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Management Institute for<br />

National Development<br />

Training for Public Service Excellence<br />

Caribbean<br />

Journal of<br />

Public Sector<br />

Management<br />

<strong>Volume</strong> 12 Number 1<br />

January 2017<br />

. . .<br />



Management Institute for National Development<br />


Copyright © January 2017<br />

Management Institute for National Development<br />

All rights reserved<br />

No part of this publication may be reproduced, stored in a retrieval system, or transmitted<br />

in any form or by any means, electronic, mechanical, photocopying, recording,<br />

scanning or otherwise, except as described below, without the permission in writing of<br />

the publisher.<br />

Copying of articles is not permitted except for personal and internal use, in the case of<br />

brief quotations embodied in critical reviews and certain other non-commercial uses<br />

permitted by the National Copyright Law.<br />

Statements and opinions expressed in the articles are those of the individual contributors<br />

and are not statements and opinions of the Management Institute for National Development<br />

(MIND).<br />

Designed and Published by the Management Institute for National Development<br />

Kingston Jamaica 2017

Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

Training for Public Service Excellence<br />

Caribbean Journal of<br />

Public Sector Management<br />

The Caribbean Journal of Public Sector Management (<strong>CJPSM</strong>) is an annual publication<br />

of the Management Institute for National Development (MIND) aimed at promoting<br />

research through the sharing of information on matters pertaining to governance, public<br />

policy and public sector management, engaging the widest possible audience both<br />

locally and regionally. The <strong>CJPSM</strong> takes a multi-disciplinary approach and is the main<br />

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

objectives of the <strong>CJPSM</strong> are to:<br />

1. Serve as a forum for the exchange of information on public sector<br />

management practices throughout the region.<br />

2. Provide an avenue for the dissemination of multi-disciplinary research<br />

on a wide range of topics relating to the Caribbean public sector.<br />

3. Contribute to the professional growth and development of policy makers,<br />

managers, researchers, trainers and stakeholders with an interest in the<br />

Caribbean public sector.<br />

4. Educate its audience on achievements, innovations, developments and<br />

experiences, in management throughout the Caribbean public sector.<br />

5. Explore influencing factors in policy formulation, implementation and<br />

monitoring of the Caribbean public sector.<br />

Since the first publication in 1999, the MIND has collaborated with several agencies<br />

including the Caribbean Center for Development Administration (CARICAD), the<br />

University of the West Indies (UWI) St. Augustine and the Caribbean Leadership<br />

Project (CLP).<br />

The publication of the <strong>CJPSM</strong> will disseminate original research on public sector<br />

issues, thus stimulating new ideas, through fundamental and applied research, identify<br />

critical problems, provide solutions, and assess possible roadmaps for future trends.<br />


Management Institute for National Development<br />


Editor-in-Chief:<br />

Managing Editor:<br />

Associate Editor:<br />

Line Editor:<br />

Copy Editor:<br />

Graphic Design:<br />

Dr. Ruby Brown<br />

Mr. Kirk Frankson<br />

Mr. Christopher Thomas<br />

Ms. Janet Morrison<br />

Ms. Marlene Campbell<br />

Mr. Shawn McEwan<br />


The current issue was edited by a prestigious panel of reviewers, representing<br />

a multiplicity of disciplines. They are well-known and respected academics<br />

and practitioners engaged in the field of governance, public administration,<br />

sociology, health economics and research.<br />

• Professor Neville Duncan<br />

Professor Emeritus and former Director of the Sir Arthur Lewis Institute<br />

of Social and Economic Studies<br />

University of the West Indies, Mona Campus<br />

Jamaica<br />

• Professor Edwin Jones<br />

Professor and former Head of the Department of Government<br />

University of the West Indies, Mona Campus<br />

Jamaica<br />

• Dr. Aldrie Henry Lee<br />

Senior Research Fellow and Director of the Sir Arthur Lewis Institute of<br />

Social and Economic Studies<br />

University of the West Indies, Mona Campus<br />

Jamaica<br />

• Dr. Stanley Lalta<br />

Research Fellow<br />

Center for Health Economics<br />

University of the West Indies, St. Augustine Campus<br />

Trinidad and Tobago<br />

• Mr. Peter Stoyko<br />

Chief Social Scientist and Information Designer<br />

Elanica, Ottawa<br />

Canada<br />


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />


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

became operational February 1, 1994, with a mandate “to provide effective<br />

leadership development programmes and management training appropriate to<br />

all levels, and in line with the demands of a modern and competitive public<br />

service”. In 1999, MIND was accorded Executive Agency Status in keeping<br />

with the Public Sector Modernisation thrust. This decision was aimed at raising<br />

the level and capacity of the public service to implement and fast track the<br />

modernisation programme.<br />

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

organisational and leadership development institute in Jamaica, serving the<br />

Caribbean”. Bolstered by our mandate and vision, our mission is, “to provide<br />

public servants with quality leadership development options, management<br />

training, supporting services and outreach that sustain a culture of enterprise,<br />

efficiency and responsiveness to the publics they serve”. The mission is undergirded<br />

by our core values of: Customer-focus, Professionalism, Integrity, Results<br />

Oriented and Teamwork.<br />

MIND and its predecessor organisations have been providing training since<br />

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

tertiary level institution. MIND’s suite of learning products, including its special<br />

learning initiatives (Forums, Conferences, Workshops, Public Lectures and<br />

Consultancy Assignments), demonstrates the Agency’s commitment to develop<br />

an effective, competent and forward looking public service equipped to undertake<br />

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

offered at the Certificate, Diploma, Associate of Science Degree and Post<br />

Graduate Diploma levels. On an annual basis, we deliver over one hundred and<br />

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

thousand five hundred (4500) participants in Scheduled and Customised training<br />

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

resource development with an emphasis on Leadership and Management.<br />

Over the years MIND has forged and or leveraged critical partnerships and<br />

collaborations with local, regional and international learning organisations and<br />

donor agencies, to strengthen its capacity to provide a coordinated and integrated<br />

approach to deliver first class leadership development and management training<br />

to the public sector and allied sector professionals.<br />


Management Institute for National Development<br />

Table of Contents<br />

Preface<br />

Kirk Frankson<br />

V<br />

State of Governance and Governance of the<br />

State of Jamaica<br />

Professor Edwin Jones<br />

1<br />

Governance and Safeguarding Institutions in<br />

Small Islands: A Case of Aruba (2009-2011)<br />

Dr. Carolien Klein-Haarhuis, Dr. Monika Smit, Dr. Anton Weenink<br />

and Roelof-Jan Bokhorst<br />

13<br />

Free Healthcare in Jamaica.<br />

Frontline Workers: Walk a Day in our Shoes<br />

Shanise Allen<br />

39<br />

Accountability of Executive Agencies: To Whom?<br />

Dr. Valoris Smith<br />

59<br />


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

Preface<br />

The Management Institute for National Development is pleased to present this<br />

issue of the Caribbean Journal of Public Sector Management, with a focus on<br />

Governance and Accountability: Good Governance is important as governments<br />

grapple with balancing effective allocation of resources, exercising power,<br />

allowing participation by the citizenry, deliver services to its stakeholders<br />

while undertaking meaningful reforms. The main thrust globally is to reform<br />

public sector institutions in order to overcome several common problems such<br />

as bureaucracy, corruption, the concentration of power and ineffective institutions.<br />

The United Nations further notes that Good Governance is anchored<br />

on eight major pillars; accountability, consensus, participation, transparency,<br />

responsiveness, efficiency and effectiveness, equity and inclusiveness and reduced<br />

corruption.<br />

Foremost Caribbean Scholar and authority figure on governance, Edwin Jones<br />

elucidates that Governance and Accountability are important variables that may<br />

be negatively affected by favours and notes that Governance and Accountability<br />

in Jamaica have focused on the reform of public sector institutions and policies<br />

as they contend with the problems in Jamaica which include but are not limited<br />

to:<br />

1. Entanglement in bureaucratic red tape.<br />

2. Featherbedding; overstaffing the state with political appointments<br />

through nepotism and patronage.<br />

3. The absence of creativity and bad business decisions.<br />

4. Clientelism due to the capturing of the state by special interests that<br />

use the state for their purposes.<br />

He posited the view that the Jamaican state must stick to reform process as the<br />

long term solution. He further opined that over the last twenty years corruption<br />

has become a major challenge for governance and accountability. He provides<br />

at least two other necessary but insufficient conditions excluding constitutional<br />

reform by concluding that Jamaica is currently on the best pathway to achieving<br />

governance and accountability since independence. Most importantly, he identifies<br />

the need for the construction of a leadership infrastructure.<br />

In the second article Klein-Haarhuis et al. from the Research and Documentation<br />

Centre in The Hague provide empirical data to conclude that favours extended<br />

in a dynamic of close relationships in small states, negatively affects governance<br />


Management Institute for National Development<br />

and accountability. The authors postulate that public sector employees share the<br />

responsibility for safeguarding governance and therefore policy and guidance<br />

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

Authors outline several principles and best practices that provide guidance to<br />

employees operating within an acceptable ethical framework, without consideration<br />

for favour, in order to ensure good governance and accountability.<br />

Shanise Allen, Doctoral Student and Physiotherapist, addresses the perception that<br />

the desire to appeal to political emotions could adversely influence the decisions and<br />

behaviours of actors in the public sector as opposed to consultation, preparation and<br />

planning. In her contribution the removal of user fees and its concomitant perceived<br />

increase in health care while supporting the larger strategic goals: Millennium Development<br />

Goals, Sustainable Development Goals and Vision 2030 was hampered by<br />

the exclusion of key stakeholders in the decision making process. Empirical research<br />

by the author indicates that issues of governance made on the basis of favour will<br />

result in negative externalities, in this case economic and operational consequences<br />

including longer waiting times and reduced quality of service. Thus the author<br />

concludes that favour induced decision making without regard for adequate consultation<br />

and planning resulted in increased frustration by all stakeholders and lower<br />

quality of services at several health care facilities.<br />

Valoris Smith, Lecturer and Chartered Accountant makes the case that lack of<br />

accountability to too few stakeholders or to the wrong group of stakeholders could<br />

create a myriad of issues resulting in low levels of trust and support among end<br />

users. In the final article the author examines the impact of public management<br />

executive reform on accountability amongst small and medium sized enterprises.<br />

Smith concludes that the accountability framework of public sector agencies needs<br />

to be expanded to effectuate accountability not just to the few stakeholder but to the<br />

larger stakeholder group; the end users.<br />

The MIND anticipates that by sharing information from this Journal it will bring<br />

awareness to issues of governance, accountability, probity and transparency among<br />

public bodies in order to contribute to the achievement of a more compliant,<br />

responsive, efficient and effective public service.<br />


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />




Professor Edwin Jones<br />

VII<br />


Management Institute for National Development<br />

State of Governance and<br />

Governance of the State of Jamaica<br />

Governance & Accountability: Fair or Favour<br />


The main issues raised in this address are for the most part still current and<br />

relevant to the Jamaican political economy situation. Since the original presentation,<br />

however, the governance issue of corruption has attracted extensive<br />

debates, institutional reforms and continuing policy-based focus. [See postscript<br />

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

organizing theme - governance. There is now fulsome agreement among scholars<br />

and practitioners that governance should be understood as ... a set of processes<br />

and practices involving multi-agency partnerships; a blurring of responsibilities<br />

between public and non-public sectors; a power dependence between organizations<br />

involved in collective action; the emergence of self-governing networks<br />

and the development of new governmental tasks and tools.<br />

Practitioners are usually more interested in those dimensions of governance<br />

that concentrate on its overlapping themes: processes, practices and tasks. As<br />

process, governance is about winning commitment to a wide range of pluralistic<br />

institutional structures and arrangements. In a word, the idea of governance is to<br />

build a culture of political partnerships.<br />

Promotion of a new set of universal rules and regulative principles is the second<br />

idea of the governance process. Generally this means establishing frameworks<br />

of predictability in the policy environment; agreeing on principles to promote and<br />

guarantee human rights; offering guidance for conflict resolution. Its cementing<br />

force is social trust. Essentially, trust sharpens recognition of a common future.<br />

It strengthens resolve to take action in furtherance of collective purpose. It builds<br />

reciprocity or commitment to invest in one another’s enterprises psychologically<br />

and materially. Trust is often built on the success of past action.<br />

Further, the governance process is about problem solving and opportunity<br />

creation. It therefore requires society to build all-round socio-political capacity<br />

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

improving the organizational capacity of the state to design and implement<br />

appropriate policies and efficiently deliver policy products. It involves too,<br />

improving society’s monitoring and auditing capabilities to forestall crises in<br />

governance. In particular, it involves strengthening the analytical capacities<br />

of citizen 1 activists. Capacity building for good governance usually involves a<br />

programme of ‘opportunity creation’ that is universal, collective and equitable.<br />

2<br />

1 A Public Address by Edwin Jones delivered at the MIND

Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

Fourthly, a sustainable governance process must focus on a vision of holistic<br />

development, which is why the World Bank conceptualizes governance as the<br />

‘management of a country’s economic and social resources for development’.<br />

So much for process; now we can point to practical tasks and implications of<br />

the governance agenda.<br />

• The first principle is collective action, thus implying the need to build<br />

cross-organizational arrangements of co-strategizing, co-steering and<br />

co-managing for problem solving purposes. This idea also embraces<br />

the notion of ‘joined up government’- a seeking after synergy through<br />

innovative coordination.<br />

• The second task of governance concerns the search for power sharing;<br />

social forces working with government, but retaining a degree of<br />

autonomy from the state.<br />

• Thirdly, governance is good for nothing without transparency.<br />

Accordingly, it requires that transparency must walk on five legs:<br />

voice, representation, information, choice and accountability.<br />

• In the fourth place, all advocates of governance accept the need for<br />

society-wide reform; involving changes in structures and methods,<br />

relationships and purposes, roles and responsibilities. This vision<br />

of organizational, managerial and relational change is to make<br />

government, the private sector and the civic realm perform better.<br />

The implication of meaning is more complicated than that however good<br />

governance reflects strong ideological roots, in favour of ‘marketization’. It<br />

embodies major ambiguities and tensions especially evident in a professional,<br />

technocratic language that is confusing and seductive. The governance<br />

philosophy underestimates the risks and challenges involved in searching for<br />

collaborative advantage in a context where the ethic of ambiguity and reticence<br />

is strong. Jamaica is a case in point.<br />

State of Governance & Governance of the State of Jamaica<br />


Jamaica, ambiguity, paradoxes and therefore, contradictory impulses and<br />

orientations beset the search for a new governance order. The historic sense<br />

of the majority of a people being wronged and deprived represents a readymade<br />

foundation on which to build a governance infrastructure. Colonialism,<br />

lop-sidedness in administering the independence project, and post-adjustment<br />

experiences consolidated that sense; but because these experiences tended to<br />

benefit the few and disadvantage the many, they naturally encouraged varying<br />

degrees of acceptance and rejection of governance initiatives.<br />


Management Institute for National Development<br />

Simultaneously, powerful international forces were to help impart push and pull<br />

effects on efforts to build the governance infrastructure. Architects of the globalization<br />

movement promoted governance as its instrumental, central doctrine,<br />

driven by special techniques. Its instrumental value promised a new democratic<br />

order and ‘marketization’ as catalysts for national economic development.<br />

It also promised an antidote to corruption and fiscal irresponsibility as well as<br />

meaningful reform of the state. Its marketing techniques would be as coercive as<br />

they were seductive.<br />

Governance & Accountability: Fair or Favour<br />

The typical coercive content includes ‘conditionalities’ set by the international<br />

technical bureau, departure from which would be punished as acts of ‘bad<br />

governance’. Its professional language is both instrumental and seductive. It<br />

is the language about ‘participatory’, ‘de-regulatory’, ‘inclusionary’ and ‘costeffective’<br />

processes. As such, it is appealing to most stakeholders: politicians,<br />

business people, public administrators, rights advocates and the ordinary man<br />

in the street. The language employed also conveys little or no meaning to people<br />

outside the technocratic circle and is, therefore, a source of confusion<br />

and manipulation for them. So in effect, the policy products of this governance<br />

ideology are usually distributed lop-sidedly, exciting ambivalent orientations of<br />

acceptance and rejection. Nonetheless, a dedicated core of independent local<br />

advocates has been willing to press for a new culture of governance, with or<br />

without external impetus.<br />

Moves to politicize the social sphere attract further ambivalence to the<br />

governance project and norms. By-products of such politicization are evident<br />

in the triumph of partisan interest over the public interest. Within this politicized<br />

environment public discourse is typically conducted in partisan frameworks<br />

and partisan distribution of the public largesse becomes the norm. Thus, the<br />

sense of public duty and responsibility is effectively stifled. This means that<br />

governance initiatives requiring social cooperation are easily defeated by the<br />

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

which constricts the space for social capital formation and encourages commitments,<br />

across the board, to ‘beating the system’. In these and other ways,<br />

clientelic politics shapes the manifesto for public disorder and discord as well as<br />

social ambivalence about commitment to common governance strategies.<br />

All these conditions deepen the sense of crises of governance in this deformed<br />

political order. One expression of such crises may be observed in a turn away<br />

from political objects and symbols generally. Increasing crime rates and<br />

unorthodox forms of protest also constitute reliable evidence of chronic crisis.<br />

