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Chapter 4 examines how politicians’ ability to influence bureaucrats’ careers creates opportunities for corruption in public procurement. Drawing on surveys and interviews with bureaucrats across local governments in Ghana, it finds that nearly half of bureaucrats believe procurement contracts are awarded uncompetitively, often in exchange for party financing. These perceptions highlight the vulnerability of procurement processes to partisan manipulation. A key mechanism through which politicians secure bureaucratic compliance is career control, particularly the threat of geographic transfers. Bureaucrats who resist corrupt demands risk reassignment to less desirable locations, a sanction that can disrupt both professional advancement and personal lives. Evidence from a survey experiment underscores this fear: bureaucrats anticipate that opposing corruption would trigger punitive transfers. By focusing on career management as a channel of influence, the chapter contributes to broader debates on bureaucratic autonomy and political interference. It also demonstrates that corruption is not merely the result of bureaucrats’ individual incentives but of institutionalized practices that bind bureaucrats’ careers to politicians’ partisan strategies.
Edited by
Jonathan Cylus, European Observatory on Health Systems and Policies,Rebecca Forman, European Observatory on Health Systems and Policies,Nathan Shuftan, Technische Universität Berlin,Elias Mossialos, London School of Economics and Political Science,Peter C. Smith, Imperial College of Science, Technology and Medicine, London
Chapter 3.7 reviews priority-setting. Priority-setting is about taking explicit decisions on where limited public resources should be allocated. Vertical priority-setting focuses on choices for particular sets of health conditions or population groups whereas horizontal priority-setting looks more broadly across types of care, such as primary or secondary care, and broader investments. Key learning includes that
Defining a health benefits package that is affordable and accessible by all implies a horizontal approach to priority-setting.
Countries cannot progress towards UHC without horizontal priority-setting and without some form of collective funding and procurement mechanisms.
Horizontal priority-setting is highly context-specific. Countries may need to reorganize financing and procurement mechanisms to overcome barriers to progress.
Increasing the total resources for health benefits packages (HBP) can help with the introduction of more horizontal approaches.
Improving procurement can also support the move towards horizontal priority-setting whether through national efforts (such as better data gathering and use) or international initiatives (i.e. harmonizing regulation across countries or global investment in health security).
Local capacity is key in supporting the pooling mechanisms, HBP design and regulation which enable horizontal priority-setting. Donors can usefully support health systems strengthening by investing in capacity-building and information sharing.
Strong political will and cooperation between stakeholders is critical in progressing towards appropriate priority-setting for UHC and in designing, financing and implementing a comprehensive health benefits package.
The healthcare sector is a major consumer of plastics, with single-use gloves among the most frequently used items. Their use has increased significantly over recent decades, with the COVID-19 pandemic further accelerating this trend. Despite this, little is known about the drivers of glove consumption or how it might be reduced. This study examines the use of single-use plastic gloves in healthcare settings in two Scandinavian countries, drawing on interviews with 26 respondents, observational data, and document analysis. Findings reveal substantial overuse, misuse, and unnecessary disposal driven by behavioral norms, institutional practices, procurement routines, and product design. The study examines how circular strategies (R-strategies) can be applied to enhance the effective and efficient use of gloves, emphasizing the often-overlooked importance of the use phase. Behavioral change among staff emerges as more impactful than top-down policy alone, underscoring a gap between strategic goals and daily practices. The article identifies key opportunities and barriers to implementing circular solutions, offering insights relevant to researchers, healthcare professionals, procurement officers, and policymakers. Immediate practical implications center on adjusting staff routines and incentives, while further research is needed into mechanisms bridging the gap between environmental targets and medical professionals’ everyday decision-making.
This poses the question as to why the American air arm began World War II with excellent offensive bombers but mediocre defense fighter planes, which was seemingly in contradiction to a national policy of isolationism and defense. The standard explanation for this dichotomy is that doctrine shaped force structure. I disagree and believe it was a combination of technology, economics, the Army procurement system, and personalities that played the determinant role.
