as connectors between 

the government and safeguarding institutions, Staten members have used the 

advice of the latter for political/electoral ends, or they have not used them at all. 

The Staten made insufficient use of their monitoring instruments. Political 

polarization and party discipline within the majority party probably played a 

considerable role in this. That the Public Accounts Committee had not convened 

for a long time seems to be a significant factor in an important problem on 

Aruba: a lack of any follow-up after suggestions for improvement made by, 

among others, the ARA and the CAD. For this reason, nothing changed regarding 

the internal financial supervision and accountability after the event. This 

resulted in continuously returning standard recommendations in reports of higher 

boards and the CAD. From the viewpoint of effectiveness, a serious consequence 

of this was that fundamental problems were allowed to persist or to slowly 

become unmanageable. One example is the pile of annual accounts that have not 

been dealt with by the Staten ever since the separate status was gained (1986). 

On this point, there are striking similarities with recent findings regarding three 

other Caribbean islands: Curacao, Barbados and Anguilla (see Nauta 2011). 

All in all, the Aruban safeguarding institutions such as the Staten and the ARA 

were unable to sufficiently counterbalance the combination of power and 

discretionary headroom for administrators (M+D). This seems to be tentatively 

confirmed by the described practice of procurement in which the rules are 

breached, for instance by motivating deviations from the standard either 

insufficiently or not at all. The fact that relatively clear rules were violated 

32


constitutes an indication of a lack of accountability (A). This seems to be 

generated in large part by a lack of respect among administrators for the checks 

and balances institutions. It is likely that this is rooted in part in societal relations 

that have developed gradually. To a certain extent, it is expected of administrators 

that they do something in return for the citizens who have supported them. 

For administrators, to comply with legislation and procedures may stand in the 

way of this. It seems to confirm the phrase turned by former Minister Croes 

(1995) that ‘good government is bad politics’. 

The formula M+D-A has not only proven to be helpful in the institutional 

explanation of the behaviour of administrators, but also in the explanation of the 

behaviour of officials. In the immigration chain, until a few years ago, individual 

officials could, for example, deal with an application for a residence permit from 

the intake to the conclusion. It was also possible to make unauthorized changes 

to the registration systems. The discretionary headroom was therefore considerable, 

and the supervision (A) of officials’ work was, limited. Based on different 

investigations and initiatives, the immigration chain has been subjected 

to a number of improvements. 


33


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38



3FREE HEALTHCARE IN JAMAICA. 

Free Healthcare in Jamaica. Frontline Workers: Walk a Day In Our Shoes 

FRONTLINE WORKERS: 

WALK A DAY IN OUR SHOES 

A dissertation submitted to the University of Birmingham in partial 

fulfilment of the requirements for the degree of Masters of Science 

in Public Administration and Development. 

Shanise Allen 

39


Free Healthcare in Jamaica. Frontline 

workers: Walk a Day in our Shoes 

Abstract 


Many countries are experimenting with the removal of user fees: Uganda 

(Burnham et al., 2004); South Africa (Walker and Gilson, 2004); Afghanistan 

(Steinhardt et al., 2011); in an attempt to minimise barriers to health care and 

take greater steps towards the achievement of the Millennium Development 

Goals. User fees were abolished in Jamaica in April, 2008 (MOH, 2008) notably 

after the assumption of duties by a political party that had recently won the 

general elections. Their campaign had promised to remove user fees if they 

emerged victors after the elections; that they did. The previous government had 

implemented exemptions for children and the elderly. This research sought to 

investigate the perception of the frontline staff working in a hospital; the staff 

who are the implementers of this new policy at the ground level. The findings 

revealed that the staff are less than pleased with operations since the removal of 

user fees, arguing that an increase in utilisation is not an outcome measure that 

guarantees a successful policy. Lack of planning, inadequate preparation and a 

lack of consultation with the frontline staff in the designing phase of the policy, 

has led to critical economic consequences at the hospital. Increased demand 

on fixed resources resulted in increased pressures on the staff and an admitted 

decrease in the quality of service they were providing. 

Keywords: healthcare, user fees, policy process, health financing 

40


Introduction 

The political drive towards the achievement of the Millennium Development 

Goals (MDGs) has refreshed the debate around sustainable health sector 

financing and the sufficiency of existing policies in low-income countries. A 

handful of countries have abolished user fees for health services, and many 

more are actively experimenting with exemptions for specific services, such as 

deliveries (Witter et al., 2011). Since 2007, Zambia, Burundi, Niger, Liberia, 

Kenya, Senegal, Lesotho, Sudan and Ghana have experimented with removal of 

fees for key primary health services (Yates 2009). Jamaica has joined the list of 

these countries, at first starting with the abolition of user fees for children and 

the elderly in May, 2007 and then for the general public in April, 2008. In most 

cases, with this change in policy, an increase in utilisation is observed (Masiye 

et al., 2010; Jacobs et. al., 2007), a finding fully in line with basic economic 

theory (the law of demand). However, there are other challenges that will affect 

the success of such a policy such as the financial ability of the country to 

maintain the service. 

The views of healthcare workers are crucial, at every stage, to the successful 

implementation of any health reform policy (Hercot et al., 2011). This study 

explored the perception of the staff at a hospital in Jamaica. Were they consulted 

before the reform? What are their thoughts on the implementation of the policy 

in 2012 ? 

Literature Review 

With the looming issue of the high costs of healthcare and an urgent need for 

new ways to finance this service separate from the public purse, a World Bank 

report by Akin et al., (1987) seemed to have the workable solution to the 

problem – the introduction of user fees. User fees – also known as co-payments 

– are formalized out-of-pocket expenditures incurred at the time of health care 

use (Jacobs et al., 2007). The introduction of user fees to raise financial 

resources for health and regulate demand for health care in low and middleincome 

countries has been a controversial topic in the public health discourse 

for decades (McPake et al., 2011). This became a prevailing feature of health 

financing reform in many African and other low- and middle-income countries 

in the 1980s and 1990s. In many instances, this type of reform was a clear 

requirement of structural adjustment programs forced on low income, struggling 

countries by international financial institutions and their loan conditions. These 

conditions mandated that governments lower their expenditure on health and 

social services while users of the service would contribute directly by paying fees 

to access these services (Masiye et al., 2010). 


Akin et al., (1987) suggested that implementing a charge for patients to access 

health services would have three main benefits: 1) fees would generate additional 

revenue for the health sector; 2) fees would increase efficiency of government 

41


health services delivery by reducing frivolous demand for services and encouraging 

use of those with low charges and costs; 3) they would improve access of 

poor people to health services because revenues from urban services could be 

used to cross-subsidise disadvantaged people in rural areas. Based on these 

benefits, they argued that adding user fees to healthcare would be a suitable 

financing mechanism because they would be effective (in raising additional 

funds), efficient (by encouraging an efficient use of services), and equitable (by 

applying differential fees to protect the poor. Though proposing this reform, 

Akin et al., (1987) acknowledged that this approach would not singlehandedly 

solve all the problems of any existing health care service. 


There have been mounting criticisms of the impact of user fees on ability access 

to health services, in particular for the poorest groups. For instance, experts 

assembled by UNICEF reported that almost all studies showed a negative effect 

on equity of access due to reduced use noted after the introduction of user fees, 

with the poor and vulnerable being most adversely affected (Yates, 2009). The 

evidence as presented by Gilson (1997) and Pearson (2004) (as cited in McPake 

et al, 2011) suggests that their introduction was not beneficial: user fees only 

raised an average of 5–7% of health sector recurrent expenditures at the national 

level. The findings of Lagarde and Palmer (2011) in their review of twelve different 

countries supported the view that user fees present a barrier to accessing curative 

health services for groups who would be eligible to pay for them. 