Continuing non-transparent governmental transactions reflect other symptoms<br />

of that condition. Nothing demonstrates ambivalence towards these crises more<br />

than the failure of collective vision to create and seize opportunities to confront<br />

them in a determined fashion.<br />


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

Some incapacity and much incompetence in the public and private domain<br />

complicate the situation because there is little motivation to experiment. Thus,<br />

for instance, Westminster-type governmental arrangements that little predispose<br />

to power sharing continue to encumber the ground because they are viewed as<br />

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

social exclusion, cynicism and the systemic nature of corruption are subverting<br />

the meaning of governance. Skilful leadership is obviously needed to convert<br />

these deficits into assets?<br />

Alas, the relevant leadership cohort has obviously not yet managed to bring<br />

about common understanding of these crises, much less mobilize the appropriate<br />

problem-solving tools. It seems unable to perform the strategic brokerage<br />

role that would deliver collaborative advantage. Nor has the available leadership<br />

collectively evidenced the legitimacy, mastery and craft to effectively umpire<br />

divergent interests and orientations in society. So this profile disguises a major<br />

paradox. For when operating in discrete sectors and establishments this same<br />

community of leaders appears, for the most part, imaginative, creative and<br />

sensitive to the art of performance. The challenge, then, is to realign the paradoxical<br />

leadership orientations.<br />

Realignment though, would require retreat from our strong and continuing<br />

anti-intellectual tradition. Elements of this tradition are evident in the willingness<br />

to celebrate uninformed viewpoints in the public discourse and suspicion<br />

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

ideology manifests in social expressions of self-doubt, short attention<br />

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

to viewing even objective and sincere criticisms as personal attacks.<br />

This lack of critical tradition creates special difficulties for collective civic action,<br />

for it makes social learning and unlearning a problematic enterprise. To be sure,<br />

it has generated and reinforced habits of apathy, quiescence and distraction, as<br />

well as those of suspicion and ‘grudgefulness’. None of these characteristics is in<br />

harmony with the vision of good governance.<br />

State of Governance & Governance of the State of Jamaica<br />


It is the case, however, that the principal governance-seeking organizations in<br />

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

the past decade or so. Although their agenda and behaviour have become<br />

more extensive and sophisticated, in many respects they remain constrained or<br />

compromised by ambivalence and resource shortage. We can briefly illustrate,<br />

starting with the status of corporate governance, understood simply as ‘the way<br />

big organizations are directed and controlled’.<br />

The Private Corporate Sector<br />

Once upon a time it used to be said that the private corporate sector was<br />

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


Management Institute for National Development<br />

condemned for being inward looking and for avoiding the challenges of ‘social<br />

responsibility’. Some research scholars also characterized the private corporate<br />

sector as too slow to learn how markets work and too willing to regard its<br />

regulatory pillars as unethical, unnecessary and dangerous.<br />

Others contend that certain representatives of this sector have never been committed<br />

to meeting standards of corporate governance, for they identify fully with<br />

a culture of secrecy. They tend to assign board membership on honorific rather<br />

than on technical-managerial criteria. They are often insensitive to the interests<br />

of employees and external stakeholders. With the growing materialization of<br />

contemporary life, elements within the private corporate sector would be caught<br />

up in some other well-known ‘bad governance’ practices.<br />

Governance & Accountability: Fair or Favour<br />

Which is why a new corporate governance order is still being negotiated on<br />

bases of corporate self-restraint and better regulatory and monitoring frameworks.<br />

Moreover, for the cultivation of a complete governance culture in society,<br />

corporate self-denying ordinances must be strengthened. Existing regulatory<br />

systems must be harmonized and refined. Enforcement mechanisms must be<br />

better resourced, and consumer society must be better organized and educated.<br />

Yet, there is balm in Galahad. A better sense of sound corporate governance is<br />

emerging. It is reflected in abandonment of some old patterns of behaviour and<br />

underlying beliefs. Commitment to the idea of progressive partnerships appears<br />

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

people to invest in research and human capital development. Equally positive<br />

is the trend of integrating young, qualified, external stakeholders as board<br />

members. All this portends a new determination to lay the foundations for better<br />

corporate governance. What is happening in the civic realm?<br />

Governance Orientations within the Civic Realm<br />

No one can deny the growth of civic activism in favour of good governance<br />

principles and practices. Nor can anyone deny their determined and continuing<br />

struggle especially against corruption, abuse of rights and public power, party<br />

tribalism and government ineffectiveness. Their advocacy has won ‘victories’,<br />

stimulated needed change, and raised social consciousness but practice has<br />

been contradicted by ambiguities. We concentrate on the last theme as a way of<br />

pointing to alternative approaches to opportunity creation and problem solving.<br />

Resource problems in money, leadership and analytical capabilities as well as<br />

social reach are some powerful sources of ambivalence in the civic realm. These<br />

problems reflect in remarkably urban-centred engagement. Notice too, that<br />

under-funding has exposed the so-called network of civil society partners to real<br />

and potentially compromising reliance on various forms of official and external<br />

sponsorship, and herein reside possible risks: some already manifest in intense<br />

internal competition for sponsorship, others likely to incline commitment to the<br />

sponsors’ own agenda.<br />


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

Additionally, these resource problems account for lopsided and unorthodox<br />

forms of protests that often inconvenience society and alienate sympathizers.<br />

Moreover, they evince a pattern of social advocacy and action that may be read<br />

to mean, protest against abuse of citizens’ rights, but not against abuse of the<br />

rights of agents of the state.<br />

Communities should protest bad governance mainly on their own behalf, rather<br />

than in joined-up, common cause. Trade unions must press governance claims,<br />

but only on behalf of their members, not on behalf of labour in general and so<br />

on. So there may be need for a tutorial on demand-making strategy.<br />

Good advocacy strategy usually obeys the path and sequence of issue identification,<br />

serious research or mobilization of evidence negotiation or bargaining<br />

around the evidence petitioning and claim making – then agitation and demonstration<br />

as actions of last resort. Here, however, the dominant style often proceeds<br />

differently. It tends to skip stages, often starting with agitation and demonstration.<br />

The approach is largely adversarial and threatens to devalue itself because<br />

a significant portion of public opinion considers it irrational, lopsided, insincere<br />

and partisan. How strategies are packaged and marketed therefore remains a<br />

major challenge to our governance-seeking organizations, in this place and at<br />

this time. Perhaps, however, the greatest sin besetting the expansion and maturity<br />

of civic activism in Jamaica is the retreat from investment in real, rather than<br />

symbolic coalition formation. Commitment to collaborative approaches is the<br />

greatest asset that civic formations can bring to the democratic governance<br />

process. For the simple logic of coalition building hangs on experience that<br />

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

problems and the best way to attract socio-political attention and response.<br />

Additionally, it helps to promote and consolidate legitimacy and shared learning.<br />

Thirdly, collaborative institutional arrangements carry opportunities for joint<br />

sharing of best practices, costs and risks. Moreover, civic collaboration is<br />

instrumental because it makes society more informed, more intelligent, more<br />

involved and therefore more defensive of governance principles. Yet, there<br />

is reticence to exploit the benefits of coalition building. Much of this tutorial<br />

applies to the state.<br />

State of Governance & Governance of the State of Jamaica<br />

The State-Governance Nexus<br />

On the shoulders of the Jamaican state should rest the burden of leading the movement<br />

towards democratic governance, but we already know its record of shortfalls<br />

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

First is the need to revitalize and extend the overall programme aimed at reforming<br />

the state. Among other things, that task involves opening wider the relevant gates<br />

so that transparency in official transactions may walk on its five legs; further<br />

de-bureaucratizing the administrative machinery; effectively controlling corruption<br />

and committing fully to the “De-Donification” of our politics.<br />


Management Institute for National Development<br />

The second challenge concerns retiring structural inadequacies and the ‘bullyriding’<br />

tactics of police, bureaucrats and other agents of the state that now<br />

devalue human rights and frustrate the administration of justice. In the third<br />

place, the state must offer stronger leadership to consolidate the idea that power<br />

best serves its social purpose when it is shared. Power centers other than the<br />

executive and the political party are what drive democratic governance. Society<br />

must collectively build such centers itself, as shared responsibility.<br />

Governance & Accountability: Fair or Favour<br />

Our Shared Responsibility & Conclusion<br />

The starting point toward improving the overall governance infrastructure therefore<br />

involves new ways of thinking: Thinking upside down; thinking inside out;<br />

thinking in frameworks of positives, not negatives. These forms of thinking<br />

require radically different modes. They involve drawing on the range of<br />

available technical knowledge and on the cultural wisdom from below. They<br />

involve concentrating on what elevates rather than what undermines the national<br />

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

Bible is central to these forms of thinking.<br />

We may add that these forms of thinking involve both reflective and futuristic<br />

styles, styles that focus on major historical forces that affect the governance<br />

agenda, styles that contemplate the medium and long term and better techniques<br />

for opportunity creation and problem solving.<br />

Meaningful coalition building on the basis of trust is the next collective<br />

responsibility. A lively spirit of voluntarism, much training, and civic education<br />

are central to that enterprise. Equally necessary are the sense of interdependence,<br />

the sense of a common future as well as the sense of equality, where no one partner<br />

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

for disrespect of differences, jealousy and opportunism.<br />

Self-evidently then, all modern societies need a governance programme to help<br />

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

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

role in order to insure that our project survives.<br />

So I conclude with five basic observations that may stimulate action and debate.<br />

First: Although there are many surrounding problems, our governance project<br />

has perhaps never been in a better, more promising state since the colonizers<br />

arrived in Jamaica. Let the debate begin.<br />

Second: I suggest that perhaps our sharpest governance deficit resides in the<br />

absence of a public philosophy focused on building a new moral and leadership<br />

infrastructure. Without this, society would neither be able to coordinate<br />

divergent social interests into policy nor build the sense of civic responsibility,<br />


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

social restraint and mutual obligation implicit in the governance idea. Let the<br />

building of that public philosophy begin.<br />

Third: Notice that women now appear to form the activist core of the contemporary<br />

struggle for good governance. That activism has served us well, but it<br />

must now be combined with deeper and wider masculine inputs. Let us hasten<br />

that social formation.<br />

Fourth: Do you not agree that public scrutiny of the corporate governance<br />

arrangements is the least developed part of our programme? Left in that state, the<br />

continued ‘marketization’ process would become more risky, more unbalanced<br />

more unethical and more dangerous. Let us balance the scales and avoid those<br />

awful possibilities.<br />

Finally: Even the best organized collective approach must contemplate the longterm<br />

nature of the struggle for reform of Jamaica’s governance arrangements<br />

for in reality such reforms require cultural shifts, which are the most difficult<br />

processes to realize. Let us make the time available and invest greater effort to<br />

secure that change.<br />

I thank you, and God bless.<br />


Corruption has many facets and nuances. It has been defined as “a transaction<br />

between the public and private sectors such that public goods are illegitimately<br />

converted into private-regarding pay offs”. In this jurisdiction it generally<br />

represents lack of moral commitment and integrity among public and private<br />

actors. Here too, political and administrative corruption tend to co-exist and<br />

reinforce each other. It is a problem of governance. Its most common forms<br />

involve the award of government contracts; conflicts of interest on the part of<br />

those directly involved in making decisions; partisan distribution of land and<br />

implementation of public works projects; weak government monitoring and<br />

auditing systems; non-transparent campaign financing associated with the<br />

leveraging of kickbacks; and inadequate funding of the civil service. Domestic<br />

corruption has also taken on a ‘cross border’ dimension, especially positioning<br />

organized crime to use the profits of illegal enterprise to bribe public officials<br />

and infiltrate legal businesses and political parties.<br />

State of Governance & Governance of the State of Jamaica<br />

We emphasize three dominant motivations that appear to propel corrupt<br />

practices throughout the region. Self-interest and greed are a powerful motivator.<br />

Commitment to ‘market fundamentalism’ seems to strengthen these impulses. A<br />

permissive environment of social tolerance, weaknesses in public administration<br />

and decline in the probity of public and private actors also enable the exercise<br />


Management Institute for National Development<br />

of corrupt motives. Secondly, the relatively unequal bargaining power of<br />

public and private organizations and individuals spawns another motive.<br />

Arguably, the incentive for ‘grand’ corruption is heightened because of unequal<br />

relations between ‘powerful private interests’ and ‘underpaid and undermotivated<br />

public officials’. Of course, ‘grand corruption and petty corruption’<br />

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

increased opportunities and stirred motivations towards corruption – through nontransparent<br />

private treaties.<br />

Governance & Accountability: Fair or Favour<br />

Domestic corruption imparts negative effects on the society. Overall, it<br />

undermines the quality of democratic institutions and public policy. Equally,<br />

it undermines revenue collection capacity, contributing to fiscal weaknesses<br />

and macroeconomic difficulties. It tends to lower investment and economic<br />

development, thereby retarding the poverty alleviation drive. Corruption reduces<br />

efficiency and imposes additional tax on business and society. It leads as well<br />

to the expansion of the informal economy. Widespread corruption also brings<br />

government into disrepute and encourages cynicism about political objects and<br />

public policy.<br />

While the need to combat widespread corruption is recognized, public attitudes<br />

have been ambivalent and reform measures accordingly piecemeal. In reality<br />

there are no quick fixes, but experience suggests a manifesto for reform. Its<br />

underlying strategy focuses on ‘prevention, enforcement, public awareness and<br />

support, as well as institution building.’ Thus, certain authorities (e.g., Rondinelli<br />

and Cheema 2003) recommend that the following approaches may be tried, viz:<br />

• Create strong political will as the basis for effective anti-corruption<br />

programmes<br />

• Focus on prevention and changing systems through changing values,<br />

creating a culture of professionalism and training, providing adequate<br />

pay and ensuring deterrence<br />

• Identify government activities most prone to corruption and review<br />

both substantive law and administrative procedures<br />

• Enforce accountability mechanisms and learn from good practices<br />

and examples of others. Enact comprehensive anti-corruption legislation.<br />

• Establish broad ownership of reforms, among others, by creating<br />

strong partnerships with civil society and the private sector<br />

• Make corruption high risk and low profit<br />


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

Strategy should guide these reform actions. Credible reform requires that<br />

politico-administrative and private institutional leadership stand, in every way<br />

possible, above the taint of corruption. Nor is reform possible without fundamental<br />

change in the way public policy is made and administered. Logic dictates<br />

too that reform be directed at creating new beneficiaries who will defend the<br />

anti-corruption drive. To avoid institutional shelter it must be discussed openly.<br />

Timing also matters. Corruption will not wither away because of reform or<br />

because of economic growth. Effective reform is most likely in time of great<br />

crisis and dissatisfaction with the status quo. Sustainability of effort often<br />

requires a permanent anti-corruption commission. All the issues discussed so<br />

far appear to have implications for all citizens of Caribbean states including<br />

those living abroad.<br />

State of Governance & Governance of the State of Jamaica<br />


Values<br />

Customer-focused<br />

Integrity<br />

The core values that guide the actions,<br />

transactions and behaviours of the MIND Team<br />

Vision<br />

Statement<br />

To be the pre-eminent and preferred<br />

public service training, organisational<br />

and leadership development institution<br />

in Jamaica serving the Caribbean<br />

Professionalism<br />

Teamwork<br />

Results-Oriented<br />

Mission<br />

Statement<br />

To provide public servants with quality<br />

training and leadership development<br />

options, supporting services and<br />

outreach which sustain a culture of<br />

enterprise, efficiency and responsiveness<br />

to the publics they serve<br />


Caribbean Journal of Public Sector Management, Vol. XI No. 1, March 2016<br />



A CASE OF ARUBA (2009-2011)<br />

Dr. Carolien Klein-Haarhuis, Dr. Monika Smit,<br />

Anton Weenink and Roelof-Jan Bokhorst<br />


Management Institute for National Development<br />

Governance and Safeguarding<br />

Institutions in Small Islands:<br />

A Case of Aruba<br />

Abstract<br />

Governance & Accountability: Fair or Favour<br />

This contribution examines the quality of governance in microstates. It contains<br />

the report of an empirical study into the practice of Aruba. According to the<br />

literature, realizing counterweights to public administration is a challenge in<br />

small-scale settings: human capital is limited and people regularly encounter<br />

each other in various social roles. Two important safeguarding institutions were<br />

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

fields of administrative decision-making were studied: public procurement and<br />

the granting of residence permits. The findings support the hypothesis that the<br />

interplay of capacity problems and closely knit social relations complicate the<br />

administration’s impartiality and also render it difficult to safeguard it.<br />

Keywords: checks and balances, governance, microstates, public procurement,<br />

residence permits<br />


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

1. Introduction<br />

This contribution examines the quality of governance in small islands. The<br />

practice in Aruba constitutes the case study. Aruba enjoys an autonomous status<br />

within The Kingdom of the Netherlands. This Caribbean island with a surface<br />

area of 193 square kilometres has approximately 108,000 inhabitants. This<br />

situates it on the dividing line between a microstate and a mini-state (Oostindie<br />

and Sutton 2006, 10).<br />

Aruban public administration has been set up according to the Dutch organizational<br />

model of public administration, as is shown by the Aruban Staatsregeling<br />

(‘constitution’). This constitution prescribes a parliament elected according to<br />

proportional representation (the Staten), an Advisory Council, and the Aruban<br />

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

a Protocol was drawn up in 1993 between Aruba and the Netherlands.<br />

It included, among other things, a focus on good governance. It also contained<br />

agreements to institutionalize legitimacy, transparency and accountability as<br />

major features of the governance structure.<br />

From 2009 to 2011, the Research and Documentation Centre (WODC) of the<br />

Ministry of Security and Justice in the Netherlands carried out a study on the<br />

