Conceptual and Practical Considerations in Alternative Service Delivery

The new South Africa came into being in 1994. The new government inherited the national public service and those of a variety of former provinces and homelands that had to be amalgamated to form a national unified public service. Although this task was accomplished rapidly, the resulting public service was very large, and exhibited many features of traditional bureaucracy, including hierarchical structures, limited automation and IT applications, low levels of training, a poor work culture, language and cultural barriers, and an overall orientation towards inputs and processes rather than service delivery and results. Within the first three years of the new order, substantial effort was devoted to reforming the bureaucracy. New public service legislation and regulations were introduced, new and powerful central personnel agencies were created, English became the language of administration, and substantial authority was devolved to departments and provinces. Despite these reforms, progress in improving results in terms of service delivery, especially to previously disadvantaged communities, was mixed. Towards the end of the 1990s increased attention was paid to means of improving service delivery. Three important initiatives in this regard were Batho Pele (1997), the adoption of eight nationwide principles for better service delivery; a public private partnerships initiative (2000) and the promotion of alternative service delivery. While alternative service delivery initiatives are largely at pilot stage, they offer a promising alternative both to traditional bureaucracy (with its cost and poor service delivery focus) and to a narrow version of privatisation (which could involve heavy social costs, job losses, and regressive redistribution of wealth). This paper reviews these developments and outlines some promising alternative service delivery pilot projects.

The new integrated global environment has resulted in a paradigm shift from the nation-state to the international community as a driver of change, an unprecedented degree and speed of change, the replacement of single policy issues with cross-cutting ones and a demand by citizens for improved service delivery. In response, governments are creating alternative service delivery (ASD) arrangements. Jurisdictions using ASD can be placed on a continuum of organizational change. There are slow starters in which all service delivery is state-owned, operated and designed around government needs. There are structural changers that pursue a formulaic approach to organizational change. Finally, there are transformational changers that take a principles-based case-by-case approach to organizational renewal, ensuring that each initiative responds to the particular challenge of the nation and its entities. In Canada, the Policy on Alternative Service Delivery provides guidance for jurisdictions contemplating organizational change with the Public Interest Test. This article will examine the role that organizational change plays in countries that are implementing major governmental change initiatives. It will review the influence of an increasingly integrated global environment on government change and examine how ASD can act as an organizational response to this environment. It will look at the governance issues that countries face when implementing ASD and propose a typology for classifying countries as change agents. Finally, it will reference a principles-based approach for implementing organizational change through ASD that is being implemented in Canada.

BackgroundIn response to the COVID-19 pandemic, sexual health services have started to implement alternative service delivery methods that reduce in-person contact (e.g., telemedicine, virtual health). We sought to understand acceptability...

Five - Alternative Service Delivery Options

BackgroundAs a consequence of stay-at-home and other lockdown measures, such as social distancing, all health care service provisions during the COVID-19 pandemic have been affected, including the provision of speech therapy. Telehealth services can play a major role in maintaining access to health care, help speech and language pathologists (SLPs) overcome physical barriers by providing patients and caregivers with access to health care, and limit the discontinuity of patient care. To have a better understanding of the changes that have occurred in these services during COVID-19, this research was conducted to explore the nature and current situation of speech-language services in Saudi Arabia based on caregivers’ perspectives. It also investigated whether changes have occurred in these services during the COVID-19 lockdown. The study also determined the perception of caregivers in delivering SLS sessions remotely.MethodA cross-sectional study was conducted with 385 caregivers in Saudi Arabia. An online survey asked whether children were experiencing any SLS problems and if they had received any intervention. The survey also assessed the perception of changes in service during the COVID-19 lockdown and the perceptions, acceptance, and willingness of the caregivers to deliver telehealth speech services in Saudi Arabia.ResultsAbout 50% of the respondents had or were suspected to have a child with SLS problems, and just over half of them had accessed SLS services. Most of the respondents reported suspension of therapy sessions as a response to the COVID-19 pandemic. While the respondents had little experience using telehealth prior to the pandemic, they generally showed a willingness to use telehealth in therapy sessions, expressing a preference for video calls over other options.ConclusionThe study revealed that SLS services in Saudi Arabia are limited and that accessing these services is challenging. Alternative service delivery using remote services could help caregivers overcome such challenges. When telehealth was introduced as an option for service delivery, the caregivers showed welcoming responses, particularly with video calls.