Financing the Reform 

Before user fees can be removed, the levels of funding available for health care 

must be increased. As user fees have been shown to restrict utilisation and create 

a large pool of unmet need, removal of fees is likely to result in significant and 

sustained increases in utilisation. Without the necessary increased funding for 

health care, the increases in utilisation could very well lead to falling quality of 

care generated by drug shortages and staff difficulties in managing increased 

workloads (Gilson and McIntyre, 2005). 

Formulation of Policy 

McPake et al., (2011) proposed a series of six sequential steps that should be 

followed in the making of policy to remove user fees to maximise the benefits 

of such policy: 

(1) Analysis of start-up position, 

(2) Estimation of the impact of fee removal on utilisation, 

(3) Estimation of additional requirements for human resources and drugs, 

(4) Mobilization of additional financial resources, 

42


(5) Building political commitment for the policy reform, 

(6) Communicating the policy change to all stakeholders. 

Meessen et al., (2011a) discussed that in the formulation of reform policies for the 

countries reviewed, the most frequent divergences between country practices 

and their framework were: a paucity of, or too basic, computation of the effect 

of the reform on the utilisation by the populace, improper assessment of the 

additional burden on frontline health staff, inadequate allocation of resources to 

finance the increase in utilisation, poor commitment of public budget funding, 

weak planning forecast (e.g. quantity of drugs required) and little involvement 

or thought for the needs of frontline staff in the design. For the implementation 

stage, the most frequent deviations between country practices and their framework 

were: no pilot project was used to assess certain strategies, poor communication 

with managers and frontline health staff, insufficient public information 

activities, inadequate monitoring of services (monitoring focused on accounting), 

insufficient enforcement effort, deficiency in evaluation interest (or the 

adoption of approaches below par), inadequate feedback loop (altering the 

system after observing problems). 

Politicians and technicians have different patterns of action and this will 

influence any reform process. It seems that political leaders tend to undervalue 

and take very lightly the technical challenges related to user fee removal 

reforms. In several countries, informants have reported inadequate consultation 

with stakeholders and technicians concerning reform for healthcare financing. 

This deficiency in preparation creates what Gilson et al., (2003) describes as 

weaknesses in the design, formulation and implementation of the reform and 

eventually leads to an unsuccessful policy (Ridde and Diarra, 2009). 

Effect of User Fee Removal on Utilisation 

Where there are exemptions from user fees most of the time, an increase in 

utilisation is observed. The study done by Jacobs et al., (2007) in Cambodia 

observed higher hospitalization rates among the pre-identified poor when 

compared with the non-exempted. This was attributed to the exemption of fees 

and the vulnerable groups being knowledgeable of their entitlement to service. 

Masiye et al., (2010) looked at user fee abolition in Zambia. They found in the 

twelve months immediately following the removal of user fees that utilisation 

in public health facilities across all rural districts among the population aged 

five years or older increased by 55%. In Afghanistan, analysis of facility 

utilisation data indicated that utilisation of curative care increased (Steinhardt et 

al., 2011). This was not necessarily so for preventive and promotive care. 


Hay and Alexis (2012) explored the impact of the removal of user fees on the 

quality of patient care/service delivery in Jamaican public hospitals. They 

43


reported increased demand for services, increased workload for insufficiently 

staffed facilities, inadequate budgetary support, increased waiting time for 

services, demoralisation of staff and a derailing of the ministry of health’s 2006- 

2010 strategic plan. 

Evaluation of Reform 


Evaluations of policies relating to the removal of user fees typically rely on 

utilisation rates as a measure of success. Hadley (2011) found that in order 

to evaluate policies we need to look at the way these policies relate to local 

everyday practices. “The operating assumption in removal of user fee policies 

and in statistical evaluations of these policies is that the rise in utilisation is a 

result of those in need of care seeking treatment, that those who seek treatment 

receive all the care they need to recover fully, and that those receiving treatment 

adhere to advice on their return home” (Hadley, 2011). The results of the study 

could not substantiate the extent to which a rise in utilisation rates alone can 

determine the success of a user fee policy in terms of enhanced health outcomes. 

Perceptions of the Reform 

While the literature is abundant on other issues regarding health reform, it was 

not found to be so with regard to the perspectives of frontline workers. Ridde 

and Diarra (2009) looked at the perceptions of the judiciousness of the abolition 

of user fees in Niger. The researchers summarised the findings into three 

categories: those for the abolition, those saying yes, but…., and those who 

were mostly in opposition. The group supporting the removal of user fees was 

made up mostly of the general population and they unanimously considered the 

abolition to be justified. Health officials and local government decision makers 

were in favour of the abolition but were troubled about whether or not the state 

was capable of sustaining such a measure. Among the frontline staff, health 

workers, there was more opposition to the free services, although not totally. 

They would have preferred to see drugs provided at lower prices and made 

more accessible, rather than abolishing fees altogether. The frontline workers 

asserted that the abolition had incited unwelcome behaviour by patients: lack of 

respect and appreciation for services they received and poor maintenance of the 

facilities’ property. 

Methodology 

This is a qualitative study investigating the perspectives of the frontline staff at 

a public hospital in Jamaica. Ethical approval was sought from the governing 

Regional Health Authority to conduct the study. The hospital has over 200 beds 

complemented by 668 members of staff offering medical, surgical, orthopaedic, 

paediatric, and renal care. It was found suitable for this research because of the 

44


extensive services provided and also it being one of the larger hospitals, serving 

approximately 700,000 persons from at least five surrounding parishes. 

Semi-structured interviews were conducted in a one week period with 11 

members of staff who were granted permission from the CEO. The researcher 

sought to interview at least one staff member from each department, but the 

staff members and the participating departments were ultimately chosen by the 

CEO (meaning the researcher was only given approval to speak to specific team 

members). Further details are provided in the limitations section of this paper. 

Description of participants: Two members were from the administrative office 

while the remaining nine were a part of the health care team; some heads of 

department, some junior staff. The group included representation from the 

nursing department, physicians, allied health and clerical staff and hence was 

considered representative of the views of the wider staff. For the purpose of 

anonymity, their name and titles will not be used in this study. Consent was granted 

verbally by all interviewees. Interviews were recorded with a voice recorder. All 

participants were assured that their responses would be kept anonymous and 

were only being recorded for transcription purposes. Each interview was done 

separately and privately. Semi-structured interviews were used rather than a 

pre-determined list of questions for each participant, to allow new ideas and 

responses arising from the interview to direct the interview and facilitate 

relevant comprehensive data collection. No patients were involved in the study. 

Results 

Are services free? 

When asked whether they considered healthcare to be free, the responses were 

always ‘yes, but….’, 

“Everything is free for public patients and you need to understand 

the distinction. Private patients are still required to pay for whatever 

services they obtain here.” – Administrator 1 

A private patient is someone that is referred to the hospital for a service by a 

private practitioner. Staff members were quick to point out that a lot of medications 

still have to be purchased by patients because they are not on the VEND 

list. The Vital Essential and Necessary Drugs (VEND) list is a list of drugs 

identified by the Ministry of Health. Initially all drugs were provided free and 

then about one year into the reform, this changed. 

“When free healthcare came first every single thing under the sun that 

was stocked in Drugserv (pharmacy) was free…It was 2009 or 2010 

that the late Permanent Secretary, she had written and given directives 

that only items that were on the VEND list should be free.” – Front Line 

Staff 2 


45


All tests done by the laboratory are free but one team member suggested that these 

were more basic labs. 