‘state of governance and on the maintenance of ‘law and order’ in Aruba. The<br />

study was commissioned by the Minister of the Interior and Kingdom Relations<br />

and the Aruban Prime Minister. The major reason was the idea that ‘concerning<br />

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

problems mentioned pertained to alleged corruption or conflicts of interest; a<br />

poor functioning of the Staten and thus of democracy; and the failure to<br />

operationalize a number of the agreements set down in the 1993 Protocol,<br />

including establishing a procedure for the funding of political parties. The chain<br />

for maintaining law and order was alleged to show several weak links, also<br />

because of a shortage of staff at the Public Prosecution Service and the Criminal<br />

Investigation Bureau. Furthermore, a number of high profile cases were alleged<br />

to heavily over-burden the prosecution of other criminal cases. Shortly before<br />

the final signing of the research commission in November 2009, a change of<br />

government took place. The AVP (the Aruban Popular Party) took over from the<br />

MEP (Movimiento Electoral di Pueblo) as the majority party.<br />

In many parliamentary democracies, the functioning of checks and balances<br />

such as parliaments and audit offices are taken for granted. Yet, for small islands<br />

the realization of such counterweights to public administration constitutes a<br />

continuing challenge. People do encounter each other daily in various social<br />

roles, which serve to compromise the administration’s impartiality and make it<br />

difficult to guarantee it. These circumstances make it more necessary to have<br />

effective safeguards which are scrupulously implemented.<br />

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


Management Institute for National Development<br />

Based on the findings of the afore-mentioned study (Weenink, Klein-Haarhuis,<br />

Bokhorst and Smit 2011), this paper focuses on the extent to which the important<br />

independent safeguarding institutions – the Aruban Staten (parliament) and the<br />

ARA – succeed in performing their monitoring and correcting roles. This paper<br />

also seeks plausible explanations for the extent to which these tasks have been<br />

adequately executed. This will be supplemented with a description of some<br />

practical experiences in two important fields; the interaction between society<br />

(citizens and companies) on the one hand and public administration (procurement<br />

and immigration policy) on the other.<br />

Relevant theoretical and empirical literature on good governance in small-scale<br />

contexts is examined to establish a suitable explanatory framework.<br />

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

Governance & Accountability: Fair or Favour<br />

2.1 Good governance<br />

The multidimensional concept of ‘good governance’ has been interpreted, in<br />

more detail in various ways, in an international context, for instance by the<br />

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

The dominant interpretation emphasizes economic management supported by<br />

an efficient bureaucracy, based on a transparent, participatory and accountable<br />

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

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

Neo-institutionalists start from the assumption that governments and their<br />

constituent parts have and pursue their own interests (see also criminologist<br />

Felson 2009). How any organization performs strongly depends on the way<br />

in which both the internal relations and the relations within the organization’s<br />

environment have been arranged. With regard to the quality of governance, the<br />

literature often discusses problems of limited integrity and serious corruption<br />

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

In this context, the World Bank refers to the work of neo-institutionalist<br />

Robert Klitgaard, who has summarized this insight into a simple formula:<br />

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

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

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

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

Good governance = A - (M + D)<br />

Monopoly power (M) represents the power of officials to portion out favours,<br />

for instance when jobs, subsidies, permits and contracts are allocated. The D<br />

stands for the discretion exercised by these officials, their headroom to let their<br />

16<br />

1<br />

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

while good governance actually comprises more. Klitgaard is President and University Professor, Claremont<br />

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

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

Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

own interest (or that of potential followers, relatives or others) prevail over the<br />

public interest without violating the law. Complex regulations and unclear<br />

competences may encourage less transparency and thus lead to an increase in<br />

discretion. Whenever power and discretion go together, this provides officials<br />

with the opportunity to hand out favours for their own benefit or that of friends<br />

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

consider the issuing of permits and exemptions and the granting of subsidies and<br />

government contracts to be fertile areas for such practices. This opportunity is<br />

contained when institutions such as parliament and the audit office – the A in the<br />

formula – are able to exercise effective supervision on the government. To sum<br />

up, good governance is the upshot of limitations placed on the exercise of power<br />

and the reduction of discretionary headroom, on the one hand, and effective<br />

safeguarding of institutions, on the other.<br />

Aruba’s safeguarding and other institutions have been modelled after the Dutch<br />

system, yet the circumstances under which they function are quite different. The<br />

most notable and unchangeable difference is that of scale – a small face-to-face<br />

tiny island state versus an infinitely larger and more complex country.<br />

2.2 Governance in a small scale society<br />

Based on empirical data from the World Bank, Oostindie and Sutton (2006)<br />

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

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

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

Netherlands Antilles which, in his view, are unable to attain the Dutch level of<br />

good governance. The global image of governance in the small-scale overseas<br />

territories is therefore neither ‘negative’ nor simply ‘positive’.<br />

Quantitative empirical research into the effects of scale on corruption has not<br />

yielded any unequivocal outcomes. According to Knack and Azfar (2003), there<br />

is no clear empirical connection between population figures and the extent of<br />

corruption, while theoretical explanations allegedly point in different directions.<br />

Based on corruption figures from research among companies, Amin (2011)<br />

argues, however, that corruption occurs less often in countries with low population<br />

figures than in countries with large populations. This would fit in with the<br />

argument that a small scale generates better results and therefore leads to less<br />

corruption. In order to achieve economic stability and success, the nation’s<br />

limited resources must be used as efficiently as possible.<br />

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

According to several authors, a small scale influences administrative decisions<br />

and acts directly, through the often more intimate social relationships, as well<br />

as indirectly, through the effectiveness of formal (safeguarding) institutions<br />

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

according to the theory are examined.<br />

2<br />

The control of corruption, rule of law, voice and accountability, regulatory quality, political stability and the<br />

absence of violence and government effectiveness.<br />


Management Institute for National Development<br />

Less capacity and a low level of specialization<br />

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

a government, causing relatively high recurring costs to burden the community<br />

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

number of public tasks to be accomplished is small. This also goes for small<br />

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

that a post will remain vacant or will be taken up by people with a lower<br />

education or less expertise than would be the case in a more populous country<br />

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

influencing the quality of governance is the relatively low level of specialization<br />

(Munneke 1994; Nauta 2007; Oostindie and Sutton 2006). Small countries<br />

frequently have only one administrative layer (cf. Borman 2011). Different<br />

competences are often concentrated in one hand, while they are spread over<br />

different administrative levels and positions in larger societies (see also World<br />

Bank 2001).<br />

Governance & Accountability: Fair or Favour<br />

The lack of staff and low level of specialization also affect the safeguarding<br />

institutions. A bicameral system, for example, is not feasible in many small<br />

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

personnel to staff the safeguarding institutions (see, among others, Oosting<br />

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

become clear more quickly which official is responsible for a specific decision or<br />

action, and therefore who is accountable for it (Oostindie and Sutton 2006).<br />

Social and physical proximity<br />

The smaller a community is, the greater the likelihood that citizens and officials<br />

will be acquainted, not only formally, but also informally. Because social<br />

relations are more often multiplex (Verbrugge 1979), an official’s formal<br />

performance may result in informal sanctions or rewards from his social<br />

surroundings (World Bank 2001). An official who decides negatively about an<br />

application for a building permit, for example, may encounter opposition in<br />

his role as brother or neighbour. In other words, multiplexity complicates the<br />

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

A small scale society also leads to physical proximity. Contactability provides<br />

the opportunity to reach agreements, whether these constitute a transgression<br />

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

increases the power (M) of the individual official; in a manner of speaking, the<br />

minister not only decides on part of the national budget but also on individual<br />

applications for permits, which involve private interests. In addition, in a smallscale<br />

society, each vote carries relatively significant weight during election time.<br />

This may tempt administrators even more to give specific voters preferential<br />

treatment. Since the yield of personal attention paid to individual voters is<br />

comparatively large, voters and candidates will maintain a more direct and<br />

sustained relationship than they would have in large-scale societies. Such<br />

18<br />

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

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

(AUSAID 2009, 33, 46).

Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

relationships may hamper the impartial execution of formal duties. This easily<br />

generates at least the appearance of a conflict of interest. Yet, whether this<br />

actually happens also depends on the degree of effectiveness of safeguarding<br />

institutions.<br />

The relatively great power monopoly (M) of administrators combined with the<br />

‘discretion’ (D) and ‘proximity factors’ mentioned earlier, means that safeguarding<br />

institutions have an even more important task in effectuating ‘accountability’<br />

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

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

is not possible and pressures towards partisanship are considerable, means that<br />

special attention must be paid to mechanisms ensuring impartiality of administration<br />

and justice’.<br />

Again, the aforementioned aspects of social and physical proximity will also<br />

affect the safeguarding institutions. Any member of the Audit Office who<br />

assesses the administrative decision-making process to have been ineffective,<br />

may expect to encounter disapproval in another social role (World Bank 2001).<br />

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

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

supervision (…) and auditing (…). However, collusion can occur between the<br />

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

for members of parliament who are critical of the actions of administrators. 4<br />

Similar to limited manpower, social and physical proximity may also work to<br />

the advantage of safeguarding institutions: it becomes clear more quickly who is<br />

responsible for any possible slips.<br />

3. Study design<br />

The research period runs from the second half of the 1990s to the moment of the<br />

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

all to prevent memory effects – the study has focused on the years prior to the<br />

commission.<br />

We began by studying written material related to aspects of good governance<br />

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

Dutch-Aruban) fact-finding or advisory committees of international organizations<br />

such as the IMF (on government finances) and studies by individuals.<br />

We also studied sources from both checks and balances and enforcement<br />

institutions, such as annual reports and annual surveys, or research reports<br />

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

(CAD), the Advisory Council, or studies carried out on behalf of political<br />

parties. We have also obtained material from the Criminal Investigation Bureau<br />

and the Public Prosecution Service. We have used the studied material for the<br />

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

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

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

(AUSAID 2009, 46).<br />


Management Institute for National Development<br />

preparation as well as the validation of (findings from) a large number of semistructured<br />

interviews. 5 The interviewees were, among others, representatives<br />

from safeguarding institutions, politicians – including members of the Staten<br />

and the government; officials, representatives from enforcing institutions and<br />

immigration services; representatives from the business world and civil society;<br />

and several former functionaries. The interviews lasted more than two hours<br />

on average. The combination of data collecting techniques helps to obviate the<br />

weaknesses of individual methods. Variable recall of events among respondents<br />

constitute a threat to the validity of data. We have counteracted this as much as<br />

possible by confronting the respondents with information from written material.<br />

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

science and the science of public administration (see, among others, Brewer and<br />

Hunter 2005).<br />

Governance & Accountability: Fair or Favour<br />

Now, we will first discuss the functioning of two important safeguarding<br />

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

administrative decision-making: public procurement and the granting of residence<br />

permits.<br />

4. Safeguarding institutions: the performance of parliament (the Staten)<br />

and ARA<br />

4.1 The Staten: Aruban politics<br />

Capacity and independence<br />

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

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

of the Staten provide it with ample opportunity to monitor the government.’<br />

Similar to the Dutch system, the Aruban Staten have the right of initiative, of<br />

amendment, of inquiry, of demanding changes in the Budget, of interpellation<br />

and of moving a motion. The Rules of Procedure for the Staten prescribe the way<br />

in which the Staten assembles, while the Staten Chair sees to their observance.<br />

The plenary sessions of the Staten are public and, since 2010, the minutes can be<br />

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

and the standing and special committees are not public.<br />

In some respects, however, the authority of the Staten members is confined by<br />

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

the Staten when drawing up their own budget: 6 limitations on the speaking time<br />

allotted to Staten members which do not apply to ministers; and the appointment<br />

of the Staten Chair by the government, even if this happens on the Staten’s<br />

recommendation. The government also appoints the staff of the Secretariat.<br />

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

20<br />

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

and in the Netherlands.<br />

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

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

Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

Roles played in practice<br />

Just as much as the government is required in small-scale Aruban society to<br />

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

also required of parliament. This requires the 21 Staten members to possess a<br />

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

certain amount of specialization of the activities, but even then, each Aruban<br />

Staten member is part of several committees, while the one-man party Partido<br />

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

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

Members has increased, while the technical support for party specialists and<br />

the secretariat with regard to legislation is said to be insufficient (Fesca 2003a;<br />

Swaen 2011).<br />

The role of the Staten in the budgetary process has been limited since Aruba<br />

gained its autonomous status. Up to 2012, governments structurally presented<br />

their budgets late and budget overruns were sometimes approved afterwards.<br />

The Advisory Council has repeatedly denounced the practice of retroactive<br />

adaptation of budgetary laws. 8 To this day, annual accounts have never been<br />

discussed in the Staten. The goal of the Staten, formulated at the end of the<br />

1990s, to deal with the annual accounts pertaining to the 1987-1996 period<br />

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

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

accounts have not been audited. The CAD considered them to be impossible<br />

to check. The Land’s Expenditure Committee, established in 1998, seems to<br />

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

to finally be able to discuss the annual accounts, with support from the Dutch<br />

Lower House.<br />

Through the years, Staten members have made use of the right to pose questions<br />

to the government, yet in the decade before 2009 more than half of the questions<br />

submitted in writing remained unanswered. As of yet, there is no information on<br />

the ratio of answered and unanswered questions after 2009. In 2011, however,<br />

the Staten did criticize some ministers for their failure to provide answers.<br />

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

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

............................................................................................................<br />

7<br />

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

aw).<br />

8<br />

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

authorization were also concerns (RvA 2006).<br />

9<br />

Repeatedly, the ARA found considerable problems in the annual accounts. Government services and agencies,<br />

especially the Finance Directorate, were heavily criticized for the many gaps in their administrative organization<br />

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

10<br />

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

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

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

advice, but it cannot enforce its recommendations<br />

11<br />

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

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

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

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

21<br />

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

Management Institute for National Development<br />

The foregoing suggests that, during the past decade, the Aruban Staten has made<br />

limited use of its supervisory authority and also had little grip on the executive<br />

branch. Various respondents characterized political relations through the years as<br />

essentially monistic, to such an extent that the Staten has insufficiently fulfilled<br />

its supervisory task. As such, monism and parliamentary supervision are not<br />

incompatible, but according to several observers, on Aruba, it obstructed a sound<br />

functioning of parliamentary democracy. Bakker (2000), among others, has<br />

alleged that when a majority of the Staten supported the government, members<br />

of the opposition bypassed the Staten in taking their issues directly to the Public<br />

Prosecutor and the Dutch government. In this respect, since 2009, a change<br />

seems to have set in. The governing party has regularly posed questions to its<br />

own members of government. 12<br />

Governance & Accountability: Fair or Favour<br />

Polarization and patronage<br />

According to all respondents who commented on Aruban politics, since its<br />

Separate Status, the island has constantly suffered from a polarized political<br />

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

MEP, represent the two poles, while smaller parties usually find it hard to obtain<br />

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

uncompromising attitude towards the other party and has interfered with an<br />

objective discussion of subjects that could not be deemed truly controversial.<br />

This is still the current situation. Polarization is thought to harm parliamentary<br />

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

is solely focused on the electorate”. Party discipline may rob Staten members<br />

of an incentive to criticize their ‘own’ ministers concerning political content,<br />

thus eroding the Staten’s supervisory function. The consequences become most<br />

clearly noticeable if one party holds an absolute majority, as was the case after<br />

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

contributed to the docile attitude of the government parties in the Staten. 13<br />

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

importance of campaigning (Fesca 2003a). The considerable amount of money<br />

raised externally for political campaigns – without any legal regulation –<br />

reinforces the impression that donations have not been made selflessly. Whether<br />

unsolicited or after being asked, several respondents confirmed this image of a<br />

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

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

new bill to the Staten. 14<br />

22<br />

............................................................................................................<br />

12<br />

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

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

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

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

the party relatively weak.<br />

14<br />

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


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

4.2 The Aruban Audit Office (ARA)<br />

An important supplier of information to the Staten is the ARA. According to the<br />

Aruban constitution, the ARA is entrusted with the investigation of the efficiency<br />

and legitimacy of the country’s receipts and expenditures. The Land’s Regulation<br />

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

the ARA is to receive surveys from every ministry and every other official<br />

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

and such. This authority also extends to state companies, statutory bodies and<br />

institutions subsidized by the government. Ministries and other official bodies<br />

are legally liable to supply these items. The ARA can use the investigative<br />

results of the CAD (Article 24 paragraph 3, LARA).<br />

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

enterprises, institutions and budgetary funds (Article 24 paragraph 1 and<br />

2, LARA). The Accountability Regulation obliges ministers to draw these up<br />

once every year and send them to the ARA. The subsequent task of the ARA is<br />

to report detected deficiencies or irregularities to the Staten and the Governor,<br />

if prior consultation with the Minister of Finance has not yielded satisfactory<br />

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

annual report.<br />

Capacity and independence<br />

Despite the ARA’s authority, at least up to 2006, proposals have circulated<br />

to adapt the LARA for the purpose of accentuating the checking tasks and<br />

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

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

advice. In addition, the privatization of the ARA with regard to its finances, staff<br />

and planning, which was recommended by a governance committee (Croes et al.<br />

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

to appoint its own staff, even though the selection procedure is done by the<br />

ARA’s Board and the staff is accountable to this Board. For the realization<br />

of the remainder of its budget, the ARA is also dependent on the cooperation<br />

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

budget itself, just like the Advisory Council and the Staten. According to the<br />