This section focuses on the relationship between accountability and policy outcomes such as the quality of service delivery. This relationship, the main dimensions of accountability and several important contextual factors are analyzed in the context of decentralization. Then, this section focuses on the recent experience in alternative service delivery and financing models. The role of indicators/indices for policy, program, and project design and for monitoring results is also discussed. Finally, the last section deals with the lessons from the international experience and implications for the nexus approach to management of environmental resources.KeywordsAccountabilityGovernancePublic-private partnershipResults-based financing

The study was conducted in Wakiso District Local Government. The main purpose was to investigate the relationship between financial management and service delivery in public institutions. Specific objectives were; to establish the relationship between budgeting and service delivery in public institutions; to assess the relationship between financial records and service delivery in public institutions and to examine the relationship between financial reporting and service delivery in public institutions. Financial management was looked at from various dimensions including budgeting, financial records and financial reporting, while service delivery was determined by reliability, assurance, responsiveness, tangibility and empathy. The research design was a case study based on both quantitative and qualitative approaches in relation to cross section, correlation and regression as research designs. The methods used for data collection were questionnaires and interviews. The sample study involved Administration and Heads of departments, District Finance, and Sub County & Town Council Finance Departments, Internal Audit, District Public Accounts Committee, Resident Auditors, District Executive, Sub County & Town Council Executive with a population of 111 and a sample of 103 respondents. Data was analyzed through the use of SPSS Version 20 for quantitative purposes and grouped into categories and themes for qualitative analysis. The conclusions were drawn from tables. Based on the data and research findings, there was a positive relationship between budgeting, financial records, financial reporting and service delivery in public institutions. The study established a positive relationship between financial management and service delivery in public institutions. Hence, it made recommendations such as; Leaders and managers of Local Governments should ensure that there is effective financial management to facilitate realistic budgets, up-to-date records on finances that could be traced in service areas and they should facilitate regular financial reporting and follow-ups in Local governments so as to identify areas that they could address and ensure that services related to the reports are verifiable. The study, therefore, concludes with a call to the stakeholders in Wakiso District Local Government to enhance financial management in form of budgeting, financial records and financial reporting since it enhances service delivery

It has been crucial to solve the service delivery problem since civil society emerged. Even though several barriers to top-quality public service exist, there is little research based on evidence about how digital technologies help address these barriers in Ghana’s public sector. Public service quality remains a problem for people in Ghana who use government ministries, departments, and agencies on a daily basis. As a result, the study assessed the impact of digital technologies on service delivery and quality in Ghana’s public sector. The study used a causal research design with a quantitative approach. The study sample size was 384 respondents who mostly patronized the public institutions considered for the study. SPSS (version 26) was used to analyze all the data with descriptive statistics, correlation analysis, regression analysis and ANOVA to investigate the relationships among measured variables. A mediation analysis, was conducted to assess whether service expectation mediates the relationship between digital technology adoption and service delivery and quality. Findings revealed a significant positive relationship between digital technology adoption and service quality and delivery (β = 0.315, p < 0.001). Service expectation also had a moderate significant positive influence on service quality and delivery (β = 0.508, p < 0.001), and significantly mediated the relationship between technology adoption and service quality (indirect effect: β = 0.237, p < 0.001). These findings underscore the importance of service expectation as a key mechanism through which digital technology improves public service outcomes. Customers who patronize most public sector institutions should be provided with sustainable, high-quality digital experiences through the maintenance of digital infrastructure, including dependable Internet connectivity and accessible digital platforms, and should be given top priority by the management.