“The consultation is free but the added tests you do are not necessarily 

free. Basic labs are free but additional labs such as thyroid function 

tests are not free. So if you are just coming to see a doctor and get a 

prescription it might be free but if you have to do tests and do other 

things, it’s not totally free. ” – Front Line Staff 5 

Transport services are only provided free for patients who are admitted to 

hospital. Ambulance services to communities to collect persons who are ill or 

to accident sites to pick up victims are not included in the free healthcare. 

Utilisation 


Only one staff member interviewed denied an increase in the utilisation of 

services since the abolition of user fees. Administrator 1 noted that the increase 

was evident in most areas of service. 

“We were always available for the entire population...With the abolition 

we saw an increase in attendance for most of our services.” 

– Administrator 1 

The departmental heads agreed that this increase in utilisation was evident in 

their departments. The accident and emergency department, the pharmacy and 

medical laboratory noted the most increases. This has caused a long waiting list in 

each of these areas. 

“The services that have been most utilised are first of all our Accident 

and Emergency department. It has been misused to an extent because 

you do have persons who come here who do not require Emergency 

service, ideally they should be seen in primary care... Two other major 

areas that we have seen increase in that we associate with the abolition 

is in terms of pharmaceuticals, and that continues to increase and in 

terms of diagnostic services particularly laboratory services. Those 

have continued to increase.” – Administrator 1 

Front Line Staff 5 responded to a question of abuse of the system. 

“I think it’s abused yes, because it is free and because of a lack of 

sensitisation as to what the system really is for and by whom it should 

be used especially being an emergency room so people come here for 

very minor complaints for which they should go to the clinic or in some 

cases they could have probably took two Panadols for example and see 

what happens.” – Front Line Staff 5. 

46


Effect on Budget, Personnel and Equipment 

Administrator 2 approximated that user fees covered up to 85-90% of operational 

cost (excluding salaries). She said that this has been drastically reduced 

with the abolition and the hospital now has to stick to a strict budget provided 

by the government, often trying to save costs. 

When asked where the resources now come from to fill the gap that has been 

created by the removal of user fees, Administrator 2 chuckled and reinforced 

that the hospital has to stick to the budget given by the government. 

Administrator 2 believes that the allocation from the government post-reform 

was essentially to plug the gap left by the removal of user fees, without taking 

into account the intended increase in utilisation. 

“I believe the thinking was that the budget would be so designed to 

accommodate the shortfall that would come from not collecting the 

fees... There are certain individual expenses that I think yes there may 

have been increase, let us say for drugs, there have been increased 

provision for drugs and for medical sundries to an extent but as a 

general budget there has not been any major increase to accommodate 

additional equipment, furniture, staffing”. – Administrator 1 

Administrator 2 on increase in budgetary allocation: 

“Uhm, I can’t, I don’t see, (pause, change of thought, then continues) 

They try to give us (pause, change of statement). We do a budget 

every year so we have to go through and cost the things, send in the 

budget according to what we will need for the year. We cannot factor 

in now user fees because it has been abolished. What they do is give 

us some allocation which is not sufficient to cover. When we had the 

user fees we could look towards doing certain things from that money 

that is collected. Now we have to just look at what is provided from the 

government.” – Administrator 2 

Administrator 1 said that the facility was extremely challenged to cover its 

expenses. Administrator 2 chuckled and admitted to having a constant situation 

of credit with suppliers. 


“(Laughs) With much strain. We are not able to meet a lot of deadlines. 

Suppliers are still good to us. We have a lot of credit rating. They 

(suppliers) give us credit. Some have cut off from us because they can’t 

wait on payment. At some point in time they are paid but it is taking a 

longer time for the bills to be paid.” – Administrator 2 

All departmental heads interviewed except one admitted not only to not 

receiving an increase in budgetary allocation to department but in fact they were 

getting a decrease in the budgetary allocation. Front Line Staff 7 admitted to 

47


having to ‘under-buy’ products each month. He said they continuously have to 

find creative ways to manage so as to not have that department closed at any time. 

“Every year we get less and less money to run the service.” 

– Front Line Staff 1 

“We have to be creating some very creative ways of, you know, ensuring 

that the (department) is not closed at any point and that the day-to-day 

activities especially for those in-house patients are available.” 

– Front Line Staff 2 

As it relates to personnel, everyone agreed there was no increase to correspond 

with the increased utilisation. 

Pattern of Provision 


Administrator 1 denied the discontinuance of any service since the removal of 

user fees. Administrator 2 agreed but added that some things had to be curbed. 

“To be honest we have not really stopped any service but we have tried 

to… to uhm... to sort of curtail some of the things that are really done. 

Uhm… like, like even for cooking, feeding the patients we have to from 

time to time look at what is available at the time, seasonally, and try to 

go out, because you know those produce would be cheaper seasonally, 

so we go for those, but we have to bear in mind the diet of the patients 

but we have to go search for cheaper products.” – Administrator 2 

Burden on Staff and Quality of Care 

All persons interviewed agreed that there was an increased workload on the staff. 

Some admitted to an increased burden. 

“…The staff can be stressed mentally, physically because they don’t 

have what to actually work with at times.” – Administrator 2 

Front Line Staff 1 described the burden on the nurses as extreme. 

“It was extreme because being that there is this burnt out syndrome 

among nursing staff by virtue of the fact that they had to be working 

overtime, 16 hours, and that really took a toll on the service so the 

quality of care was not satisfactory.” – Front Line Staff 1 

A majority of those interviewed agreed that there was a decrease in the quality 

of service being provided at the hospital. This they said was because of the 

extremely long waiting hours at accident and emergency, pharmacy and 

laboratory and the lack of supplies, equipment and other resources. 

48


Front Line Staff 2 said she found that at times workers were more concerned 

with the numbers accomplished at the end of the day rather than the quality of 

service provided. 

“We are more concerned about how many patients we do rather than 

qualitatively looking at how we do it.” – Front Line Staff 2. 

Informal Charges 

Front Line Staff 9 was aware of one instance of an informal charge. The patient 

had been charged for a lab investigation. The patient reported it to the Patients’ 

Affairs Officer and the money was returned and there was a meeting with the 

offender. 

Discussions before Reform 

Administrators 1 and 2 claimed there were discussions with them before the 

implementation of the policy to abolish user fees. When asked initially though, 

this was the response from Administrator 2. 

“No (pause). Well, uhm, the directors might have been consulted, the 

directors. I would suppose they have been. They had their inputs.” 


Other frontline staff denied having any discussions about the reform. They 

thought that the decision was political. 

“I think that was a political decision which was meant to win electoral 

votes.” – Front Line Staff 5 

“…It came out just before elections…It was a part of that 

administration’s strategy…So they had no time to assess and to inform 

us for us to look at us in details to see how it was going to impact 

the providers of care as well as those persons who were going to be 

accessing it here.” – Front Line Staff 1 

“The public knew and then we were told what to do because it 

was a politically driven decision.…Meetings were held where the 

information was relayed, was given out to us as to how it is going to be 

implemented, meaning that, the decision was made and the discussion 

wasn’t had.” – Front Line Staff 6 


There was no pilot study carried out on the health reform policy. 

49


Monitoring and Evaluation 

The staff admitted to there being monitoring of the services in the initial stages 

of the reform by central administrators but this has not continued. Locally there 

is monitoring within the departments with heads of departments devising their 

own way of keeping check on their affairs. The frontline staff are unaware of any 

evaluation done on the policy since its implementation to give feedback on the 

reform. 