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

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

staff of approximately six people needs to be expanded.<br />

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

The role played in practice<br />

The ARA checks the annual accounts, produces annual reports (which include<br />

shorter sub-investigations) and conducts a study into a designated subject on<br />

average every three years. During the past decade, the ARA did not always<br />

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

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

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


Management Institute for National Development<br />

A faulty registration made this checking difficult or even impossible, as had been<br />

proven in the case of the non-examination of the Aruban annual accounts by the<br />

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

systems for the granting of permits.<br />

In general, the ARA reports have a good reputation in terms of quality and<br />

objectivity. They focus on the facts and when irregularities have been found,<br />

the responsible members of government are called to account for them. Our<br />

respondents cast doubt, however, on the question, whether the reports focused<br />

on the most urgent aspects of the quality of governance. 16 The ARA has sometimes<br />

also been accused of inertia.<br />

Governance & Accountability: Fair or Favour<br />

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

people involved have stated. Close social relations make it hard to voice any<br />

criticism as regards content without this being considered a personal attack. As<br />

several respondents stated, members of the ARA repeatedly had to endure public<br />

criticism by the government, which they learned from the media, among other<br />

channels.<br />

Response by the government and the Staten<br />

The response of the government and the Staten to studies by the ARA can be<br />

called limited, to say the least. The ARA presents its findings to the responsible<br />

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

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

b). In three cases, the ARA considered the responses incomplete and unsatisfactory.<br />

Only a part of the responsible government members responded, for example,<br />

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

According to the ARA, the reactions it received were often insufficiently<br />

specific. Contact with the ministers from the MEP government was minimal.<br />

Through the years, Staten members, responded inadequately to the ARA<br />

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

assemblies of the Staten. This is a deficiency, yet also a failure to appreciate the<br />

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

ARA, the government and the Staten have been intensified after 2009. At the<br />

beginning of 2010, in consultation with the Dutch National Audit Office, the<br />

Prime Minister, the Minister of Finance and the Staten Chair laid down their<br />

pursuit of an Operation Accountable Order in a memorandum. In May 2011, the<br />

ARA presented a strategic policy plan, with the intent to conduct its investigations<br />

more productively and independently in the future. 17<br />

5. Two integrity-related cases: public procurement and residence permits<br />

Since the extent to which good governance exists has to primarily be shown by<br />

the decisions made in concrete cases, we have examined the practice of different<br />

24<br />

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

about the legitimacy of the use of public means.<br />

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

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

Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

government actions that are vulnerable with regard to integrity. In the following,<br />

we will present cases in two fields in which the integrity of those involved has<br />

been compromised: public procurement and the granting of residence permits.<br />

5.1 Public procurement<br />

In general, the integrity of decisions made regarding public procurement is<br />

vulnerable because of the interaction between the government and private<br />

enterprise. With regard to government contracts, integrity problems occur when<br />

an official allows his choice to be influenced by something done in return by a<br />

company that benefits him personally, instead of focusing on criteria of efficiency.<br />

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

every country – even those at the high end of the honesty index such as the<br />

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

This vulnerability makes an effective legal framework absolutely necessary<br />

(CAD 2010.04).<br />

Regulatory framework<br />

According to the Aruban Audit Service (CAD), the aim of the regulation of<br />

procurement is ‘to have control over the costs and to encourage the transparency<br />

of the decision-making process’. The Aruban rules for procurement are included<br />

in the Accountability Regulation of 1989 (CV 1989). Article 25 of the CV 1989:<br />

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

of hand, 18<br />

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

up to either public tender or private tender (when a limited number of<br />

companies are asked to submit a tender),<br />

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

public tender.<br />

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

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

Decree on private contracts does not exist. In addition, with regard to public<br />

contracts, the WTO decrees that it is prohibited to discriminate against foreign<br />

bidders (ARA 2005b). The WTO rules also apply to governmental Public<br />

Limited Companies and foundations according to an internal overview of<br />

legislation (dated May, 18, 2010), whereas the contracting procedures of the<br />

Accountability Regulation of 1989 do not. 19 The Finance Directorate is in charge<br />

of checking whether the Accountability Regulations are observed. Article 26<br />

CV 1989 provides the reasons that may justify a deviation from the prescribed<br />

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

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

impossible or inefficient, may the contract be granted out of hand. A deviation<br />

from a public tender must be motivated in the Ministerial Order that generates<br />

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

18 1.00 Afl. is 0.56 US$.<br />

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

htm#articleIV.<br />

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<br />

the minister involved, the signature of the Prime Minister is required.<br />


Management Institute for National Development<br />

the deviation. 20 Article 26 leaves unresolved whether this must be done before<br />

or after the granting, but in 2005, the ARA pointed out the desirability of getting<br />

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

results in nullity of contract (article 31). A member of government who<br />

knowingly violates the rules commits a malfeasance and is liable in both civil<br />

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

Code). 21<br />

Governance & Accountability: Fair or Favour<br />

Practice: The Fondo case and beyond<br />

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

procurement occurred. The case resulted in a lengthy lawsuit, in which members<br />

of government and officials had to account for alleged criminal violations of the<br />

public procurement rules. A number of building contractors were prosecuted for<br />

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

the rules stricter in response to the aforementioned committee report by Croes<br />

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

regarding the Fondo Desaroyo Nobo San Nicolas (FDNSN). The suspicion was<br />

that, during the AVP period of 1999-2001, officials and politicians had accepted<br />

contributions to the campaign war chest of individual politicians from companies,<br />

in exchange for contracts for building and maintenance projects.<br />

The lawsuit, which took place from 2002 until 2008, was accompanied by much<br />

political commotion, to the extent that the Public Prosecution Service, the ARA<br />

and the Court of First Instance (GEA) were accused of partiality, while the<br />

government was accused of attempted influencing. In the heavily polarized<br />

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

preceding the lawsuit, both the Truth Commission (2002) and the ARA carried<br />

out an investigation into the Fondo issue. The Truth Commission concluded,<br />

among other things, that corrupt acts had been committed, in particular in<br />

connection to public contracts in the context of a redevelopment plan for the<br />

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

at the request of the Staten, chiefly focused on the ‘Sasaki Fund’, in which<br />

25 million Aruban Florins had been deposited for payment of the costs of the<br />

property developer PDN San Nicolas, who financed projects under the flag of<br />

FDNSN. According to the ARA, a violation of the procurement rules of<br />

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

therefore a deviation from the rules had taken place without any apparent<br />

motivation.<br />

Other procurement issues<br />

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

Fondo case, the acting AG urged the Staten Chair to start a parliamentary inquiry<br />

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

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

were examined. 22 The number of Ministerial Orders drawn up by the various<br />

26<br />

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

the OLA party to the payment of Afl. 670,000 damages.<br />

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

100,000 for which no Ministerial Orders were found.

Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

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

these decisions against four criteria: the mention of a budget item, the mention<br />

of the financial scope of a project, a clear project description, and the additional<br />

signing by another minister. The majority of the decisions did not meet these<br />

criteria. It thus turned out that the problems regarding procurements and<br />

Ministerial Orders were not over during the period of MEP government following<br />

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

the Public Prosecution Service came across ‘a practice of many years of<br />

exceptions to the Accountability Regulation’. 24 The Public Prosecution Service<br />

mentioned, for example, observed contracts awarded out of hand without any<br />

attempt to follow a private procedure; missing motivations for deviations in<br />

accordance with article 26 CV 1989 in approximately 20% of the cases; and the<br />

use of literally the same motivations in 50% of the cases. According to the<br />

Public Prosecution Service, “the motivation of urgency was surprising, since the<br />

procurement pertained to an annually returning activity. It was also surprising<br />

that for two identical cases, the special qualities of one candidate were called<br />

upon, while two other candidates possessed the same qualities but were nonetheless<br />

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

letter to the Staten Chair.<br />

The Public Prosecution Service was of the opinion that, in the first instance, it<br />

was the task of the Staten to check the government’s procurements and applied<br />

its line of policy to prosecute or investigate a ministerial malfeasance only if it<br />

had been committed in combination with a general offence such as forgery. Yet,<br />

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

public, the Staten failed to respond.<br />

The procurement cases on which similar doubt was cast sometimes involved<br />

large sums. A problematic procurement trajectory in 2005 regarding a refuse<br />

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

florin in bureaucratic and judicial red tape against an estimated project size of 7<br />

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

After 2004, the ARA stopped taking stock of procurement issues. In 2010, the<br />

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

the financial year 2008 (CAD 2010.04). The results confirmed the impression<br />

that, in most cases, the procurement rules had not been observed: in none of<br />

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

Ministerial Order drawn up. A Ministerial Order had been formulated in only<br />

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

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

with CV 1989 articles 25 and 26.<br />

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

............................................................................................................<br />

23 In addition, in an investigation into the government investments in 2002 and 2003, the CAD concluded: ‘[t]he<br />

abandonment of putting contracts up for public tender is more often rule than exception’. The CAD also observed<br />

that the procedure for inviting tenders was frequently ignored and that the regulations of the WTO agreement<br />

regarding government contracts are not included in Aruba’s regulatory framework (CAD 2005.04, 3).<br />

24<br />

‘Tussenstand inzake de Namdar-zaak’ [‘Situation so far regarding the Namdar case’], press communiqué issued<br />

by the Aruban Public Prosecution Service, 17 April, 2008.<br />


Management Institute for National Development<br />

Governance & Accountability: Fair or Favour<br />

Threats to integrity<br />

Two aspects relating to the rules for procurement provided officials with the<br />

discretion (‘D’) which in principle enabled them to favour close relations without<br />

placing themselves outside the law:<br />

1. The possibility to deviate from the procurement rules through a<br />

Ministerial Order without any sound motivation, since the reasons for a<br />

deviation described in article 26 were not precise enough. As the CAD<br />

has stated: “Precisely because of the lack of clarity, these arguments are<br />

often (…) not used as intended when the procedure of putting up a<br />

contract for public or private tender is abandoned. In fact, this abandonment<br />

is no more than a formality. It is peculiar that the law has created<br />

these simple possibilities” (CAD 2010.04, 7-8).<br />

2. The lack of a procedure for private procurements. According to the CAD,<br />

this is the reason why tenders did not have to meet any technical requirements,<br />

for instance, which made it impossible to compare them (CAD<br />

2010.04).<br />

Furthermore, in practice the manifold deviations from the rules did not seem to<br />

have any consequences. Usually, the deviation was brought about by drawing up<br />

a Ministerial Order only after the Land had been committed. The contract had<br />

now been signed and the bypassing of the procurement procedure was adjusted<br />

by means of a decision, thus side-lining the Staten and the judge. At other times,<br />

no Ministerial Order was used to deviate from the procurement rules. In these<br />

cases, the problem turned out not to be too much discretion (D) but ineffective<br />

safeguarding mechanisms (too little A). This being said, the ARA, CAD (and<br />

the Advisory Council) have been reporting violations of the CV 1989 and have<br />

already been making recommendations for improvement for over twenty years.<br />

The response of the Staten members to these actions, however, left a lot to be<br />

desired. This confirms the picture of political monism. The fact that, in principle,<br />

the Public Prosecution Service only swung into action when the violation of CV<br />

1989 coincided with a general offence and otherwise referred the case to the<br />

Staten, possibly meant a further weakening of the counterweight (A) perceived<br />

by administrators.<br />

The procurement regulations were the subject of debate in the Staten again in<br />

the spring of 2011. The Minister of Finance responded in April of that year with<br />

the statement that improvement in this area is desirable and that a study group is<br />

now examining the rules for procurement. 25<br />

5.2 Residence permits<br />

Because of the incessant labour and other forms of migration to Aruba, immigration<br />

policy is of vital importance to the island. Until the end of the 1990s Aruba<br />

had a strong net influx of migrants. Between 1988 and 2006, the Aruban<br />

28<br />

25 ”Parlement gehinderd door uitblijven beantwoording Statenvragen” [“Parliament hindered by delayed answers to<br />

Staten questions”], Amigoe, 28 March, 2011; “Overheidsaanbestedingen nog steeds niet goed geregeld” [“Public<br />

procurement still not regulated properly”], Amigoe, 21 April, 2011.

Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

population increased annually by an average of 3%, from more than 60,000<br />

to 102,000 inhabitants. In the new millennium, in particular after 2005, immigration<br />

slackened; and in 2007-2008, the annual population growth amounted to<br />

only 1%. The result of the migration movements was that in 2007, 34% of the<br />

Aruban population had not been born on Aruba. In that year, 28% of the immigrant<br />

population originated from Colombia, 14% from the Netherlands, 13%<br />

from the Dominican Republic, and 11% from Venezuela. A quarter to a third<br />

of the immigrants were Arubans who had returned to Aruba. Estimates of the<br />

number of illegal immigrants on Aruba vary from 4,000 to 20,000 (CBS Aruba<br />

2008b; DIP 2009; Public Prosecution Service Aruba 2007).<br />

Varying policy and regulation<br />

The Aruban policy regarding immigrants has been changed quite frequently.<br />

The background of this is a tension between concern about the great number of<br />

immigrants on Aruba on the one hand and the need for foreign workers on the<br />

other. With regard to this subject the two largest political parties had different<br />

priorities, which resulted in a changing immigration policy that was translated<br />

into legislation belatedly. The immigration law, the Land’s Regulation of Admittance<br />

and Expulsion (Article 7 paragraph 1, LTUV 2008), prescribes that a<br />

temporary residence permit is granted by or on behalf of the minister in charge<br />

of immigration affairs for the duration of one year at the most. For persons in<br />

employment, this period extends to a maximum of three years, during which<br />

the permit must be renewed annually. In special cases, this three-year period<br />

can be extended with a year at the request of the employer. This regulation dates<br />

from before 29 June 2006, but the policy has already been applied since 2002,<br />

under the Oduber III government. Prior to 2002, the length of stay was not<br />

bound to a maximum. The alteration in 2002 consisted of the introduction of<br />

the so-called Swiss Model, which basically meant that immigrants applying for<br />

a residence permit had to leave Aruba after three years. The aim of this was to<br />

limit the number of naturalizations and to regulate entry to the labour market.<br />

Since the middle of 2005, the Swiss Model policy had not been applied to a<br />

limited number of occupational groups and in 2010 its application was<br />

completely abandoned. This means that the three-year maximum was dropped.<br />

Applications are now assessed according to the new policy, which as of the<br />

middle of 2011 had not yet been laid down in legislation.<br />

Since 2006, the main organization for the granting of residence permits is the<br />

DIMAS (Departamento di Integracion, Maneho y Admision di Stranhero),<br />

which assesses applications of immigrants who want to stay on Aruba. Predecessors<br />

of the DIMAS were the DINA (2002-2006) and the Directorate Public<br />

Order and Security (DOOV, until 2002). From 2001 to 2006, residence permits<br />

were granted by the Minister of Justice.<br />

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

Two integrity issues<br />

Integrity issues constitute a recurring subject in the reports published on the<br />


Management Institute for National Development<br />

immigration chain in the past years. These publications refer to actually<br />

discovered irregularities as well as to the suspicion that permits are obtained<br />

(more easily) by payment, or that applications are dealt with more quickly after<br />

payment. Furthermore, several respondents (representing the Public Prosecution<br />

Service, the immigration chain and tourism) took the view that application<br />

procedures for residence permits gave rise to abuses.<br />

Governance & Accountability: Fair or Favour<br />

According to the Public Prosecution Service, in one case there were sufficient<br />

indications to start an investigation. It involved a DINA employee who<br />

allegedly organized residence permits on payment through a consultant for staff<br />

of an enterprise in the tourist sector. The Minister of Justice had previously<br />

rejected the applications in question, but granted several residence permits at a<br />

later stage. According to the minister and the entrepreneur involved, the minister<br />

had become convinced of the economic importance of not deporting them. The<br />

employee himself also stated that he had not held out the prospect of money to<br />

the minister. Yet, one of the minister’s staff members was actually suspected of<br />

taking money. Ultimately, this case was dismissed because two witnesses who<br />

were essential in furnishing proof could not be found (Speech of the acting<br />

Aruban AG, 22 January 2008).<br />

Another criminal investigation regarding the immigration chain involved fraud<br />

with immigration cards, which enabled the owner to extend his or her stay on<br />

Aruba. The fraud was committed by an immigration official, who ‘stamped’<br />

five women of Venezuelan and Colombian origin onto the island in this way. A<br />

Venezuelan woman who stayed on Aruba illegally supplied women on payment,<br />

who were then helped out by the immigration official, again on payment. She<br />

stamped a false date of arrival on Aruba on the card that everybody must fill in<br />

upon arrival and must subsequently always be carried on their person. In this<br />

way, she concealed the fact that the women’s maximum length of stay had<br />

already expired. The women got caught when the LTUV was altered and the<br />

permitted length of stay for Venezuelans was reduced from three months to one<br />

month. The official was sentenced to fifteen months in prison and discharged<br />

from office for a maximum of five years. The mediator was sentenced to twelve<br />

months in prison. The two foreign women were sentenced to terms equal to the<br />

length of their custody, not for their illegal stay, but for bribery.<br />

Threats to integrity<br />

In the empirical study, we encountered a number of integrity risks of a more<br />

permanent nature with regard to the granting of residence permits. Decisions<br />

made in the immigration chain are often of vital importance to the applicants<br />

involved, and according to our informants, applying pressure on Aruban government<br />

employees does occur. This vital interest may result in integrity risks when<br />

the officials involved possess the ‘D’ to meet (urgent) demands. That discretion<br />

was present to begin with, because of the many policy changes. In practice, this<br />

led to a lack of clarity about the application of the policy and a steep increase<br />