Until the Japanese attack on Pearl Harbour, America did not want war, with the 1930s marked by strong isolationism and an emphasis on defense. However, in December 1941, it wasn't defensive aircraft the Army Air Corps had been steadily procuring, but offensive long-range heavy bombers, whilst US pursuit planes were decidedly inferior to their European counterparts. In this new history of the development of American air power, Phillip Meilinger dispels the notion that young air zealots pushed for a bomber-heavy force, revealing instead the technological, economic and bureaucratic forces which shaped the air force. He examines the role of scientists and engineers, developments in commercial aviation, and conflicting priorities of the Army and Air Corps, as well as how these were in turn influenced by America's political leaders. Building an Air Force is essential for understanding a conflict in which whoever controlled the skies controlled the land and seas beneath.
Brokers and ship captains sent thousands of people from the British Isles to work in the English American colonies without indentures. These immigrants only entered written contracts after arrival. Here – and in other labor arrangements in England – the concept of “enticement” dominated. Subordinates’ consent to serve was imagined to be the result of campaigns of temptation to which they succumbed. While previous studies of enticement in early modern England have been limited to sexual seduction, at the time enticement also meant servant poaching. Claims of enticement allowed commentators to emphasize the power of personal interactions in servant procurement, instead of drawing attention to the structural conditions that made a segment of society disproportionately vulnerable to abuse by illicit brokers denounced as "spirits."
In the state of Uttar Pradesh, the political elites tried out land reform as a viable, competing strategy of agrarian modernization. This was an alternate vision of modernization rooted in the freedom movement that put trust in creating a land of healthy peasant proprietorship where efficient, productive cultivators would produce for the market. This reform-based approach came to be personified by a regional peasant leader, Chaudhary Charan Singh. Meanwhile, as part of the Indo-US treaty of 1954, the American land grants helped set up India’s very first agricultural university in the state, the Uttar Pradesh Agricultural University (or UPAU). The new agriculture university showcased a technological approach to enhancement of yield. The central state introduced a new program of productive agriculture around Mexican HYVs in 1964-66 and partnered with the technocrats at UPAU to help facilitate its spread in the state. Charan Singh broke ranks with the Congress party in 1967 whose government at the center was the sponsor of the HYV-program.
This chapter develops a framework for algorithmic governance, including considerations of the nature and consequences of the decision through processes of impact assessment. It analyzes ex ante AI design issues, such as mechanisms for sourcing technology through departmental or agency development or procurement processes, the calibration of error rates, level of human oversight, and participatory processes. Following this, the chapter considers the implementation of models of internal and external algorithmic auditing. The chapter then canvasses the trend towards centralized coordination of AI policies and principles across government, both through horizontal mechanisms of central agencies and regulators and vertical arrangements at the supranational and international organizational level imposed upon nation states. It also discusses transparency measures, including central publication of algorithmic tools, and individual notification and explanation of automated decisions.
With the passage of the Climate Change Act, and to help meet its net zero obligations by 2060, Nigeria must transition from its dependence on fossil fuel energy sources to renewable energy. This will involve the procurement of large amounts of renewable energy by the government. In the past, procurement of power from the government-owned bulk trader has been chaotic, with no discernible strategy, and it is doubtful whether the government or Nigeria's citizens have derived value for money from the process. This article suggests a transition from the current, mostly unsolicited, proposal system to energy auctions, as the authors believe that this will help the country achieve low prices for renewable energy. The article also examines polices that have been implemented in other countries to drive energy auctions, with a view to applying relatable practices to the Nigerian exercise.
This chapter analyses crimes involving procuring sex, including procuring sex by deception. It argues that to appreciate the nature of these offences, and their place within this book, it is necessary both to understand how the verb ‘to procure’ was interpreted, including when and why it required deception, and to pay attention to the acts whose procurement was proscribed by law. The chapter provides elucidation on both fronts, showing how the procuring offences were geared towards prohibiting ‘illicit’ (i.e., immoral) sexual activities and therefore criminalised the use of deception to lure others into committing such acts. In demonstrating this point, the chapter argues that a culturally sensitive vision of what makes intimacy valuable shaped and constrained the use of the procuring offences. Finally, the chapter argues that the demise of the procuring offences set the stage for the expansion of the crime of rape by deception and that examining how the procuring offences worked yields important lessons for those attempting to engage critically with this development.