Staff Perception 

While some persons thought that free healthcare is necessary for the development 

of a country, they all thought that there need to be changes made to the 

current policy. They all thought that it was not working efficiently as is. 


“The persons on the ground from where I am standing, we are crying 

out and saying this thing is not working and the screams, they are 

deafening…You are looking all around and you see that we are 

suffering on the frontline just from the fact that we don’t have enough 

resources to carry out basic duties.” – Front Line Staff 4 

“I think then (at the onset of the reform) not looking into certain issues 

it (removal of user fees) was welcomed but now with the challenges that 

we face with purchasing goods to cover these services then we would 

want to change our minds to say it is just not working. It is working on 

the patients’ side but looking from our perspective to have to get the 

reagents to work with, get the supplies to work with, no it’s not working. 

We need to, we need to think of something that can generate some funds 

in order to continue to provide the services at the maximum.” 


“…because we are not getting any revenue from the patients so to 

speak, we do not have any funds here to replace equipment and to 

maintain services so you find that equipment are overused, they run 

into disrepair. Some services because of the lack of funding cannot be 

maintained.” – Front Line Staff 5 

Suggestions 

The suggestions from the staff on the frontline were almost unanimous. Ten of 

the 11 staff on the frontline that were interviewed suggested that those who can 

pay for healthcare should be asked to pay. They thought that there should be 

considerations for the young and the elderly, the poor and vulnerable, but the 

working class should be asked to contribute directly to their healthcare. 

The other individual, while not saying outright that those who can pay should 

pay, did say that some health services at the hospital should carry a cost. 

50


Discussion 

Utilisation of services 

All persons except one agreed that utilisation of services at the hospital had 

increased since the abolition of user fees. This is an expected outcome and has 

been shown by studies done in many other countries where user fees have been 

abolished (Jacobs et al. 2007; Masiye et al. 2010). 

Several staff members alluded to an increase in frivolous demands made at the 

hospital after the removal of user fees. Individuals were not utilising the 

preventive care services, such as the health centres and clinics, as they should, 

and so this led to them coming straight to the hospital for minor complaints. 

Although this was a concern prior to the removal of user fees, there was an 

escalation in the misuse of the accident and emergency department. Wilkinson 

et al. (2001) commented on this when they noted that following the introduction 

of free health care in South Africa, the total number of consultations for curative 

care in the mobile unit almost doubled, while the number of consultations for 

preventive services fell. Proper education of the public would have helped to 

reduce this. 

Free healthcare? 

The abolition of user fees did not translate to totally free healthcare for the 

public. Notably, only some basic diagnostic tests were provided at the hospital 

and did not attract out-of-pocket payments. Other tests which are considered 

more revealing in terms of diagnostic properties had to be accessed in private 

facilities and there was no provision made by the government to cover these 

costs. So, if an individual required a magnetic resonance imaging (MRI) or a 

computerised axial tomography (CAT) scan, they would have to pay out-ofpocket 

for these services outside of the hospital. The investigation did reveal 

that one machine that was used for barium meals and enemas has been out of 

service since the abolition of user fees and it has not been fixed. 

The ministry has determined a list of drugs which they call Vital Essential 

and Necessary Drugs, and only these drugs, can be had free at the hospital. The 

hospital has in store drugs that are also not on this list; but to get them, the patient 

has to pay the full costs unless they have some insurance scheme that covers it. 


The public was not fully educated on the extent of the ‘free healthcare’ prior to 

the implementation of the policy. This might have been in an effort to secure 

electoral votes, as the decision to abolish user fees was through a promise made 

in the electoral campaign of the then opposing administration. 

51


Changes in Pattern of Provision 

While administrators stated that the hospital is still providing the services it did 

before the abolition of user fees, it is with extreme strain as there is not enough 

budgetary allocation to cover the operational costs and supplies necessary to 

deal with the increased utilisation. There has been some effect on the pattern 

of provision at the hospital. There is no availability of local funds to address 

matters of maintenance of equipment that may arise throughout service and this 

was seen with the machines in the radiology department which have been out of 

service with no money available to repair them. 


Notably, at the onset of the removal of user fees, all drugs provided at the 

hospital were free, but then this was changed about a year into the policy. Front 

line staff said that there was no explanation given as to why the change, but she 

did note that the bill at the end of a month during the period of all medications 

being free was in the millions. This shows that there was inadequate planning 

put into the reform and an underestimation of the cost of providing medication 

free to the population. Plans for adequate drugs and staff to cope with increased 

utilisation, and how to deal with wider drug and staffing problems in the longer 

term have to be undertaken when planning health reform (Gilson and McIntyre, 

2005). 

Budgetary Allocation 

The funding for health reform in Jamaica comes from the national budget. 

Administration was not able to identify any funding secured from any other 

source prior to the implementation of the policy. This is contrary to the advice of 

Gilson and McIntyre (2005) who stated that ‘Fee removal must be underpinned 

by action at the international level that allows for the sustained mobilisation of 

resources to achieve human rights to health, along with health equity goals’. 

Failure to adhere to this route has led to negative consequences which are 

obvious to those on the frontline. Any policy design that does not anticipate the 

increase in utilisation and provide an increase in all areas that will be affected 

by this increase is flawed and will have critical consequences. Masiye et al., 

(2010) noted that although the increase in utilisation in Zambia was somewhat 

higher than that predicted before the implementation of the user fee abolition 

policy, the planning for a major utilisation increase ameliorated potentially 

adverse consequences for quality of care. There was an increase in the budgetary 

allocation for healthcare in Jamaica but Administrator 1 noted that this was far 

from what was needed to respond to the increased utilisation. 

Effect on Staff and Quality of Care 

With the removal of user fees accompanied by increased utilisation of services, 

there has been increased wear and tear on personnel and equipment. There was 

52


no increase in staff complement to deal with the effect of the policy until recently, 

where the hospital has seen an increase in the nursing staff. The staff all agree 

to an increased workload and some admit to a greater burden now. There is no 

compensation for the increased burden on the staff. No incentives and increased 

workloads can lead to frustration among staff. They will become dissatisfied and 

this will adversely affect the quality of care provided. 

No increase in equipment, a lack of local funds to maintain and repair existing 

equipment that is overworked and malfunctioning, and increased hospital debt to 

suppliers and manufacturers are some other consequences. Creditors will reach a 

point where they will eventually stop supplying items. This has admittedly 

already begun. This path is headed towards a complete downfall of the health 

system. Nimpagaritse and Bertone (2011) noted that the suddenness of the 

decision to remove user fees in Burundi along with the lack of preparation and 

of a carefully considered planning process had critical consequences for the 

entire health system. 

Quality depreciated as it relates to waiting time. The interaction of pressures: 

increased demand on a fixed number of resources causing a fall in the supply 

and increased burden on staff is very pronounced in this case study. 

Consultation before Reform 

The lack of consultation with all stakeholders before the implementation of the 

reform was attributed to the policy being a quick follow through on an election 

promise. This does not follow the good practices framework developed by 

Hercot et al. (2011) on the successful implementation of user fee removal. 

‘Actors whose co-operation will be required in the implementation stage should 

already be involved when designing the policy. Their early-stage participation 

can help to design policies that are realistic and workable...To increase the 

likelihood of success, the reform has to be largely endorsed or at least accepted 

by the persons who will be responsible for its implementation’ (Hercot et al., 

2011). 


Gilson et al. (2003) noted from their assessment that political leaders tend to 

underestimate the technical challenges related to user fee removal reforms. 