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

in the number of legal procedures. At the same time, accountability (‘A’) was<br />

put into practice only to a limited extent. In the past, individual employees were<br />

allowed to, for example, deal with an application for a permit from beginning<br />

to end. This meant that functions were seldom separated. In addition, there was<br />

little supervision at the workplace, which made it possible, for instance, to make<br />

unauthorized changes to the registration systems.<br />

An additional problem was the inadequate filing by the then immigration service<br />

DINA and the Labour and Research Directorate (DAO). Documents frequently<br />

went missing and registration was faulty. The documents the ARA asked for<br />

at the DINA often turned out to be untraceable (ARA 2007). This inaccurate<br />

registration and filing increased the opportunities to issue permits illegally.<br />

Registration problems not only generate integrity risks, they also make it difficult<br />

for the ARA or the Public Prosecution Service to unearth the truthfulness of<br />

alleged breaches of that integrity afterwards.<br />

The DIMAS struggled with a shortage of personnel, who were not well-educated,<br />

while no attention had been paid for a long time to in-service training. In<br />

addition, clear frameworks or working instructions were not always on hand.<br />

Integrity risks may result from such capacity problems. The throughput times for<br />

the granting of permits were longer than the period legally prescribed. This may<br />

be caused by the observed capacity and registration issues. People who applied<br />

for permits or naturalization got into trouble when they had to wait for a permit<br />

for a long time, or when they were unable to prove that their stay on Aruba was<br />

legal or their stay on Aruba had been uninterrupted. The long throughput times<br />

also generated integrity risks: they increased the temptation to speed up the<br />

dispatching of specific cases, for example when this was in the interest of<br />

acquaintances. Recently, the throughput times for the issuing of permits have<br />

become shorter (to what extent is still unclear), as the result of working<br />

agreements between the DIMAS and the DAO, the directorate that advises the<br />

DIMAS about aspects of the labour market in connection with the granting of<br />

permits.<br />

At the DIMAS, internal supervision has been improved and a separation of<br />

functions has been introduced (PWC 2008b). Intake and decision-making, for<br />

instance, are no longer done by the same person. The process of issuing permits<br />

has also become more reliable and less susceptible to fraud because of process<br />

descriptions. A threat to this improvement and its consolidation is the shortage of<br />

staff (ARA 2007).<br />

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

6. Analysis and conclusions<br />

Our findings regarding the safeguarding institutions support the hypothesis<br />

that the interplay of capacity problems and closely knit social relations hamper<br />

their functioning in a small-scale society like that on Aruba. Lack of staff was<br />


Management Institute for National Development<br />

a problem we encountered everywhere on the island and the supply of highereducated<br />

people is small, partly because of the competition from business and from<br />

abroad. It is probable that the shortage of staff has been the cause of the low<br />

production of the ARA. Shortage of staff also had its effect on the limited<br />

specialization among Staten members.<br />

Governance & Accountability: Fair or Favour<br />

The findings may also be considered a symptom of an unchangeable social and<br />

physical proximity. The ARA, for example, was regularly subjected to political<br />

pressure. ARA research is in danger of easily getting politically charged because<br />

of the far-reaching polarization among the political parties. This also applies<br />

to the investigations of the Public Prosecution Service. Furthermore, in the<br />

ARA’s view, it had insufficient say in the execution of its budget and the appointment<br />

of its staff, a complaint also based on the idea that a greater say decreases<br />

the risk of political influencing. Moreover, because of shortcomings in the<br />

internal registration and supervision, there was little left to check by safeguarding<br />

institutions afterwards. The Advisory Council and the ARA have carried out<br />

checks as well as investigations that were more far-reaching. They investigated<br />

administrative actions in many cases, and they pointed out weaknesses in the<br />

legislation and regulations or in procedures that generated the risk of loss of<br />

integrity.<br />

According to several observers, instead of playing a role as connectors between<br />

the government and safeguarding institutions, Staten members have used the<br />

advice of the latter for political/electoral ends, or they have not used them at all.<br />

The Staten made insufficient use of their monitoring instruments. Political<br />

polarization and party discipline within the majority party probably played a<br />

considerable role in this. That the Public Accounts Committee had not convened<br />

for a long time seems to be a significant factor in an important problem on<br />

Aruba: a lack of any follow-up after suggestions for improvement made by,<br />

among others, the ARA and the CAD. For this reason, nothing changed regarding<br />

the internal financial supervision and accountability after the event. This<br />

resulted in continuously returning standard recommendations in reports of higher<br />

boards and the CAD. From the viewpoint of effectiveness, a serious consequence<br />

of this was that fundamental problems were allowed to persist or to slowly<br />

become unmanageable. One example is the pile of annual accounts that have not<br />

been dealt with by the Staten ever since the separate status was gained (1986).<br />

On this point, there are striking similarities with recent findings regarding three<br />

other Caribbean islands: Curacao, Barbados and Anguilla (see Nauta 2011).<br />

All in all, the Aruban safeguarding institutions such as the Staten and the ARA<br />

were unable to sufficiently counterbalance the combination of power and<br />

discretionary headroom for administrators (M+D). This seems to be tentatively<br />

confirmed by the described practice of procurement in which the rules are<br />

breached, for instance by motivating deviations from the standard either<br />

insufficiently or not at all. The fact that relatively clear rules were violated<br />


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

constitutes an indication of a lack of accountability (A). This seems to be<br />

generated in large part by a lack of respect among administrators for the checks<br />

and balances institutions. It is likely that this is rooted in part in societal relations<br />

that have developed gradually. To a certain extent, it is expected of administrators<br />

that they do something in return for the citizens who have supported them.<br />

For administrators, to comply with legislation and procedures may stand in the<br />

way of this. It seems to confirm the phrase turned by former Minister Croes<br />

(1995) that ‘good government is bad politics’.<br />

The formula M+D-A has not only proven to be helpful in the institutional<br />

explanation of the behaviour of administrators, but also in the explanation of the<br />

behaviour of officials. In the immigration chain, until a few years ago, individual<br />

officials could, for example, deal with an application for a residence permit from<br />

the intake to the conclusion. It was also possible to make unauthorized changes<br />

to the registration systems. The discretionary headroom was therefore considerable,<br />

and the supervision (A) of officials’ work was, limited. Based on different<br />

investigations and initiatives, the immigration chain has been subjected<br />

to a number of improvements.<br />

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


Management Institute for National Development<br />

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Governance & Accountability: Fair or Favour<br />


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Caribbean Journal of Public Sector Management, Vol.11 No.1, January 2017<br />


Free Healthcare in Jamaica. Frontline Workers: Walk a Day In Our Shoes<br />



A dissertation submitted to the University of Birmingham in partial<br />

fulfilment of the requirements for the degree of Masters of Science<br />

in Public Administration and Development.<br />

Shanise Allen<br />


Management Institute for National Development<br />

Free Healthcare in Jamaica. Frontline<br />

workers: Walk a Day in our Shoes<br />

Abstract<br />

Governance & Accountability: Fair or Favour<br />

Many countries are experimenting with the removal of user fees: Uganda<br />

(Burnham et al., 2004); South Africa (Walker and Gilson, 2004); Afghanistan<br />

(Steinhardt et al., 2011); in an attempt to minimise barriers to health care and<br />

take greater steps towards the achievement of the Millennium Development<br />

Goals. User fees were abolished in Jamaica in April, 2008 (MOH, 2008) notably<br />

after the assumption of duties by a political party that had recently won the<br />

general elections. Their campaign had promised to remove user fees if they<br />

emerged victors after the elections; that they did. The previous government had<br />

implemented exemptions for children and the elderly. This research sought to<br />

investigate the perception of the frontline staff working in a hospital; the staff<br />

who are the implementers of this new policy at the ground level. The findings<br />

revealed that the staff are less than pleased with operations since the removal of<br />

user fees, arguing that an increase in utilisation is not an outcome measure that<br />

guarantees a successful policy. Lack of planning, inadequate preparation and a<br />

lack of consultation with the frontline staff in the designing phase of the policy,<br />

has led to critical economic consequences at the hospital. Increased demand<br />

on fixed resources resulted in increased pressures on the staff and an admitted<br />

decrease in the quality of service they were providing.<br />

Keywords: healthcare, user fees, policy process, health financing<br />


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

Introduction<br />

The political drive towards the achievement of the Millennium Development<br />

Goals (MDGs) has refreshed the debate around sustainable health sector<br />

financing and the sufficiency of existing policies in low-income countries. A<br />

handful of countries have abolished user fees for health services, and many<br />

more are actively experimenting with exemptions for specific services, such as<br />

deliveries (Witter et al., 2011). Since 2007, Zambia, Burundi, Niger, Liberia,<br />

Kenya, Senegal, Lesotho, Sudan and Ghana have experimented with removal of<br />

fees for key primary health services (Yates 2009). Jamaica has joined the list of<br />

these countries, at first starting with the abolition of user fees for children and<br />

the elderly in May, 2007 and then for the general public in April, 2008. In most<br />

cases, with this change in policy, an increase in utilisation is observed (Masiye<br />

et al., 2010; Jacobs et. al., 2007), a finding fully in line with basic economic<br />

theory (the law of demand). However, there are other challenges that will affect<br />

the success of such a policy such as the financial ability of the country to<br />

maintain the service.<br />

The views of healthcare workers are crucial, at every stage, to the successful<br />

implementation of any health reform policy (Hercot et al., 2011). This study<br />

explored the perception of the staff at a hospital in Jamaica. Were they consulted<br />

before the reform? What are their thoughts on the implementation of the policy<br />

in 2012 ?<br />

Literature Review<br />

With the looming issue of the high costs of healthcare and an urgent need for<br />

new ways to finance this service separate from the public purse, a World Bank<br />

report by Akin et al., (1987) seemed to have the workable solution to the<br />

problem – the introduction of user fees. User fees – also known as co-payments<br />

– are formalized out-of-pocket expenditures incurred at the time of health care<br />

use (Jacobs et al., 2007). The introduction of user fees to raise financial<br />

resources for health and regulate demand for health care in low and middleincome<br />

countries has been a controversial topic in the public health discourse<br />

for decades (McPake et al., 2011). This became a prevailing feature of health<br />

financing reform in many African and other low- and middle-income countries<br />

in the 1980s and 1990s. In many instances, this type of reform was a clear<br />

requirement of structural adjustment programs forced on low income, struggling<br />

countries by international financial institutions and their loan conditions. These<br />

conditions mandated that governments lower their expenditure on health and<br />

social services while users of the service would contribute directly by paying fees<br />

to access these services (Masiye et al., 2010).<br />

Free Healthcare in Jamaica. Frontline Workers: Walk a Day In Our Shoes<br />

Akin et al., (1987) suggested that implementing a charge for patients to access<br />

health services would have three main benefits: 1) fees would generate additional<br />

revenue for the health sector; 2) fees would increase efficiency of government<br />


Management Institute for National Development<br />

health services delivery by reducing frivolous demand for services and encouraging<br />

use of those with low charges and costs; 3) they would improve access of<br />

poor people to health services because revenues from urban services could be<br />

used to cross-subsidise disadvantaged people in rural areas. Based on these<br />

benefits, they argued that adding user fees to healthcare would be a suitable<br />

financing mechanism because they would be effective (in raising additional<br />

funds), efficient (by encouraging an efficient use of services), and equitable (by<br />

applying differential fees to protect the poor. Though proposing this reform,<br />

Akin et al., (1987) acknowledged that this approach would not singlehandedly<br />

solve all the problems of any existing health care service.<br />

Governance & Accountability: Fair or Favour<br />

There have been mounting criticisms of the impact of user fees on ability access<br />

to health services, in particular for the poorest groups. For instance, experts<br />

assembled by UNICEF reported that almost all studies showed a negative effect<br />

on equity of access due to reduced use noted after the introduction of user fees,<br />

with the poor and vulnerable being most adversely affected (Yates, 2009). The<br />

evidence as presented by Gilson (1997) and Pearson (2004) (as cited in McPake<br />

et al, 2011) suggests that their introduction was not beneficial: user fees only<br />

raised an average of 5–7% of health sector recurrent expenditures at the national<br />

level. The findings of Lagarde and Palmer (2011) in their review of twelve different<br />

countries supported the view that user fees present a barrier to accessing curative<br />

health services for groups who would be eligible to pay for them.<br />

Financing the Reform<br />

Before user fees can be removed, the levels of funding available for health care<br />

must be increased. As user fees have been shown to restrict utilisation and create<br />

a large pool of unmet need, removal of fees is likely to result in significant and<br />

sustained increases in utilisation. Without the necessary increased funding for<br />

health care, the increases in utilisation could very well lead to falling quality of<br />

care generated by drug shortages and staff difficulties in managing increased<br />

workloads (Gilson and McIntyre, 2005).<br />

Formulation of Policy<br />

McPake et al., (2011) proposed a series of six sequential steps that should be<br />

followed in the making of policy to remove user fees to maximise the benefits<br />

of such policy:<br />

(1) Analysis of start-up position,<br />

(2) Estimation of the impact of fee removal on utilisation,<br />

(3) Estimation of additional requirements for human resources and drugs,<br />

(4) Mobilization of additional financial resources,<br />


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

(5) Building political commitment for the policy reform,<br />

(6) Communicating the policy change to all stakeholders.<br />

Meessen et al., (2011a) discussed that in the formulation of reform policies for the<br />

countries reviewed, the most frequent divergences between country practices<br />

and their framework were: a paucity of, or too basic, computation of the effect<br />

of the reform on the utilisation by the populace, improper assessment of the<br />

additional burden on frontline health staff, inadequate allocation of resources to<br />

finance the increase in utilisation, poor commitment of public budget funding,<br />

weak planning forecast (e.g. quantity of drugs required) and little involvement<br />

or thought for the needs of frontline staff in the design. For the implementation<br />

stage, the most frequent deviations between country practices and their framework<br />

were: no pilot project was used to assess certain strategies, poor communication<br />

with managers and frontline health staff, insufficient public information<br />

activities, inadequate monitoring of services (monitoring focused on accounting),<br />

insufficient enforcement effort, deficiency in evaluation interest (or the<br />

adoption of approaches below par), inadequate feedback loop (altering the<br />

system after observing problems).<br />

Politicians and technicians have different patterns of action and this will<br />

influence any reform process. It seems that political leaders tend to undervalue<br />

and take very lightly the technical challenges related to user fee removal<br />

reforms. In several countries, informants have reported inadequate consultation<br />

with stakeholders and technicians concerning reform for healthcare financing.<br />

This deficiency in preparation creates what Gilson et al., (2003) describes as<br />

weaknesses in the design, formulation and implementation of the reform and<br />

eventually leads to an unsuccessful policy (Ridde and Diarra, 2009).<br />

Effect of User Fee Removal on Utilisation<br />

Where there are exemptions from user fees most of the time, an increase in<br />

utilisation is observed. The study done by Jacobs et al., (2007) in Cambodia<br />

observed higher hospitalization rates among the pre-identified poor when<br />

compared with the non-exempted. This was attributed to the exemption of fees<br />

and the vulnerable groups being knowledgeable of their entitlement to service.<br />

Masiye et al., (2010) looked at user fee abolition in Zambia. They found in the<br />

twelve months immediately following the removal of user fees that utilisation<br />

in public health facilities across all rural districts among the population aged<br />

five years or older increased by 55%. In Afghanistan, analysis of facility<br />

utilisation data indicated that utilisation of curative care increased (Steinhardt et<br />

al., 2011). This was not necessarily so for preventive and promotive care.<br />

Free Healthcare in Jamaica. Frontline Workers: Walk a Day In Our Shoes<br />

Hay and Alexis (2012) explored the impact of the removal of user fees on the<br />

quality of patient care/service delivery in Jamaican public hospitals. They<br />


Management Institute for National Development<br />

reported increased demand for services, increased workload for insufficiently<br />

staffed facilities, inadequate budgetary support, increased waiting time for<br />

services, demoralisation of staff and a derailing of the ministry of health’s 2006-<br />

2010 strategic plan.<br />

Evaluation of Reform<br />

Governance & Accountability: Fair or Favour<br />

Evaluations of policies relating to the removal of user fees typically rely on<br />

utilisation rates as a measure of success. Hadley (2011) found that in order<br />

to evaluate policies we need to look at the way these policies relate to local<br />

everyday practices. “The operating assumption in removal of user fee policies<br />

and in statistical evaluations of these policies is that the rise in utilisation is a<br />

result of those in need of care seeking treatment, that those who seek treatment<br />

receive all the care they need to recover fully, and that those receiving treatment<br />

adhere to advice on their return home” (Hadley, 2011). The results of the study<br />

could not substantiate the extent to which a rise in utilisation rates alone can<br />

determine the success of a user fee policy in terms of enhanced health outcomes.<br />

Perceptions of the Reform<br />

While the literature is abundant on other issues regarding health reform, it was<br />

not found to be so with regard to the perspectives of frontline workers. Ridde<br />

and Diarra (2009) looked at the perceptions of the judiciousness of the abolition<br />

of user fees in Niger. The researchers summarised the findings into three<br />

categories: those for the abolition, those saying yes, but…., and those who<br />

were mostly in opposition. The group supporting the removal of user fees was<br />

made up mostly of the general population and they unanimously considered the<br />

abolition to be justified. Health officials and local government decision makers<br />

were in favour of the abolition but were troubled about whether or not the state<br />

was capable of sustaining such a measure. Among the frontline staff, health<br />

workers, there was more opposition to the free services, although not totally.<br />