Factors influencing the demand of the service of community based animal health care in Zimbabwe

BackgroundThe recent trend of increasing health care costs in the United States is likely not sustainable. To make health care more economically sustainable, attention must be directed toward improving the quality while simultaneously reducing the cost of health care. One of the recommended approaches to provide better care at a lower cost is to develop high-quality data collection and reporting systems, which support health care professionals in making optimal clinical decisions based on solid, extensive evidence.ObjectiveThe objective of this project was to develop an integrated mobile health Augmentative and Alternative Communication (AAC) platform consisting of an AAC mobile app and a Web-based clinician portal for supporting evidence-based clinical service delivery.MethodsA questionnaire and interviews were used to collect clinicians’ ideas regarding what constitutes their desired “clinically relevant” data. In response, a Web-based portal was designed by combining mobile and Web technologies with an AAC intervention to create an integrated platform for supporting data collection, integration, and reporting. Finally, a usability study was conducted with health care professionals.ResultsA Web-based portal was created and integrated with a tablet-based AAC mobile app and data analysis procedures. In the usability study, all participants agreed that the integrated platform provided the ability to collect comprehensive clinical evidence, automatically analyze collected data in real time, and generate clinically relevant performance measures through an easily accessible Web-based portal.ConclusionsThe integrated platform offers a better approach for clinical data reporting and analytics. Additionally, the platform streamlines the workflow of AAC clinical service delivery.

Contracting critics suggest that when governments outsource, they reduce their capacity to produce services and manage service delivery. In this paper, we decompose the service delivery decision into service production and service management components. When governments contract for service production, they may also choose to contract for a portion of service delivery management. Studies that only compare the management activities of contracting and direct service delivery governments, without examining the management activities contracted to vendors are likely to be incomplete and biased. Drawing on a unique survey of governmental refuse collection service directors, matched with a survey of refuse collection vendors operating under municipal contracts, we show that the vendors’ management activities offset the decline in management capacity that occurs when governments contract for service delivery for this particular service. Governments can «buy» management activities when contracting for service production.

Contracting critics suggest that when governments outsource, they reduce their capacity to produce services and manage service delivery. In this paper, we decompose the service delivery decision into service production and service management components. When governments contract for service production, they may also choose to contract for a portion of service delivery management. Studies that only compare the management activities of contracting and direct service delivery governments, without examining the management activities contracted to vendors, are likely to be incomplete and biased. Drawing on a unique survey of governmental refuse collection service directors, matched with a survey of refuse collection vendors operating under municipal contracts, we show that the vendors' management activities offset the decline in management capacity that occurs when governments contract for service delivery for this particular service. Governments can “buy” management activities when contracting for service production. © 2006 by the Association for Public Policy Analysis and Management

Productivity Improvement and Alternative Service Delivery

Comparative Experiences with Functional Reviews and Alternative Service Delivery

A public private partnership (PPP) is an agreement between a public and a private party to achieve a strategic objective. The PPP model is based on three principles: risk allocation and transfer, affordability, and value for money. Traditionally, PPPs have been leveraged for hard service development such as infrastructure development. The advancement of technology within the context of the Fourth Industrial Revolution (4IR) has created new opportunities and risks for PPPs as important mechanisms for the promotion of development. The 4IR has implications for government service delivery, which have brought about an increased demand for service delivery innovation and the development of information and communications technology (ICT). Although PPPs have traditionally focused on hard services, it is important to consider PPPs for soft service delivery. It is therefore necessary to rethink the role of the PPP model as an alternative service delivery mechanism. The aim of this article is to discuss risk allocation in ICT PPPs. The research approach is qualitative in nature. The research method is based on a desktop analysis of literature and secondary data utilising unobtrusive research techniques such as conceptual and documentary analyses. The article identified various risks and opportunities for PPPs for service delivery innovation. These partnerships are often faced with high levels of uncertainty in terms of funding, level of stakeholder commitment, and complex relationships. Other risks include vendor financing, market risk, intellectual property (IP) risk, data governance, and regulatory risk. The deployment of ICT can reinforce and expand PPPs beyond all previous limitations and boundaries. This research makes proposals for good practices for risk allocation in ICT PPPs.