In several countries, informants have reported insufficient consultation with 

stakeholders and technicians. In those countries where the decision to remove 

user fees was unexpected or sudden, the reform was characterized by a lack of 

preparation which generates what they perceive as weaknesses in all stages of the 

reform; the design, formulation and implementation. 

There was no pilot study done before nationwide implementation of the policy 

in 2008. A pilot study would have given information on what to expect from 

53


implementation of a user fee abolition reform. In Burundi, the decision to 

introduce the health care reform was made at the highest possible political level, 

with little participation of technicians at the Ministry of Health (at central level) 

and no involvement of health staff at peripheral level (Nimpagaritse and Bertone, 

2011). The suddenness of the decision and the lack of preparation before 

implementing the policy had critical consequences for the entire health system 

in the country (Nimpagaritse and Bertone, 2011); while the health financing 

pilot study and subsequent nationwide user fee ban at the primary care level 

implemented in Afghanistan represent the successful application of a pilot study 

to make an informed national policy decision (Steinhardt et al., 2011). 

Monitoring and Evaluation 


There was some monitoring of the policy in the early stages, but this has waned 

over time. The staff were not generally aware of any ongoing evaluation of the 

policy being carried out. This is very troublesome and is a recipe for failure of 

the policy. Monitoring and evaluation of the reform across all levels is crucial to 

follow up implementation and to check whether and how instructions are being 

followed (Hercot et al., 2011). Monitoring systems should be established to 

cover utilisation trends, including the relative use of preventive versus curative 

care, and give health workers and managers opportunities to give feedback on 

health facility experiences (Gilson and McIntyre, 2005). 

Staff Perception and Suggestions 

The perception of most of the staff is that the policy as is, isn’t working. While 

the reform may be helpful for the socially disadvantaged individual in accessing 

healthcare, the frontline workers believe that the government had not properly 

prepared for the outcomes of the policy. The suggestion is that user fees should 

be put in place for those who can afford to pay. In depth assessments should 

be carried out to properly identify individuals who are poor and vulnerable 

and they should be exempted from fees along with children and the elderly. 

Although there were exemptions made for some social cases, these were not 

being properly implemented or monitored. To combat this weakness in the past 

system, exemptions to be made for vulnerable groups would need to be accompanied 

by systems to guarantee timely access by these groups and continued 

monitoring and evaluation. 

Changes are necessary, and with the country in negotiations (2012) with the IMF 

who is pressuring the government to make serious changes to the current state 

of the public sector before any further help is given, it hangs in the balance what 

will be done about this user fee policy. 

The Caribbean Policy Research Institute (CaPri) conducted a survey of the 

no-user fee policy in public hospitals in Jamaica in 2013 (after this study was 

done and paper was completed). Their findings supported the findings of this 

54


study and researchers concluded that health workers were most concerned 

about the quality of care provided being compromised due to insufficient human 

and material resources, and were worried about the sustainability of the system 

(CaPRI, 2013). 

Limitations 

There was some resistance from the Regional Health Authority in granting 

approval for the study and so the original objectives of the study had to be 

modified. This whole process greatly reduced the time available to do the study. 

After receiving approval to conduct the study, one administrator made final 

approval on which individuals I would be allowed to interview. Interviews from 

other frontline staff members from other departments in the hospital that were 

not represented in this study could have added greater insight on the perceptions 

of the ground level workers. 

Interviews were recorded with a voice recorder and even though participants 

were informed that their views were not going to be used outside of this study 

and their names would not be used, they may have been less than honest in their 

responses out of fear of being associated with a particular statement. 

Conclusion 

The health workers at the hospital do not believe that the user fee removal 

policy has been a success. Based on the information derived from the interviews, 

there was woeful lack of planning and preparation of the policy which has 

led to critical economic consequences for the hospital. The frontline workers 

were not a part of the designing stages of the reform. The increased utilisation 

was not followed by a proportionate increase in funding or staffing. This has 

led to reduced quality of service as it relates to a lack of equipment and other 

resources, longer waiting times and an overworked and burdened staff. 

Recommendation 

The author recommends that the government commissions a detailed evaluation 

of the reform and its effects since implementation. All stakeholders; politicians, 

administrators, technicians and clinicians centrally and peripherally should be 

consulted. The findings should be used to inform any reform of the current 

policy. 

Akin, J., Birdsall, N. & de Ferranti, D. (1987). Financing health services in 

developing countries: an agenda for reform 1987 World Bank Policy 

Study. Washington, DC: the World Bank, 1987. 


Burnham, G., Pariyo, G., Galiwango, E. & Wabwire-Mangen, F. (2004) 

Discontinuation of cost sharing in Uganda. Bulletin of the World Health 

55


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in Jamaica. Available from: www.capricaribbean.com/documents/nouser-fee-policy-public-hospitals-jamaica 

De La Haye, W. & Alexis, S. (2012) The Impact of a No-user-fee Policy on 

the Quality of Patient Care/Service Delivery in Jamaica. West Indian 

Medical Journal, 61 (2), 168-173. 


Gilson L., Doherty J., Lake S., McIntyre D., Mwikisa C., and Thomas S., 

(2003). The SAZA study: implementing health financing reform in 

South Africa and Zambia. Health Policy and Planning, 18, 31–46. 

Gilson, L. (1997). The lessons of user fee experience in Africa. Health Policy 

and Planning, 12, 273–85. 

Gilson, L. and McIntyre, D. (2005). Removing user fees for primary care in 

Africa: the need or careful action. BMJ, 331, 762 – 765. 

Hadley, M. (2011). Does increase in utilisation rates alone indicate the success of 

a user fee removal policy? A qualitative case study from Zambia. 

Health Policy, 103, 244-254. 

Hercot D., Meessen B., Ridde V., and Gilson L., (2011). Removing user fees for 

health services in low-income countries: a multi-country review 

framework for assessing the process of policy change. Health Policy 

and Planning, 26 (2), 5–15. 

Jacobs, B., Price, N.L., Oeun, S. (2007). Do exemptions from user fees mean 

free access to health services? A case study from a rural Cambodian 

hospital. Tropical Medicine and International Health, 12 (2), 1391– 

1401. 

Lagarde, M. and Palmer, N. (2011). The impact of user fees on access to health 

services in low and middle-income countries (Review). The Cochrane 

Library, Issue 4. 

Masiye, F., Chitah, B.M., and McIntyre, D. (2010). From targeted exemptions to 

user fee abolition in health care: Experience from rural Zambia. Social 

Science & Medicine, 71, 743 – 750. 

McPake B., Brikci N., Cometto G., Schmidt A., Araujo E., (2011). Removing 

user fees: learning from international experience to support the process. 

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Health Policy and Planning, 26 (2), 104–117. 

Meessen, B., Hercot B., Noirhomme M., Ridde V., Tibouti A., Tashobya C., 

and Gilson L.,(2011a). Removing user fees in the health sector: a 

review of policy processes in six sub-Saharan African countries Health 

Policy and Planning, 26 (2), 16–29. 

Meessen, B., Gilson, L., and Tibouti, A. (2011b) User fee removal in lowincome 

countries: sharing knowledge to support managed 

implementation. Health Policy and Planning, 26 (2), 1–4. 

MOH. (2008). Annual Report 2006. Kingston, Jamaica. 

Nimpagaritse, M. and Bertone, M.P. (2011). The sudden removal of user fees: 

the perspective of a frontline manager in Burundi. Health Policy and 

Planning, 26 (2), 63–71. 

Pearson, M. (2004). Issues Paper: The case for abolition of user fees for primary 

health services. London: DFID Health Systems Resource Centre. 