They would have preferred to see drugs provided at lower prices and made<br />

more accessible, rather than abolishing fees altogether. The frontline workers<br />

asserted that the abolition had incited unwelcome behaviour by patients: lack of<br />

respect and appreciation for services they received and poor maintenance of the<br />

facilities’ property.<br />

Methodology<br />

This is a qualitative study investigating the perspectives of the frontline staff at<br />

a public hospital in Jamaica. Ethical approval was sought from the governing<br />

Regional Health Authority to conduct the study. The hospital has over 200 beds<br />

complemented by 668 members of staff offering medical, surgical, orthopaedic,<br />

paediatric, and renal care. It was found suitable for this research because of the<br />


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

extensive services provided and also it being one of the larger hospitals, serving<br />

approximately 700,000 persons from at least five surrounding parishes.<br />

Semi-structured interviews were conducted in a one week period with 11<br />

members of staff who were granted permission from the CEO. The researcher<br />

sought to interview at least one staff member from each department, but the<br />

staff members and the participating departments were ultimately chosen by the<br />

CEO (meaning the researcher was only given approval to speak to specific team<br />

members). Further details are provided in the limitations section of this paper.<br />

Description of participants: Two members were from the administrative office<br />

while the remaining nine were a part of the health care team; some heads of<br />

department, some junior staff. The group included representation from the<br />

nursing department, physicians, allied health and clerical staff and hence was<br />

considered representative of the views of the wider staff. For the purpose of<br />

anonymity, their name and titles will not be used in this study. Consent was granted<br />

verbally by all interviewees. Interviews were recorded with a voice recorder. All<br />

participants were assured that their responses would be kept anonymous and<br />

were only being recorded for transcription purposes. Each interview was done<br />

separately and privately. Semi-structured interviews were used rather than a<br />

pre-determined list of questions for each participant, to allow new ideas and<br />

responses arising from the interview to direct the interview and facilitate<br />

relevant comprehensive data collection. No patients were involved in the study.<br />

Results<br />

Are services free?<br />

When asked whether they considered healthcare to be free, the responses were<br />

always ‘yes, but….’,<br />

“Everything is free for public patients and you need to understand<br />

the distinction. Private patients are still required to pay for whatever<br />

services they obtain here.” – Administrator 1<br />

A private patient is someone that is referred to the hospital for a service by a<br />

private practitioner. Staff members were quick to point out that a lot of medications<br />

still have to be purchased by patients because they are not on the VEND<br />

list. The Vital Essential and Necessary Drugs (VEND) list is a list of drugs<br />

identified by the Ministry of Health. Initially all drugs were provided free and<br />

then about one year into the reform, this changed.<br />

“When free healthcare came first every single thing under the sun that<br />

was stocked in Drugserv (pharmacy) was free…It was 2009 or 2010<br />

that the late Permanent Secretary, she had written and given directives<br />

that only items that were on the VEND list should be free.” – Front Line<br />

Staff 2<br />

Free Healthcare in Jamaica. Frontline Workers: Walk a Day In Our Shoes<br />


Management Institute for National Development<br />

All tests done by the laboratory are free but one team member suggested that these<br />

were more basic labs.<br />

“The consultation is free but the added tests you do are not necessarily<br />

free. Basic labs are free but additional labs such as thyroid function<br />

tests are not free. So if you are just coming to see a doctor and get a<br />

prescription it might be free but if you have to do tests and do other<br />

things, it’s not totally free. ” – Front Line Staff 5<br />

Transport services are only provided free for patients who are admitted to<br />

hospital. Ambulance services to communities to collect persons who are ill or<br />

to accident sites to pick up victims are not included in the free healthcare.<br />

Utilisation<br />

Governance & Accountability: Fair or Favour<br />

Only one staff member interviewed denied an increase in the utilisation of<br />

services since the abolition of user fees. Administrator 1 noted that the increase<br />

was evident in most areas of service.<br />

“We were always available for the entire population...With the abolition<br />

we saw an increase in attendance for most of our services.”<br />

– Administrator 1<br />

The departmental heads agreed that this increase in utilisation was evident in<br />

their departments. The accident and emergency department, the pharmacy and<br />

medical laboratory noted the most increases. This has caused a long waiting list in<br />

each of these areas.<br />

“The services that have been most utilised are first of all our Accident<br />

and Emergency department. It has been misused to an extent because<br />

you do have persons who come here who do not require Emergency<br />

service, ideally they should be seen in primary care... Two other major<br />

areas that we have seen increase in that we associate with the abolition<br />

is in terms of pharmaceuticals, and that continues to increase and in<br />

terms of diagnostic services particularly laboratory services. Those<br />

have continued to increase.” – Administrator 1<br />

Front Line Staff 5 responded to a question of abuse of the system.<br />

“I think it’s abused yes, because it is free and because of a lack of<br />

sensitisation as to what the system really is for and by whom it should<br />

be used especially being an emergency room so people come here for<br />

very minor complaints for which they should go to the clinic or in some<br />

cases they could have probably took two Panadols for example and see<br />

what happens.” – Front Line Staff 5.<br />


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

Effect on Budget, Personnel and Equipment<br />

Administrator 2 approximated that user fees covered up to 85-90% of operational<br />

cost (excluding salaries). She said that this has been drastically reduced<br />

with the abolition and the hospital now has to stick to a strict budget provided<br />

by the government, often trying to save costs.<br />

When asked where the resources now come from to fill the gap that has been<br />

created by the removal of user fees, Administrator 2 chuckled and reinforced<br />

that the hospital has to stick to the budget given by the government.<br />

Administrator 2 believes that the allocation from the government post-reform<br />

was essentially to plug the gap left by the removal of user fees, without taking<br />

into account the intended increase in utilisation.<br />

“I believe the thinking was that the budget would be so designed to<br />

accommodate the shortfall that would come from not collecting the<br />

fees... There are certain individual expenses that I think yes there may<br />

have been increase, let us say for drugs, there have been increased<br />

provision for drugs and for medical sundries to an extent but as a<br />

general budget there has not been any major increase to accommodate<br />

additional equipment, furniture, staffing”. – Administrator 1<br />

Administrator 2 on increase in budgetary allocation:<br />

“Uhm, I can’t, I don’t see, (pause, change of thought, then continues)<br />

They try to give us (pause, change of statement). We do a budget<br />

every year so we have to go through and cost the things, send in the<br />

budget according to what we will need for the year. We cannot factor<br />

in now user fees because it has been abolished. What they do is give<br />

us some allocation which is not sufficient to cover. When we had the<br />

user fees we could look towards doing certain things from that money<br />

that is collected. Now we have to just look at what is provided from the<br />

government.” – Administrator 2<br />

Administrator 1 said that the facility was extremely challenged to cover its<br />

expenses. Administrator 2 chuckled and admitted to having a constant situation<br />

of credit with suppliers.<br />

Free Healthcare in Jamaica. Frontline Workers: Walk a Day In Our Shoes<br />

“(Laughs) With much strain. We are not able to meet a lot of deadlines.<br />

Suppliers are still good to us. We have a lot of credit rating. They<br />

(suppliers) give us credit. Some have cut off from us because they can’t<br />

wait on payment. At some point in time they are paid but it is taking a<br />

longer time for the bills to be paid.” – Administrator 2<br />

All departmental heads interviewed except one admitted not only to not<br />

receiving an increase in budgetary allocation to department but in fact they were<br />

getting a decrease in the budgetary allocation. Front Line Staff 7 admitted to<br />


Management Institute for National Development<br />

having to ‘under-buy’ products each month. He said they continuously have to<br />

find creative ways to manage so as to not have that department closed at any time.<br />

“Every year we get less and less money to run the service.”<br />

– Front Line Staff 1<br />

“We have to be creating some very creative ways of, you know, ensuring<br />

that the (department) is not closed at any point and that the day-to-day<br />

activities especially for those in-house patients are available.”<br />

– Front Line Staff 2<br />

As it relates to personnel, everyone agreed there was no increase to correspond<br />

with the increased utilisation.<br />

Pattern of Provision<br />

Governance & Accountability: Fair or Favour<br />

Administrator 1 denied the discontinuance of any service since the removal of<br />

user fees. Administrator 2 agreed but added that some things had to be curbed.<br />

“To be honest we have not really stopped any service but we have tried<br />

to… to uhm... to sort of curtail some of the things that are really done.<br />

Uhm… like, like even for cooking, feeding the patients we have to from<br />

time to time look at what is available at the time, seasonally, and try to<br />

go out, because you know those produce would be cheaper seasonally,<br />

so we go for those, but we have to bear in mind the diet of the patients<br />

but we have to go search for cheaper products.” – Administrator 2<br />

Burden on Staff and Quality of Care<br />

All persons interviewed agreed that there was an increased workload on the staff.<br />

Some admitted to an increased burden.<br />

“…The staff can be stressed mentally, physically because they don’t<br />

have what to actually work with at times.” – Administrator 2<br />

Front Line Staff 1 described the burden on the nurses as extreme.<br />

“It was extreme because being that there is this burnt out syndrome<br />

among nursing staff by virtue of the fact that they had to be working<br />

overtime, 16 hours, and that really took a toll on the service so the<br />

quality of care was not satisfactory.” – Front Line Staff 1<br />

A majority of those interviewed agreed that there was a decrease in the quality<br />

of service being provided at the hospital. This they said was because of the<br />

extremely long waiting hours at accident and emergency, pharmacy and<br />

laboratory and the lack of supplies, equipment and other resources.<br />


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

Front Line Staff 2 said she found that at times workers were more concerned<br />

with the numbers accomplished at the end of the day rather than the quality of<br />

service provided.<br />

“We are more concerned about how many patients we do rather than<br />

qualitatively looking at how we do it.” – Front Line Staff 2.<br />

Informal Charges<br />

Front Line Staff 9 was aware of one instance of an informal charge. The patient<br />

had been charged for a lab investigation. The patient reported it to the Patients’<br />

Affairs Officer and the money was returned and there was a meeting with the<br />

offender.<br />

Discussions before Reform<br />

Administrators 1 and 2 claimed there were discussions with them before the<br />

implementation of the policy to abolish user fees. When asked initially though,<br />

this was the response from Administrator 2.<br />

“No (pause). Well, uhm, the directors might have been consulted, the<br />

directors. I would suppose they have been. They had their inputs.”<br />

– Administrator 2<br />

Other frontline staff denied having any discussions about the reform. They<br />

thought that the decision was political.<br />

“I think that was a political decision which was meant to win electoral<br />

votes.” – Front Line Staff 5<br />

“…It came out just before elections…It was a part of that<br />

administration’s strategy…So they had no time to assess and to inform<br />

us for us to look at us in details to see how it was going to impact<br />

the providers of care as well as those persons who were going to be<br />

accessing it here.” – Front Line Staff 1<br />

“The public knew and then we were told what to do because it<br />

was a politically driven decision.…Meetings were held where the<br />

information was relayed, was given out to us as to how it is going to be<br />

implemented, meaning that, the decision was made and the discussion<br />

wasn’t had.” – Front Line Staff 6<br />

Free Healthcare in Jamaica. Frontline Workers: Walk a Day In Our Shoes<br />

There was no pilot study carried out on the health reform policy.<br />


Management Institute for National Development<br />

Monitoring and Evaluation<br />

The staff admitted to there being monitoring of the services in the initial stages<br />

of the reform by central administrators but this has not continued. Locally there<br />

is monitoring within the departments with heads of departments devising their<br />

own way of keeping check on their affairs. The frontline staff are unaware of any<br />

evaluation done on the policy since its implementation to give feedback on the<br />

reform.<br />

Staff Perception<br />

While some persons thought that free healthcare is necessary for the development<br />

of a country, they all thought that there need to be changes made to the<br />

current policy. They all thought that it was not working efficiently as is.<br />

Governance & Accountability: Fair or Favour<br />

“The persons on the ground from where I am standing, we are crying<br />

out and saying this thing is not working and the screams, they are<br />

deafening…You are looking all around and you see that we are<br />

suffering on the frontline just from the fact that we don’t have enough<br />

resources to carry out basic duties.” – Front Line Staff 4<br />

“I think then (at the onset of the reform) not looking into certain issues<br />

it (removal of user fees) was welcomed but now with the challenges that<br />

we face with purchasing goods to cover these services then we would<br />

want to change our minds to say it is just not working. It is working on<br />

the patients’ side but looking from our perspective to have to get the<br />

reagents to work with, get the supplies to work with, no it’s not working.<br />

We need to, we need to think of something that can generate some funds<br />

in order to continue to provide the services at the maximum.”<br />

– Administrator 2<br />

“…because we are not getting any revenue from the patients so to<br />

speak, we do not have any funds here to replace equipment and to<br />

maintain services so you find that equipment are overused, they run<br />

into disrepair. Some services because of the lack of funding cannot be<br />

maintained.” – Front Line Staff 5<br />

Suggestions<br />

The suggestions from the staff on the frontline were almost unanimous. Ten of<br />

the 11 staff on the frontline that were interviewed suggested that those who can<br />

pay for healthcare should be asked to pay. They thought that there should be<br />

considerations for the young and the elderly, the poor and vulnerable, but the<br />

working class should be asked to contribute directly to their healthcare.<br />

The other individual, while not saying outright that those who can pay should<br />

pay, did say that some health services at the hospital should carry a cost.<br />


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

Discussion<br />

Utilisation of services<br />

All persons except one agreed that utilisation of services at the hospital had<br />

increased since the abolition of user fees. This is an expected outcome and has<br />

been shown by studies done in many other countries where user fees have been<br />

abolished (Jacobs et al. 2007; Masiye et al. 2010).<br />

Several staff members alluded to an increase in frivolous demands made at the<br />

hospital after the removal of user fees. Individuals were not utilising the<br />

preventive care services, such as the health centres and clinics, as they should,<br />

and so this led to them coming straight to the hospital for minor complaints.<br />

Although this was a concern prior to the removal of user fees, there was an<br />

escalation in the misuse of the accident and emergency department. Wilkinson<br />

et al. (2001) commented on this when they noted that following the introduction<br />

of free health care in South Africa, the total number of consultations for curative<br />

care in the mobile unit almost doubled, while the number of consultations for<br />

preventive services fell. Proper education of the public would have helped to<br />

reduce this.<br />

Free healthcare?<br />

The abolition of user fees did not translate to totally free healthcare for the<br />

public. Notably, only some basic diagnostic tests were provided at the hospital<br />

and did not attract out-of-pocket payments. Other tests which are considered<br />

more revealing in terms of diagnostic properties had to be accessed in private<br />

facilities and there was no provision made by the government to cover these<br />

costs. So, if an individual required a magnetic resonance imaging (MRI) or a<br />

computerised axial tomography (CAT) scan, they would have to pay out-ofpocket<br />

for these services outside of the hospital. The investigation did reveal<br />

that one machine that was used for barium meals and enemas has been out of<br />

service since the abolition of user fees and it has not been fixed.<br />

The ministry has determined a list of drugs which they call Vital Essential<br />

and Necessary Drugs, and only these drugs, can be had free at the hospital. The<br />

hospital has in store drugs that are also not on this list; but to get them, the patient<br />

has to pay the full costs unless they have some insurance scheme that covers it.<br />

Free Healthcare in Jamaica. Frontline Workers: Walk a Day In Our Shoes<br />

The public was not fully educated on the extent of the ‘free healthcare’ prior to<br />

the implementation of the policy. This might have been in an effort to secure<br />

electoral votes, as the decision to abolish user fees was through a promise made<br />

in the electoral campaign of the then opposing administration.<br />


Management Institute for National Development<br />

Changes in Pattern of Provision<br />

While administrators stated that the hospital is still providing the services it did<br />

before the abolition of user fees, it is with extreme strain as there is not enough<br />

budgetary allocation to cover the operational costs and supplies necessary to<br />

deal with the increased utilisation. There has been some effect on the pattern<br />

of provision at the hospital. There is no availability of local funds to address<br />

matters of maintenance of equipment that may arise throughout service and this<br />

was seen with the machines in the radiology department which have been out of<br />

service with no money available to repair them.<br />

Governance & Accountability: Fair or Favour<br />

Notably, at the onset of the removal of user fees, all drugs provided at the<br />

hospital were free, but then this was changed about a year into the policy. Front<br />

line staff said that there was no explanation given as to why the change, but she<br />

did note that the bill at the end of a month during the period of all medications<br />

being free was in the millions. This shows that there was inadequate planning<br />

put into the reform and an underestimation of the cost of providing medication<br />

free to the population. Plans for adequate drugs and staff to cope with increased<br />

utilisation, and how to deal with wider drug and staffing problems in the longer<br />

term have to be undertaken when planning health reform (Gilson and McIntyre,<br />

2005).<br />

Budgetary Allocation<br />

The funding for health reform in Jamaica comes from the national budget.<br />

Administration was not able to identify any funding secured from any other<br />

source prior to the implementation of the policy. This is contrary to the advice of<br />

Gilson and McIntyre (2005) who stated that ‘Fee removal must be underpinned<br />

by action at the international level that allows for the sustained mobilisation of<br />

resources to achieve human rights to health, along with health equity goals’.<br />

Failure to adhere to this route has led to negative consequences which are<br />

obvious to those on the frontline. Any policy design that does not anticipate the<br />

increase in utilisation and provide an increase in all areas that will be affected<br />

by this increase is flawed and will have critical consequences. Masiye et al.,<br />