Ridde, V. and Diarra, A. (2009). A process evaluation of user fees abolition for 

pregnant women and children under five years in two districts in Niger 

(West Africa) BMC Health Services Research, 9, 89. 

Steinhardt, L.C., Aman I., Pakzad I., Kumar B., Singh L., and Peters D., (2011). 

Removing user fees for basic health services: a pilot study and national 

roll-out in Afghanistan. Health Policy and Planning,26 (2), 92–103. 

Walker, L. & Gilson, L. (2004) “We are bitter but we are satisfied’’: nurses as 

street-level bureaucrats in South Africa. Social Science & Medicine, 59, 

1251–61. 

WHO. 2005a. World Health Assembly resolution WHA 58.31: Working towards 

universal coverage of maternal, newborn and child health interventions. 

Geneva: World Health Organization. 

WHO. 2005b. World Health Assembly resolution WHA 58.33: Sustainable 

health financing, universal coverage and social health insurance. 

Geneva: World Health Organization. 


Wilkinson, D. et al., (2001). Effect of removing user fees on attendance for | 

curative and preventive primary health care services in rural South 

Africa. Bulletin of the World Health Organization, 79, 665–671. 

Witter S., Khadka S., Nath H., and Tiwari S. (2011). The national free delivery 

policy in Nepal: early evidence of its effects on health facilities. Health 

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Policy and Planning, 26 (2), 84–91. 

Yates, R. (2009). Universal health care and the removal of user fees. Lancet, 

373: 2078 – 2081. 


58


4ACCOUNTABILITY OF EXECUTIVE 

AGENCIES: TO WHOM ? 

Dr. Valoris Smith 

59


Accountability of Executive Agencies: 

To Whom? 

Abstract 

Agencification has been examined through various strands – historical perspectives, 

convergence, variations in roles and diffusion, other countries and effects. 

The purpose of this paper is to examine the influence of the new public management 

executive agency reform on the users – the private sector organizations 

sub-sector – small- and medium-sized enterprises (SMEs); and to understand 

the accountability issues arising and to recommend strategies to address the 

implications. 


Executive agencies were implemented to facilitate greater accountability by the 

public sector agencies, which was to be achieved through the requirement to 

operate within a framework of performance agreements. Under the Executive 

Agencies Act (2002) the chief executive officer (CEO) is accountable for the 

performance of the organization. Nevertheless, there is the main accountability 

implication, inter alia, of the increased attention to the achievements of the 

key performance indicators (KPIs) by the CEOs. The KPIs are determined by 

the CEOs in conjunction with the senior managers which could be suboptimal 

(Smith, 1995) and that could easily be achievable. 

In this case study, the findings reported the agencies achievements of the KPIs, 

but the users (SMEs) views were that the agencification did not translate into the 

expected outcome or have a positive influence on the users (SMEs) operations 

and profitability (Smith, 2014). 

Accountability is equated to performance – the agencies’ performance, the 

performance of the executive agencies, CEOs – but what of accountability to the 

users? 

Keywords: agencification, new public management, accountability, performance 

60


PUBLIC SECTOR REFORM 

The veracity of public sector reform represented a significant challenge of 

determining how the reform impacted the accountability of public sector 

administration. The antecedents to the Jamaican public sector reform were 

the formation of statutory bodies or organizations; the administrative reform 

programmes of the 1980s; and privatization. 

Following the spate of reform programmes undertaken, the government recognized 

that the public sector reforms had not achieved the expected improvements 

in efficiency, and had not resulted in better service delivery from the public 

sector. Hence the Public Sector Modernization Programme (PSMP) was 

introduced in 1996. 

The Public Sector Modernization Programme sought to strengthen and reform 

the institutional framework of several government ministries, departments and 

agencies (Jamaica Information Service, 2008, March 31) through the establishment 

of performance-based institutions or executive agencies, among other 

things. The executive agency model in Jamaica was established in 1996 with 

the objective of generating “a small, effective, efficient and accountable public 

sector, capable of providing high quality services” (Tindigarukayo, n.d., p. 4). 

Consequent to this, the Executive Agencies Act No. 4 of 2002 was 

passed to formalize: “the establishment of Executive Agencies; … and the 

provision of appropriate mechanisms for proper management, accountability 

and transparency in the operations of Executive Agencies” (Government of 

Jamaica, 2002, p. 3). 

AGENCIFICATION 

The concept of agencification is defined in the Financial Instructions to 

Executive Agencies as: 


a government entity, which has been formally designated as an 

Executive Agency in accordance with the provisions of section 4 of the 

Executive Agencies Act 2002. The process for establishing Executive 

Agencies is set out in section 4(2) of the Executive Agencies Act 2002. 

(Government of Jamaica, 1999, p. 2-1.1) 

Executive Agencies are described in the Financial Instructions to Executive 

Agencies as: 

Government entities which focus primarily on the delivery of services 

with a results oriented approach to government. In exchange for 

delegated managerial autonomy, the Chief Executive Officer of each 

Executive Agency is held accountable for achieving stated results 

61


economically, efficiently and effectively. (Government of Jamaica, 

1999, p. 2-1.2) 

‘Agency’ in terms of agencification concerns an organization that is operated 

at arm’s length (structurally disaggregated) from the central government and 

functions under more businesslike conditions than the government bureaucracy 

(Talbot, 2004). 

Opinions are however divided on the extent to which agencies have become 

autonomous, efficient, effective, and accountable for their performance to their 

key stakeholders and the public in general (Talbot & Johnson, 2007). The 

adoption of agencification reform was expected to allow agencies and politicians 

“to focus on their core tasks” and “policy execution and policy development” 

(Van Thiel & CRIPO, 2009, September, p. 3). 


Located within the many different expressions of agencification are discourses 

surrounding structural disaggregation (Pollitt & Talbot, 2004; Pollitt, et al. 

2005; Talbot, 2004; Verhoest, et al. 2012); managerial autonomy (James & 

Van Thiel, 2010; Pollitt & Talbot, 2004; Pollitt et al., 2005; Verhoest, et al., 

2012), decentralization (Pollitt & Bouckaert, 2000); performance contract 

(Pollitt & Talbot, 2004; Verhoest et al., 2012); and businesslike management 

(Talbot, 2004). James and Van Thiel (2010) classified executive agencies as 

semi-autonomous organizations, without legal independence but with some 

managerial autonomy. These elements are also (all) located within the new 

public management doctrine (Aucoin, 1990; Hood, 1991). 

NEW PUBLIC MANAGEMENT 

The new public management, the intellectual antecedent to the executive agency 

model reform, promoted efficiency, effectiveness and responsiveness to the 

process of governing (Hughes, 1994; Pollitt, 1990). The doctrinal components 

of the new public management outlined, inter alia, the setting of standards and 

measures of performance, placed emphasis on output controls and advocated 

the use of private sector management techniques and practices (Hood, 1991). 

The new public management paradigm encouraged government to implement 

performance measurements against targets to encourage greater efficiency in 

the delivery of services (Mulgan, 2005). The new public management is the 

theoretical framework that focused on how the ‘new’ public sector management 

led to improvement in productivity and efficiency (Hood, 1991). 

Various common themes and trends were identified in the new public management 

literature such as decentralization of management (Pollitt, 1993, 1994, 

November); decentralization of organizations, (Ferlie et al, 1996); disaggregation 

and breaking up of traditional monolithic bureaucracy into separate agencies, 

(Dunleavy & Hood, 1994; Hood, 1991; Pollitt, 1993, 1994, November); the use 

of private sector techniques and practice (Aucoin, 1990; Dunleavy & Hood, 

62


1994; Hood, 1991); responsiveness to customer (Ferlie, et al., 1996; Osborne & 

Gaebler, 1992; Pollitt, 1993, 1994, November); and performance targets and 

measures for management (Dunleavy & Hood, 1994; Ferlie, et al., 1996; Hood, 

1991; Osborne & Gaebler, 1992; Pollitt, 1993, 1994, November). These themes 

were expected to strengthen the productivity and the efficiency of public sector 

management. The main characteristic of the new public management reform was 

the achievement of improvement in efficiency and the performance of public 

sector organizations (Pollitt, Van Thiel, & Homburg, 2007). 

Nevertheless, the new public management was seen as causing accountability 

problems in the public sector management since the established chain of 

responsibility (and accountability) was no longer in place (Caulfield, 2002; 

Haque, 2001). 

ACCOUNTABILITY 

Accountability is defined as “… a proactive process by which public officials 

inform about and justify their plans of action, their behaviour, and results and 

are sanctioned accordingly” (Ackerman, 2005). 

An additional description of accountability is that it includes, not only financial 

accountability, accountability for fairness and accountability for performance, 

but accountability for personal integrity and citizen interests (Behn, 2001). 

Accountability exists where the performance of tasks or functions by an 

individual or a body are subject to the review and evaluation by another person 

or entity and require, justification for actions or inactions. According to Kearns 

(1996) accountability refers to a broad range of public expectations dealing 

with organizations, performance and responsiveness. These expectations are 

sometimes based on performance criteria that are subjectively interpreted 

and at times even contradictory. Accountability encompasses responsibility 

for performance, and raises the question for the one held accountable of: 

accountable to whom? 


Types of accountability 

The aim of this article is not to explain all the various types of accountability, 

but to examine those that have implications for the new public management 

executive agency and to identify their accountability responsibilities. 

The four types of accountability identified were hierarchical, legal, political and 

professional (Romzek & Dubnick, 1987). With regard to hierarchical accountability, 

close supervision of individuals and low level of autonomy exist, while 

for legal accountability, external monitoring of performance for compliance with 

the established legislative mandate occurs. Political accountability, on the other 

63


hand is based on technical or objective charter, but is generally dependent on 

political perspectives. Stone (1995) included the typology of managerial 

accountability. Another type of accountability is administrative accountability 

which has two dimensions – horizontal and vertical. Horizontal accountability is 

reflected in the capacity of departments of government and ministries to monitor 

public agencies and or branches of government, or the requirement for agencies 

to report sideward. Vertical accountability, on the other hand, represents the way 

citizens seek to enforce standards of good performance on officials. 

Accountable to whom? 


Political accountability also encompasses both horizontal and vertical dimensions, 

which leads to the issue of who is accountable and responsible for the 

autonomous agencies – is it the political authority? The executive agencies 

chief executive officers are ‘politically’ accountable to the political authority 

and in some instance to the Parliament. The separation of policy-making and 

administrative functions and the managerial autonomy granted to the autonomous 

agencies tends to make political accountability more difficult to sustain. 

In spite of the foregoing, political accountability relationships foster the agencies’ 

chief executive officers and managers’ concerns for key stakeholders such as 

elected officials, clients and the public. 

Administrative accountability arises when the agencies operate in compliance 

with rules and procedures, and are accountable to a ‘superior’ administrative 

organization, an authority or an external organization that is responsible for 

supervision and control. The executive agencies are accountable to the Ministry 

of Finance and the Public Service, Monitoring Unit – the government unit with 

oversight responsibility – as the external organization that reviews the agencies’ 

performance. These entities are also accountable to the citizens under administrative 

accountability that guarantees fairness in the relationships with the 

administrative organizations. 

Professional accountability takes place in the ‘professional world’, for example 

where there are memberships in professional bodies or associations that afford 

significantly high degrees of autonomy to individuals within the generally 

accepted practices of their professions. Such individuals are accountable to 

the external organizations of which he or she is a member. The employment of 

the chief executive officers and the senior management teams at the executive 

agencies is guided by private sector employment criteria, and as such often 

results in the employment of the ‘brightest and the best’ and highly qualified 

professionals – accountable to external professional organizations. Notwithstanding 

the foregoing, this type of accountability does not fit in the general framework 

of administrative accountability and hence is not subjected to the principles 

of public administration and the new public management reforms. 

64


Democratic accountability occurs when the needs and interests of society and 

social groups are considered and there is a direct relationship between the public 

administration and these groups. The structure of democratic accountability with 

the users (citizens) evaluation criteria is suited to the new public management 

reforms and administrative management. In this case of accountability, the 

citizens and social groups force the public administration to give account for 

their acts/performance. 

The new public management executive agencies’ performance, accountability, as 

well as the accountability relationships are the subject of the following section. 

Performance 

The chief executive officers are guided by the executive agencies’ framework 

documents that set out the missions and objectives, stipulated deliverable 

out-puts, the required resources, and provide the methods of performance 

measurements and evaluations which must be utilized, as well as recommended 

rewards and sanctions based on the performance evaluations. The preparation 

of the framework documents and the performance agreements are the 

responsibility of the chief executive officers, and they are designed to ensure a 

greater measure of accountability. The chief executive officers, who report to 

the ministers, are responsible for the performance of the agencies and provide 

advice to the ‘responsible ministers’ on relevant matters (Cariforum Steering 

Committee, 2003, December). The chief executive officers are accountable for 

compliance with the framework document to the Executive Agency Monitoring 

Unit of the Ministry of Finance and the Public Service that monitors the executive 

agencies’ performance and approves the performance reports prior to 

the payments of performance incentives. The chief executive officers are also 

responsible and accountable for the executive agencies, compliance with the 

Financial Administration Act; the Executive Agency Act; Financial Instructions 

for Executive Agencies; relevant legislation, regulations and instructions. 


The chief executive officers and management teams are required to identify 

output levels and targeted service delivery results in the executive agencies’ 

business or operational plans, which are required to be consistent with the 

government priority areas. The targeted output levels must be supported by 

key performance indicators that are set out in the business or operational 

plans, and which are reported in the executive agencies’ annual reports. 

In the private sector, key performance indicators act as a tool to measure performance 

of both individuals and departments, as well as to assess the consequences 

of their performance (Zakaria, et al. 2011). Performance indicators are a 

private sector technique utilized under the new public management – executive 

agency – to measure performance. These performance indicators are targets that 

are achievable by government entities and agencies in a specific measurable way 

and in a shorter period of time than objectives. However, Van Thiel and Leeuw 

65


(2002) argued that an “increase of output measurement in the public sector can 

lead to several unintended consequences that may not only invalidate conclusions 

on public sector performance but can also negatively influence that performance” 

(p. 267). The consequences are varied. For example, the use of performance 

indicators and/or performance measurements which led to “ossification” or 

“organizational paralysis”; “tunnel vision which can be defined as an emphasis 

on phenomena that are quantified in the performance measurement scheme at 

the expense of unquantified aspects of performance” (Smith, 1995, p. 285); 

“suboptimization” (Smith, 1995, p. 287), whereby the focus was on the 

managers’ objectives rather than on the organizations’ objectives, and “fixation” 

(Smith, 1995, p. 290), where the single success factors were the emphasis 

instead of the underlying objectives. . 


Executive agency target-setting (through key performance indicators) and 

monitoring of performance are the responsibilities of the executive agencies’ 

chief executive officers and senior management employees, and are determined 

by these same individuals. Actual performance is compared to targets over 

the fiscal years by the executive agency; however employees lean towards 

emphasizing the achievements of these targets for performance incentives 

purposes, the consequences of which are suboptimal performances, or tunnel 

vision. 