(2010) noted that although the increase in utilisation in Zambia was somewhat<br />

higher than that predicted before the implementation of the user fee abolition<br />

policy, the planning for a major utilisation increase ameliorated potentially<br />

adverse consequences for quality of care. There was an increase in the budgetary<br />

allocation for healthcare in Jamaica but Administrator 1 noted that this was far<br />

from what was needed to respond to the increased utilisation.<br />

Effect on Staff and Quality of Care<br />

With the removal of user fees accompanied by increased utilisation of services,<br />

there has been increased wear and tear on personnel and equipment. There was<br />


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

no increase in staff complement to deal with the effect of the policy until recently,<br />

where the hospital has seen an increase in the nursing staff. The staff all agree<br />

to an increased workload and some admit to a greater burden now. There is no<br />

compensation for the increased burden on the staff. No incentives and increased<br />

workloads can lead to frustration among staff. They will become dissatisfied and<br />

this will adversely affect the quality of care provided.<br />

No increase in equipment, a lack of local funds to maintain and repair existing<br />

equipment that is overworked and malfunctioning, and increased hospital debt to<br />

suppliers and manufacturers are some other consequences. Creditors will reach a<br />

point where they will eventually stop supplying items. This has admittedly<br />

already begun. This path is headed towards a complete downfall of the health<br />

system. Nimpagaritse and Bertone (2011) noted that the suddenness of the<br />

decision to remove user fees in Burundi along with the lack of preparation and<br />

of a carefully considered planning process had critical consequences for the<br />

entire health system.<br />

Quality depreciated as it relates to waiting time. The interaction of pressures:<br />

increased demand on a fixed number of resources causing a fall in the supply<br />

and increased burden on staff is very pronounced in this case study.<br />

Consultation before Reform<br />

The lack of consultation with all stakeholders before the implementation of the<br />

reform was attributed to the policy being a quick follow through on an election<br />

promise. This does not follow the good practices framework developed by<br />

Hercot et al. (2011) on the successful implementation of user fee removal.<br />

‘Actors whose co-operation will be required in the implementation stage should<br />

already be involved when designing the policy. Their early-stage participation<br />

can help to design policies that are realistic and workable...To increase the<br />

likelihood of success, the reform has to be largely endorsed or at least accepted<br />

by the persons who will be responsible for its implementation’ (Hercot et al.,<br />

2011).<br />

Free Healthcare in Jamaica. Frontline Workers: Walk a Day In Our Shoes<br />

Gilson et al. (2003) noted from their assessment that political leaders tend to<br />

underestimate the technical challenges related to user fee removal reforms.<br />

In several countries, informants have reported insufficient consultation with<br />

stakeholders and technicians. In those countries where the decision to remove<br />

user fees was unexpected or sudden, the reform was characterized by a lack of<br />

preparation which generates what they perceive as weaknesses in all stages of the<br />

reform; the design, formulation and implementation.<br />

There was no pilot study done before nationwide implementation of the policy<br />

in 2008. A pilot study would have given information on what to expect from<br />


Management Institute for National Development<br />

implementation of a user fee abolition reform. In Burundi, the decision to<br />

introduce the health care reform was made at the highest possible political level,<br />

with little participation of technicians at the Ministry of Health (at central level)<br />

and no involvement of health staff at peripheral level (Nimpagaritse and Bertone,<br />

2011). The suddenness of the decision and the lack of preparation before<br />

implementing the policy had critical consequences for the entire health system<br />

in the country (Nimpagaritse and Bertone, 2011); while the health financing<br />

pilot study and subsequent nationwide user fee ban at the primary care level<br />

implemented in Afghanistan represent the successful application of a pilot study<br />

to make an informed national policy decision (Steinhardt et al., 2011).<br />

Monitoring and Evaluation<br />

Governance & Accountability: Fair or Favour<br />

There was some monitoring of the policy in the early stages, but this has waned<br />

over time. The staff were not generally aware of any ongoing evaluation of the<br />

policy being carried out. This is very troublesome and is a recipe for failure of<br />

the policy. Monitoring and evaluation of the reform across all levels is crucial to<br />

follow up implementation and to check whether and how instructions are being<br />

followed (Hercot et al., 2011). Monitoring systems should be established to<br />

cover utilisation trends, including the relative use of preventive versus curative<br />

care, and give health workers and managers opportunities to give feedback on<br />

health facility experiences (Gilson and McIntyre, 2005).<br />

Staff Perception and Suggestions<br />

The perception of most of the staff is that the policy as is, isn’t working. While<br />

the reform may be helpful for the socially disadvantaged individual in accessing<br />

healthcare, the frontline workers believe that the government had not properly<br />

prepared for the outcomes of the policy. The suggestion is that user fees should<br />

be put in place for those who can afford to pay. In depth assessments should<br />

be carried out to properly identify individuals who are poor and vulnerable<br />

and they should be exempted from fees along with children and the elderly.<br />

Although there were exemptions made for some social cases, these were not<br />

being properly implemented or monitored. To combat this weakness in the past<br />

system, exemptions to be made for vulnerable groups would need to be accompanied<br />

by systems to guarantee timely access by these groups and continued<br />

monitoring and evaluation.<br />

Changes are necessary, and with the country in negotiations (2012) with the IMF<br />

who is pressuring the government to make serious changes to the current state<br />

of the public sector before any further help is given, it hangs in the balance what<br />

will be done about this user fee policy.<br />

The Caribbean Policy Research Institute (CaPri) conducted a survey of the<br />

no-user fee policy in public hospitals in Jamaica in 2013 (after this study was<br />

done and paper was completed). Their findings supported the findings of this<br />


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

study and researchers concluded that health workers were most concerned<br />

about the quality of care provided being compromised due to insufficient human<br />

and material resources, and were worried about the sustainability of the system<br />

(CaPRI, 2013).<br />

Limitations<br />

There was some resistance from the Regional Health Authority in granting<br />

approval for the study and so the original objectives of the study had to be<br />

modified. This whole process greatly reduced the time available to do the study.<br />

After receiving approval to conduct the study, one administrator made final<br />

approval on which individuals I would be allowed to interview. Interviews from<br />

other frontline staff members from other departments in the hospital that were<br />

not represented in this study could have added greater insight on the perceptions<br />

of the ground level workers.<br />

Interviews were recorded with a voice recorder and even though participants<br />

were informed that their views were not going to be used outside of this study<br />

and their names would not be used, they may have been less than honest in their<br />

responses out of fear of being associated with a particular statement.<br />

Conclusion<br />

The health workers at the hospital do not believe that the user fee removal<br />

policy has been a success. Based on the information derived from the interviews,<br />

there was woeful lack of planning and preparation of the policy which has<br />

led to critical economic consequences for the hospital. The frontline workers<br />

were not a part of the designing stages of the reform. The increased utilisation<br />

was not followed by a proportionate increase in funding or staffing. This has<br />

led to reduced quality of service as it relates to a lack of equipment and other<br />

resources, longer waiting times and an overworked and burdened staff.<br />

Recommendation<br />

The author recommends that the government commissions a detailed evaluation<br />

of the reform and its effects since implementation. All stakeholders; politicians,<br />

administrators, technicians and clinicians centrally and peripherally should be<br />

consulted. The findings should be used to inform any reform of the current<br />

policy.<br />

Akin, J., Birdsall, N. & de Ferranti, D. (1987). Financing health services in<br />

developing countries: an agenda for reform 1987 World Bank Policy<br />

Study. Washington, DC: the World Bank, 1987.<br />

Free Healthcare in Jamaica. Frontline Workers: Walk a Day In Our Shoes<br />

Burnham, G., Pariyo, G., Galiwango, E. & Wabwire-Mangen, F. (2004)<br />

Discontinuation of cost sharing in Uganda. Bulletin of the World Health<br />


Management Institute for National Development<br />

References<br />

Organization, 82, 187–195.<br />

CaPri (2013). Fee or Free? A survey of the no-user fee policy in public hospitals<br />

in Jamaica. Available from: www.capricaribbean.com/documents/nouser-fee-policy-public-hospitals-jamaica<br />

De La Haye, W. & Alexis, S. (2012) The Impact of a No-user-fee Policy on<br />

the Quality of Patient Care/Service Delivery in Jamaica. West Indian<br />

Medical Journal, 61 (2), 168-173.<br />

Governance & Accountability: Fair or Favour<br />

Gilson L., Doherty J., Lake S., McIntyre D., Mwikisa C., and Thomas S.,<br />

(2003). The SAZA study: implementing health financing reform in<br />

South Africa and Zambia. Health Policy and Planning, 18, 31–46.<br />

Gilson, L. (1997). The lessons of user fee experience in Africa. Health Policy<br />

and Planning, 12, 273–85.<br />

Gilson, L. and McIntyre, D. (2005). Removing user fees for primary care in<br />

Africa: the need or careful action. BMJ, 331, 762 – 765.<br />

Hadley, M. (2011). Does increase in utilisation rates alone indicate the success of<br />

a user fee removal policy? A qualitative case study from Zambia.<br />

Health Policy, 103, 244-254.<br />

Hercot D., Meessen B., Ridde V., and Gilson L., (2011). Removing user fees for<br />

health services in low-income countries: a multi-country review<br />

framework for assessing the process of policy change. Health Policy<br />

and Planning, 26 (2), 5–15.<br />

Jacobs, B., Price, N.L., Oeun, S. (2007). Do exemptions from user fees mean<br />

free access to health services? A case study from a rural Cambodian<br />

hospital. Tropical Medicine and International Health, 12 (2), 1391–<br />

1401.<br />

Lagarde, M. and Palmer, N. (2011). The impact of user fees on access to health<br />

services in low and middle-income countries (Review). The Cochrane<br />

Library, Issue 4.<br />

Masiye, F., Chitah, B.M., and McIntyre, D. (2010). From targeted exemptions to<br />

user fee abolition in health care: Experience from rural Zambia. Social<br />

Science & Medicine, 71, 743 – 750.<br />

McPake B., Brikci N., Cometto G., Schmidt A., Araujo E., (2011). Removing<br />

user fees: learning from international experience to support the process.<br />


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Health Policy and Planning, 26 (2), 104–117.<br />

Meessen, B., Hercot B., Noirhomme M., Ridde V., Tibouti A., Tashobya C.,<br />

and Gilson L.,(2011a). Removing user fees in the health sector: a<br />

review of policy processes in six sub-Saharan African countries Health<br />

Policy and Planning, 26 (2), 16–29.<br />

Meessen, B., Gilson, L., and Tibouti, A. (2011b) User fee removal in lowincome<br />

countries: sharing knowledge to support managed<br />

implementation. Health Policy and Planning, 26 (2), 1–4.<br />

MOH. (2008). Annual Report 2006. Kingston, Jamaica.<br />

Nimpagaritse, M. and Bertone, M.P. (2011). The sudden removal of user fees:<br />

the perspective of a frontline manager in Burundi. Health Policy and<br />

Planning, 26 (2), 63–71.<br />

Pearson, M. (2004). Issues Paper: The case for abolition of user fees for primary<br />

health services. London: DFID Health Systems Resource Centre.<br />

Ridde, V. and Diarra, A. (2009). A process evaluation of user fees abolition for<br />

pregnant women and children under five years in two districts in Niger<br />

(West Africa) BMC Health Services Research, 9, 89.<br />

Steinhardt, L.C., Aman I., Pakzad I., Kumar B., Singh L., and Peters D., (2011).<br />

Removing user fees for basic health services: a pilot study and national<br />

roll-out in Afghanistan. Health Policy and Planning,26 (2), 92–103.<br />

Walker, L. & Gilson, L. (2004) “We are bitter but we are satisfied’’: nurses as<br />

street-level bureaucrats in South Africa. Social Science & Medicine, 59,<br />

1251–61.<br />

WHO. 2005a. World Health Assembly resolution WHA 58.31: Working towards<br />

universal coverage of maternal, newborn and child health interventions.<br />

Geneva: World Health Organization.<br />

WHO. 2005b. World Health Assembly resolution WHA 58.33: Sustainable<br />

health financing, universal coverage and social health insurance.<br />

Geneva: World Health Organization.<br />

Free Healthcare in Jamaica. Frontline Workers: Walk a Day In Our Shoes<br />

Wilkinson, D. et al., (2001). Effect of removing user fees on attendance for |<br />

curative and preventive primary health care services in rural South<br />

Africa. Bulletin of the World Health Organization, 79, 665–671.<br />

Witter S., Khadka S., Nath H., and Tiwari S. (2011). The national free delivery<br />

policy in Nepal: early evidence of its effects on health facilities. Health<br />


Management Institute for National Development<br />

Policy and Planning, 26 (2), 84–91.<br />

Yates, R. (2009). Universal health care and the removal of user fees. Lancet,<br />

373: 2078 – 2081.<br />

Governance & Accountability: Fair or Favour<br />


Caribbean Journal of Public Sector Management, Vol.11 No.1, January 2017<br />



Dr. Valoris Smith<br />


Management Institute for National Development<br />

Accountability of Executive Agencies:<br />

To Whom?<br />

Abstract<br />

Agencification has been examined through various strands – historical perspectives,<br />

convergence, variations in roles and diffusion, other countries and effects.<br />

The purpose of this paper is to examine the influence of the new public management<br />

executive agency reform on the users – the private sector organizations<br />

sub-sector – small- and medium-sized enterprises (SMEs); and to understand<br />

the accountability issues arising and to recommend strategies to address the<br />

implications.<br />

Governance & Accountability: Fair or Favour<br />

Executive agencies were implemented to facilitate greater accountability by the<br />

public sector agencies, which was to be achieved through the requirement to<br />

operate within a framework of performance agreements. Under the Executive<br />

Agencies Act (2002) the chief executive officer (CEO) is accountable for the<br />

performance of the organization. Nevertheless, there is the main accountability<br />

implication, inter alia, of the increased attention to the achievements of the<br />

key performance indicators (KPIs) by the CEOs. The KPIs are determined by<br />

the CEOs in conjunction with the senior managers which could be suboptimal<br />

(Smith, 1995) and that could easily be achievable.<br />

In this case study, the findings reported the agencies achievements of the KPIs,<br />

but the users (SMEs) views were that the agencification did not translate into the<br />

expected outcome or have a positive influence on the users (SMEs) operations<br />

and profitability (Smith, 2014).<br />

Accountability is equated to performance – the agencies’ performance, the<br />

performance of the executive agencies, CEOs – but what of accountability to the<br />

users?<br />

Keywords: agencification, new public management, accountability, performance<br />


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />


The veracity of public sector reform represented a significant challenge of<br />

determining how the reform impacted the accountability of public sector<br />

administration. The antecedents to the Jamaican public sector reform were<br />

the formation of statutory bodies or organizations; the administrative reform<br />

programmes of the 1980s; and privatization.<br />

Following the spate of reform programmes undertaken, the government recognized<br />

that the public sector reforms had not achieved the expected improvements<br />

in efficiency, and had not resulted in better service delivery from the public<br />

sector. Hence the Public Sector Modernization Programme (PSMP) was<br />

introduced in 1996.<br />

The Public Sector Modernization Programme sought to strengthen and reform<br />

the institutional framework of several government ministries, departments and<br />

agencies (Jamaica Information Service, 2008, March 31) through the establishment<br />

of performance-based institutions or executive agencies, among other<br />

things. The executive agency model in Jamaica was established in 1996 with<br />

the objective of generating “a small, effective, efficient and accountable public<br />

sector, capable of providing high quality services” (Tindigarukayo, n.d., p. 4).<br />

Consequent to this, the Executive Agencies Act No. 4 of 2002 was<br />

passed to formalize: “the establishment of Executive Agencies; … and the<br />

provision of appropriate mechanisms for proper management, accountability<br />

and transparency in the operations of Executive Agencies” (Government of<br />

Jamaica, 2002, p. 3).<br />


The concept of agencification is defined in the Financial Instructions to<br />

Executive Agencies as:<br />

Accountability of Executive Agencies: To Whom?<br />

a government entity, which has been formally designated as an<br />

Executive Agency in accordance with the provisions of section 4 of the<br />

Executive Agencies Act 2002. The process for establishing Executive<br />

Agencies is set out in section 4(2) of the Executive Agencies Act 2002.<br />

(Government of Jamaica, 1999, p. 2-1.1)<br />

Executive Agencies are described in the Financial Instructions to Executive<br />

Agencies as:<br />

Government entities which focus primarily on the delivery of services<br />

with a results oriented approach to government. In exchange for<br />

delegated managerial autonomy, the Chief Executive Officer of each<br />

Executive Agency is held accountable for achieving stated results<br />


Management Institute for National Development<br />

economically, efficiently and effectively. (Government of Jamaica,<br />

1999, p. 2-1.2)<br />

‘Agency’ in terms of agencification concerns an organization that is operated<br />

at arm’s length (structurally disaggregated) from the central government and<br />

functions under more businesslike conditions than the government bureaucracy<br />

(Talbot, 2004).<br />

Opinions are however divided on the extent to which agencies have become<br />

autonomous, efficient, effective, and accountable for their performance to their<br />

key stakeholders and the public in general (Talbot & Johnson, 2007). The<br />

adoption of agencification reform was expected to allow agencies and politicians<br />

“to focus on their core tasks” and “policy execution and policy development”<br />

(Van Thiel & CRIPO, 2009, September, p. 3).<br />

Governance & Accountability: Fair or Favour<br />

Located within the many different expressions of agencification are discourses<br />

surrounding structural disaggregation (Pollitt & Talbot, 2004; Pollitt, et al.<br />

2005; Talbot, 2004; Verhoest, et al. 2012); managerial autonomy (James &<br />

Van Thiel, 2010; Pollitt & Talbot, 2004; Pollitt et al., 2005; Verhoest, et al.,<br />

2012), decentralization (Pollitt & Bouckaert, 2000); performance contract<br />

(Pollitt & Talbot, 2004; Verhoest et al., 2012); and businesslike management<br />

(Talbot, 2004). James and Van Thiel (2010) classified executive agencies as<br />

semi-autonomous organizations, without legal independence but with some<br />

managerial autonomy. These elements are also (all) located within the new<br />

public management doctrine (Aucoin, 1990; Hood, 1991).<br />


The new public management, the intellectual antecedent to the executive agency<br />

model reform, promoted efficiency, effectiveness and responsiveness to the<br />

process of governing (Hughes, 1994; Pollitt, 1990). The doctrinal components<br />

of the new public management outlined, inter alia, the setting of standards and<br />

measures of performance, placed emphasis on output controls and advocated<br />

the use of private sector management techniques and practices (Hood, 1991).<br />

The new public management paradigm encouraged government to implement<br />

performance measurements against targets to encourage greater efficiency in<br />

the delivery of services (Mulgan, 2005). The new public management is the<br />

theoretical framework that focused on how the ‘new’ public sector management<br />

led to improvement in productivity and efficiency (Hood, 1991).<br />

Various common themes and trends were identified in the new public management<br />

literature such as decentralization of management (Pollitt, 1993, 1994,<br />

November); decentralization of organizations, (Ferlie et al, 1996); disaggregation<br />

and breaking up of traditional monolithic bureaucracy into separate agencies,<br />

(Dunleavy & Hood, 1994; Hood, 1991; Pollitt, 1993, 1994, November); the use<br />

of private sector techniques and practice (Aucoin, 1990; Dunleavy & Hood,<br />


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

1994; Hood, 1991); responsiveness to customer (Ferlie, et al., 1996; Osborne &<br />

Gaebler, 1992; Pollitt, 1993, 1994, November); and performance targets and<br />

measures for management (Dunleavy & Hood, 1994; Ferlie, et al., 1996; Hood,<br />

1991; Osborne & Gaebler, 1992; Pollitt, 1993, 1994, November). These themes<br />

were expected to strengthen the productivity and the efficiency of public sector<br />

management. The main characteristic of the new public management reform was<br />

the achievement of improvement in efficiency and the performance of public<br />

sector organizations (Pollitt, Van Thiel, & Homburg, 2007).<br />

Nevertheless, the new public management was seen as causing accountability<br />

problems in the public sector management since the established chain of<br />

responsibility (and accountability) was no longer in place (Caulfield, 2002;<br />

Haque, 2001).<br />


Accountability is defined as “… a proactive process by which public officials<br />

inform about and justify their plans of action, their behaviour, and results and<br />

are sanctioned accordingly” (Ackerman, 2005).<br />

An additional description of accountability is that it includes, not only financial<br />

accountability, accountability for fairness and accountability for performance,<br />

but accountability for personal integrity and citizen interests (Behn, 2001).<br />

Accountability exists where the performance of tasks or functions by an<br />

individual or a body are subject to the review and evaluation by another person<br />

or entity and require, justification for actions or inactions. According to Kearns<br />

(1996) accountability refers to a broad range of public expectations dealing<br />

with organizations, performance and responsiveness. These expectations are<br />

sometimes based on performance criteria that are subjectively interpreted<br />

and at times even contradictory. Accountability encompasses responsibility<br />

for performance, and raises the question for the one held accountable of:<br />

accountable to whom?<br />

Accountability of Executive Agencies: To Whom?<br />

Types of accountability<br />

The aim of this article is not to explain all the various types of accountability,<br />

but to examine those that have implications for the new public management<br />

executive agency and to identify their accountability responsibilities.<br />

The four types of accountability identified were hierarchical, legal, political and<br />

professional (Romzek & Dubnick, 1987). With regard to hierarchical accountability,<br />

close supervision of individuals and low level of autonomy exist, while<br />

for legal accountability, external monitoring of performance for compliance with<br />

the established legislative mandate occurs. Political accountability, on the other<br />


Management Institute for National Development<br />

hand is based on technical or objective charter, but is generally dependent on<br />

political perspectives. Stone (1995) included the typology of managerial<br />

accountability. Another type of accountability is administrative accountability<br />

which has two dimensions – horizontal and vertical. Horizontal accountability is<br />

reflected in the capacity of departments of government and ministries to monitor<br />

public agencies and or branches of government, or the requirement for agencies<br />

to report sideward. Vertical accountability, on the other hand, represents the way<br />

citizens seek to enforce standards of good performance on officials.<br />

Accountable to whom?<br />

Governance & Accountability: Fair or Favour<br />

Political accountability also encompasses both horizontal and vertical dimensions,<br />

which leads to the issue of who is accountable and responsible for the<br />

autonomous agencies – is it the political authority? The executive agencies<br />

chief executive officers are ‘politically’ accountable to the political authority<br />

and in some instance to the Parliament. The separation of policy-making and<br />

administrative functions and the managerial autonomy granted to the autonomous<br />

agencies tends to make political accountability more difficult to sustain.<br />

In spite of the foregoing, political accountability relationships foster the agencies’<br />

chief executive officers and managers’ concerns for key stakeholders such as<br />

elected officials, clients and the public.<br />

Administrative accountability arises when the agencies operate in compliance<br />

with rules and procedures, and are accountable to a ‘superior’ administrative<br />

organization, an authority or an external organization that is responsible for<br />

supervision and control. The executive agencies are accountable to the Ministry<br />

of Finance and the Public Service, Monitoring Unit – the government unit with<br />

oversight responsibility – as the external organization that reviews the agencies’<br />

performance. These entities are also accountable to the citizens under administrative<br />

accountability that guarantees fairness in the relationships with the<br />

administrative organizations.<br />

Professional accountability takes place in the ‘professional world’, for example<br />

where there are memberships in professional bodies or associations that afford<br />

significantly high degrees of autonomy to individuals within the generally<br />

accepted practices of their professions. Such individuals are accountable to<br />

the external organizations of which he or she is a member. The employment of<br />

the chief executive officers and the senior management teams at the executive<br />

agencies is guided by private sector employment criteria, and as such often<br />

results in the employment of the ‘brightest and the best’ and highly qualified<br />

professionals – accountable to external professional organizations. Notwithstanding<br />

the foregoing, this type of accountability does not fit in the general framework<br />

of administrative accountability and hence is not subjected to the principles<br />

of public administration and the new public management reforms.<br />


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

Democratic accountability occurs when the needs and interests of society and<br />

social groups are considered and there is a direct relationship between the public<br />

administration and these groups. The structure of democratic accountability with<br />

the users (citizens) evaluation criteria is suited to the new public management<br />

reforms and administrative management. In this case of accountability, the<br />

citizens and social groups force the public administration to give account for<br />

their acts/performance.<br />

The new public management executive agencies’ performance, accountability, as<br />

well as the accountability relationships are the subject of the following section.<br />

Performance<br />

The chief executive officers are guided by the executive agencies’ framework<br />

documents that set out the missions and objectives, stipulated deliverable<br />

out-puts, the required resources, and provide the methods of performance<br />

measurements and evaluations which must be utilized, as well as recommended<br />

rewards and sanctions based on the performance evaluations. The preparation<br />

of the framework documents and the performance agreements are the<br />

responsibility of the chief executive officers, and they are designed to ensure a<br />

greater measure of accountability. The chief executive officers, who report to<br />

the ministers, are responsible for the performance of the agencies and provide<br />

advice to the ‘responsible ministers’ on relevant matters (Cariforum Steering<br />

Committee, 2003, December). The chief executive officers are accountable for<br />

compliance with the framework document to the Executive Agency Monitoring<br />

Unit of the Ministry of Finance and the Public Service that monitors the executive<br />

agencies’ performance and approves the performance reports prior to<br />

the payments of performance incentives. The chief executive officers are also<br />

responsible and accountable for the executive agencies, compliance with the<br />

Financial Administration Act; the Executive Agency Act; Financial Instructions<br />

for Executive Agencies; relevant legislation, regulations and instructions.<br />

Accountability of Executive Agencies: To Whom?<br />

The chief executive officers and management teams are required to identify<br />

output levels and targeted service delivery results in the executive agencies’<br />

business or operational plans, which are required to be consistent with the<br />

government priority areas. The targeted output levels must be supported by<br />

key performance indicators that are set out in the business or operational<br />

plans, and which are reported in the executive agencies’ annual reports.<br />

In the private sector, key performance indicators act as a tool to measure performance<br />

of both individuals and departments, as well as to assess the consequences<br />

of their performance (Zakaria, et al. 2011). Performance indicators are a<br />

private sector technique utilized under the new public management – executive<br />

agency – to measure performance. These performance indicators are targets that<br />

are achievable by government entities and agencies in a specific measurable way<br />

and in a shorter period of time than objectives. However, Van Thiel and Leeuw<br />


Management Institute for National Development<br />

(2002) argued that an “increase of output measurement in the public sector can<br />

lead to several unintended consequences that may not only invalidate conclusions<br />

on public sector performance but can also negatively influence that performance”<br />

(p. 267). The consequences are varied. For example, the use of performance<br />

indicators and/or performance measurements which led to “ossification” or<br />

“organizational paralysis”; “tunnel vision which can be defined as an emphasis<br />

on phenomena that are quantified in the performance measurement scheme at<br />

the expense of unquantified aspects of performance” (Smith, 1995, p. 285);<br />

“suboptimization” (Smith, 1995, p. 287), whereby the focus was on the<br />

managers’ objectives rather than on the organizations’ objectives, and “fixation”<br />

(Smith, 1995, p. 290), where the single success factors were the emphasis<br />

instead of the underlying objectives. .<br />

Governance & Accountability: Fair or Favour<br />

Executive agency target-setting (through key performance indicators) and<br />

monitoring of performance are the responsibilities of the executive agencies’<br />

chief executive officers and senior management employees, and are determined<br />

by these same individuals. Actual performance is compared to targets over<br />

the fiscal years by the executive agency; however employees lean towards<br />

emphasizing the achievements of these targets for performance incentives<br />

purposes, the consequences of which are suboptimal performances, or tunnel<br />

vision.<br />

Nevertheless, performance is measured by the achievement of its key performance<br />

indicators by the new public management executive agency reform. The<br />

Executive Agencies Act (2002) and the Financial Instructions to Executive<br />

Agencies (Government of Jamaica, 1999) indicate that performance indicators,<br />

performance measurements method, and evaluation of the agency must be<br />

included in the agencies’ framework document. Performance indicators and<br />

the method of performance evaluation, among other things, are included in the<br />

framework document of executive agencies. The chief executive officers are<br />

required to sign the performance agreements, and are held accountable for the<br />

achievement of the key performance indicators of the agencies.<br />

Empirical study indicated that the performance indicators/targets were achieved<br />

in the majority of instances (Smith, 2014). However, there were negative<br />

implications for the small- and medium-sized enterprises (in the construction<br />

industry) that despite the key performance indicators of the executive agencies<br />

being achieved in most instances, their clients were of the view that the<br />

agencification had adversely affected the performance of their organizations<br />

and had not resulted in the anticipated positive impacts on their organizations’<br />

operations (Smith, 2014).<br />

The cases 1 were seen as focused on the achievements of targets and outputs,<br />

and not outcomes (Smith, 2014). The general consensus of this particular set of<br />

participants was that improvements in service delivery were based on targets and<br />

66<br />

1<br />

National Environment and Planning Agency, and National Land Agency – Case study (Smith, 2014)

Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

outputs which were determined by the chief executive officer and management<br />

staff, as against outcomes. The views of the respondents were that the executive<br />

agencies have hindered their performance and that agencification was insufficient<br />

to influence the performance of their organizations or enterprises, and that<br />

in fact, the agencies’ emphasis was on achievement of targets, outputs and<br />

performance and not on the outcomes (Smith, 2014). According to Romzek<br />

(2014) “when an agency’s managerial focus is on inputs and its tasks are routine,<br />

hierarchical accountability, with limited discretion is an effective alignment”<br />

(p.35). However, performance is based on the relationship between inputs,<br />

outputs and outcomes. In fact the changed emphasis from inputs, processes<br />

and outputs to outcomes is reflected in the rhetoric of public sector reforms.<br />

Researchers need to be aware of the accountability challenges that come with<br />

public sector reforms. For example, what of the managers’ comfort zone with the<br />

‘new’ autonomy? Are the ‘old’ accountability relationships discarded prior to the<br />

‘new’ accountability relationships being fully implemented and accepted by the<br />

managers? The focus on outcomes not only encourages efficiency and effectiveness,<br />

but provides a different approach to accountability, as there would be a<br />

smaller number of outcomes rather than a greater number of outputs.<br />

Empirical studies carried out on Next-Steps 2 agencies in the United Kingdom<br />

on the use of performance indicators and their impact on performance, found<br />

improvement in performance (although from the managers’ perspectives), in<br />

addition to increased use of key performance indicators (Pollitt, 2005). The<br />

United Kingdom experience suggested that setting the right number of targets<br />

was important stated by Limb (2001) that “the ideal would be 5-8 key<br />

targets for each agency”; and the concentration of targets on key things that<br />

matter to service-users such as “outcomes rather than inputs or processes/<br />

activities” (p. 27). Notably, the importance of “service processes and outcomes”<br />

is supported by the post-new public management initiative – the new public<br />

governance – as against the emphasis on “service inputs and outputs” under the<br />

new public management (Osborne, 2006, p. 383).<br />

Accountability of Executive Agencies: To Whom?<br />


The increased attention to key performance indicators as determined by the<br />

chief executive officers in conjunction with the management teams, could be<br />

sub-optimal as supported by the finding of empirical study (Smith, 2014).<br />

Agencification was found not to have translated into the expected outcomes or to<br />

have a positive influence on the small- and medium-sized enterprises’ operations<br />

and profitability.<br />

The new public management agencies and chief executive officers are purported<br />

to be accountable to the “ministers” through ‘political’ accountability; for the<br />

performance of the agencies through administrative accountability to external<br />

organizations with responsibility for supervision and control; and for profession-<br />

2<br />

The Jamaican public sector modernization programme implemented the establishment of executive agencies<br />

which are based on the United Kingdom ‘Next Steps’ model.<br />


Management Institute for National Development<br />

al accountability to a lesser extent. What of the issue of accountability to the<br />

users? Democratic accountability supports accountability relationships among<br />

the agencies, and social groups such as citizens and private sector organizations.<br />

The private sector organizations must be made aware of the roles, targets, and<br />

outputs of the agencies and their connectivity to overall outcomes and policies of<br />

the government.<br />

Further thoughts are: what are the effects of public sector reforms on employees’<br />

accountability? Are employees made more accountable under the ‘new’ public<br />

management reforms than they were before? What is the best way to manage the<br />

expectations of the users – the agencies and their staff, the ministers – that rely on<br />

differing accountability relationships?<br />

Governance & Accountability: Fair or Favour<br />


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />

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Governance & Accountability: Fair or Favour<br />


Caribbean Journal of Public Sector Management, Vol.12 No.1, January 2017<br />


Edwin Jones is a professor of Public Administration, University of the West<br />

Indies and recipient of the Vic Chancellor’s Awards for Excellence in Academia<br />

and Public Service. An outstanding scholar and the doyen of Public Administration<br />

in the Caribbean region.<br />

Carolien Klein Haarhuis is researcher at the Research and Documentation Centre<br />

(WODC), Division of Justice Administration, Legislation, International and<br />

Aliens Affairs Research (RWI). The WODC forms part of the Department of<br />

Security and Justice in The Hague, the Netherlands.<br />

Monika Smit heads the research division Justice administration, legislation,<br />

international and alien affairs (RWI) at the Research and documentation centre<br />

(WODC) in the Hague, the Netherlands. Before that, she was senior researcher at<br />

the Bureau of the Dutch national rapporteur on trafficking in human beings, and<br />

assistant professor Child & Youth Care at Leiden University.<br />

Anton Weenink is a senior researcher in the Central Unit of the National Police<br />

of the Netherlands. He studied public administration at Twente University,<br />

where he also earned his doctorate. He published on international relations,<br />

Eastern European organized crime, crime and governance in the Caribbean,<br />

and terrorism. His current research is about behavioural issues in radicals.<br />

Roelof-Jan Bokhorst is a judge in the court of Den Bosch, The Netherlands,<br />

formerly working as researcher at the Ministry of Justice / Research and<br />

Documentation Centre (WODC).<br />

Shanise Allen is a PhD candidate at Lancaster University holding a MSc. in<br />

Public Administration and Development from the University of Birmingham.<br />

She is also a registered physiotherapist whose experience includes practice in<br />

Jamaica, Grenada and the Turks and Caicos Islands.<br />


Management Institute for National Development<br />


Valoris Smith achieved her Doctorate of Business Administration (DBA) at the<br />

Mona School of Business and Management, University of the West Indies, Mona.<br />

Dr. Smith also attained her Master in Business Administration (MBA) in Finance<br />

and Banking from the Mona School of Business and Management, University of<br />

the West Indies, Mona. She is a Fellow of the Chartered Association of Certified<br />

Accountants (FCCA) and a Fellow of the Institute of Chartered Accountants<br />

of Jamaica (FCA). She currently lectures Finance and Banking to both<br />

undergraduate and graduate students at the University of Technology, Jamaica.<br />


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