Nevertheless, performance is measured by the achievement of its key performance 

indicators by the new public management executive agency reform. The 

Executive Agencies Act (2002) and the Financial Instructions to Executive 

Agencies (Government of Jamaica, 1999) indicate that performance indicators, 

performance measurements method, and evaluation of the agency must be 

included in the agencies’ framework document. Performance indicators and 

the method of performance evaluation, among other things, are included in the 

framework document of executive agencies. The chief executive officers are 

required to sign the performance agreements, and are held accountable for the 

achievement of the key performance indicators of the agencies. 

Empirical study indicated that the performance indicators/targets were achieved 

in the majority of instances (Smith, 2014). However, there were negative 

implications for the small- and medium-sized enterprises (in the construction 

industry) that despite the key performance indicators of the executive agencies 

being achieved in most instances, their clients were of the view that the 

agencification had adversely affected the performance of their organizations 

and had not resulted in the anticipated positive impacts on their organizations’ 

operations (Smith, 2014). 

The cases 1 were seen as focused on the achievements of targets and outputs, 

and not outcomes (Smith, 2014). The general consensus of this particular set of 

participants was that improvements in service delivery were based on targets and 

66 

1 

National Environment and Planning Agency, and National Land Agency – Case study (Smith, 2014)


outputs which were determined by the chief executive officer and management 

staff, as against outcomes. The views of the respondents were that the executive 

agencies have hindered their performance and that agencification was insufficient 

to influence the performance of their organizations or enterprises, and that 

in fact, the agencies’ emphasis was on achievement of targets, outputs and 

performance and not on the outcomes (Smith, 2014). According to Romzek 

(2014) “when an agency’s managerial focus is on inputs and its tasks are routine, 

hierarchical accountability, with limited discretion is an effective alignment” 

(p.35). However, performance is based on the relationship between inputs, 

outputs and outcomes. In fact the changed emphasis from inputs, processes 

and outputs to outcomes is reflected in the rhetoric of public sector reforms. 

Researchers need to be aware of the accountability challenges that come with 

public sector reforms. For example, what of the managers’ comfort zone with the 

‘new’ autonomy? Are the ‘old’ accountability relationships discarded prior to the 

‘new’ accountability relationships being fully implemented and accepted by the 

managers? The focus on outcomes not only encourages efficiency and effectiveness, 

but provides a different approach to accountability, as there would be a 

smaller number of outcomes rather than a greater number of outputs. 

Empirical studies carried out on Next-Steps 2 agencies in the United Kingdom 

on the use of performance indicators and their impact on performance, found 

improvement in performance (although from the managers’ perspectives), in 

addition to increased use of key performance indicators (Pollitt, 2005). The 

United Kingdom experience suggested that setting the right number of targets 

was important stated by Limb (2001) that “the ideal would be 5-8 key 

targets for each agency”; and the concentration of targets on key things that 

matter to service-users such as “outcomes rather than inputs or processes/ 

activities” (p. 27). Notably, the importance of “service processes and outcomes” 

is supported by the post-new public management initiative – the new public 

governance – as against the emphasis on “service inputs and outputs” under the 

new public management (Osborne, 2006, p. 383). 


CONCLUSIONS 

The increased attention to key performance indicators as determined by the 

chief executive officers in conjunction with the management teams, could be 

sub-optimal as supported by the finding of empirical study (Smith, 2014). 

Agencification was found not to have translated into the expected outcomes or to 

have a positive influence on the small- and medium-sized enterprises’ operations 

and profitability. 

The new public management agencies and chief executive officers are purported 

to be accountable to the “ministers” through ‘political’ accountability; for the 

performance of the agencies through administrative accountability to external 

organizations with responsibility for supervision and control; and for profession- 

2 

The Jamaican public sector modernization programme implemented the establishment of executive agencies 

which are based on the United Kingdom ‘Next Steps’ model. 

67


al accountability to a lesser extent. What of the issue of accountability to the 

users? Democratic accountability supports accountability relationships among 

the agencies, and social groups such as citizens and private sector organizations. 

The private sector organizations must be made aware of the roles, targets, and 

outputs of the agencies and their connectivity to overall outcomes and policies of 

the government. 

Further thoughts are: what are the effects of public sector reforms on employees’ 

accountability? Are employees made more accountable under the ‘new’ public 

management reforms than they were before? What is the best way to manage the 

expectations of the users – the agencies and their staff, the ministers – that rely on 

differing accountability relationships? 


68


References 

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Discussion, Social Development Papers No. 82, Washington DC: World 

Bank. 

Aucoin, P. (1990). Administrative reform in public management: Paradigms, 

principles, paradox and pendulums in governance. International 

Journal of Policy and Administration, 3, 115-137. 

Behn, R. D. 2001. Rethinking Democratic Accountability. Washington, DC, 

Brookings Institution Press. 

Cariforum Steering Committee. (2003, December). The Executive Agency 

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72


CONTRIBUTOR’S BIOGRAPHY 

Edwin Jones is a professor of Public Administration, University of the West 

Indies and recipient of the Vic Chancellor’s Awards for Excellence in Academia 

and Public Service. An outstanding scholar and the doyen of Public Administration 

in the Caribbean region. 

Carolien Klein Haarhuis is researcher at the Research and Documentation Centre 

(WODC), Division of Justice Administration, Legislation, International and 

Aliens Affairs Research (RWI). The WODC forms part of the Department of 

Security and Justice in The Hague, the Netherlands. 

Monika Smit heads the research division Justice administration, legislation, 

international and alien affairs (RWI) at the Research and documentation centre 

(WODC) in the Hague, the Netherlands. Before that, she was senior researcher at 

the Bureau of the Dutch national rapporteur on trafficking in human beings, and 

assistant professor Child & Youth Care at Leiden University. 

Anton Weenink is a senior researcher in the Central Unit of the National Police 

of the Netherlands. He studied public administration at Twente University, 

where he also earned his doctorate. He published on international relations, 

Eastern European organized crime, crime and governance in the Caribbean, 

and terrorism. His current research is about behavioural issues in radicals. 

Roelof-Jan Bokhorst is a judge in the court of Den Bosch, The Netherlands, 

formerly working as researcher at the Ministry of Justice / Research and 

Documentation Centre (WODC). 

Shanise Allen is a PhD candidate at Lancaster University holding a MSc. in 

Public Administration and Development from the University of Birmingham. 

She is also a registered physiotherapist whose experience includes practice in 

Jamaica, Grenada and the Turks and Caicos Islands. 

73


CONTRIBUTOR’S BIOGRAPHY 

Valoris Smith achieved her Doctorate of Business Administration (DBA) at the 

Mona School of Business and Management, University of the West Indies, Mona. 

Dr. Smith also attained her Master in Business Administration (MBA) in Finance 

and Banking from the Mona School of Business and Management, University of 

the West Indies, Mona. She is a Fellow of the Chartered Association of Certified 

Accountants (FCCA) and a Fellow of the Institute of Chartered Accountants 

of Jamaica (FCA). She currently lectures Finance and Banking to both 

undergraduate and graduate students at the University of Technology, Jamaica. 

73

Caribbean Journal of 

Public Sector Management 

This issue of the Journal addresses the state of governance in 

Jamaica, efficacy of governance in small states, relationships, 

between decision making and governance, and accountability of 

stakeholders. The MIND anticipates that the sharing of this 

information will improve accountability, probity and transparency 

among public bodies in order to contribute to a more compliant, 

responsive, efficient and effective public service. 

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