The Rapid Acceleration of Diagnostics (RADx®) program’s success would be significantly diminished without the support of the Deployment Core. For a company to successfully bring to market an in vitro diagnostic (IVD) test, it requires expertise in a variety of areas. This is especially pertinent in a pandemic landscape, as timelines are greatly reduced and market demand is constantly changing. Within the RADx initiative, the Deployment Core was established to identify and provide these necessary resources. The Deployment Core was formed in May 2020 after the IVD companies’ needs became apparent, including the need for consultant expertise and various resources to support development and scale up. This chapter explores the challenges faced by many RADx companies and the lessons learned through the Deployment Core in addressing those needs.
To better understand the process of hospital acquisition of innovative medical devices (MDs) and the hospital-based health technology assessment (HB-HTA) pathways in France, an in-depth study based on a quantitative approach is needed. The aim of the present study was to assess through a national survey how HB-HTA is currently implemented in French hospitals and to identify its level of formalization.
Methods
A quantitative online survey was conducted among hospitals performing HB-HTA in France, with a focus on the acquisition of innovative MDs for individual use. The survey, conducted between March and June 2022, was developed by a scientific board composed of members of the French-speaking Society for HB-HTA.
Results
Sixty-seven out of 131 surveyed hospitals with HB-HTA activities responded, including 29 university hospitals, 24 nonprofit private hospitals, and 14 local hospitals. Sixty-one respondents (91 percent) reported the existence of a process dedicated to evaluating innovative MDs; of these, 16 declared that their hospitals had a formalized unit with HB-HTA activity. These units were more frequently found in larger hospitals with more than 500 inpatient beds (n = 16, p = 0.0160) and in university hospitals (n = 12, p = 0.0158). No hospital reported any collaboration with HAS, the French national HTA agency.
Conclusion
A diverse range of HB-HTA organizations with different structural levels exist in France for MD procurement linked to the category of hospitals. The study highlights the need for recognition of HB-HTA activity at the regulatory level in France and for direct collaboration between HTA activities performed at local and national levels.
Defence procurement is a notoriously difficult and often controversial field of public management. In Australia, problems with schedule and budget overruns have been addressed through business process reforms aimed at tightening control and improving professionalism. However, studies of complex contracting in other contexts show the importance of relational factors of trust, collaboration and risk-sharing. These factors are not encouraged by the predominantly transactionally based contractual environment of Defence. Based on a detailed examination of three case studies, we suggest that there is a disjunct between the types of controls that are applied by Defence and the requirements of delivering complex, long-term projects involving multiple stakeholders. The need for both improved flexibility as well as heightened accountability is evident. We argue that balancing these values involves processes that encourage, rather than discourage, communication, risk-sharing and trust.
The acquisition and procurement of major weapons systems is fraught with difficulties. They tend to be delivered late, over budget and unable to meet requirements. This Element provides an economic analysis of why this happens. Market structure, demand by the military and supply by the arms firms, shapes the conduct of the agents and generates the poor performance observed. The military are trying to counter an evolving threat, subject to a budget constraint, high R&D costs and new technologies. The interaction between a government made up of warring tribes and arms firms with considerable market and political power is further complicated by a set of what economists call 'principal-agent' problems, which are examined. While the poor performance has prompted many countries to propose reforms, the difficulty of the task and the institutional incentives faced by the actors mean that the reforms rarely solve the problem.
This chapter introduces the subject matter of the book, provides the core problem statement and defines the central terms used in the book. The introduction also explains the focus on governmental adoption of cloud computing services, legal sources, and the research approach.
The introduction explains how cloud computing has made it possible and desirable for users, such as businesses and governments, to migrate their data to be hosted on infrastructure managed by third parties. The chapter further outlines why aspects of migration to cloud services pose specific legal, contractual, and technical challenges for governments.
The chapter further outlines the challenge of addressing contracting and procurement requirements, data privacy and jurisdictional obligations when using an opaque, global, multi-tenant technology such as cloud computing.
This chapter evaluates the unique obligations governments have when they commit citizen data to cloud service providers. In particular, the chapter focuses on how the responsibilities of governments are different than other types of cloud computing users focusing on specific procurement obligations, and other legal requirements.
The chapter also evaluates issues related to “data sovereignty”, outsourcing of government functions, and the potential risk to citizens from outsourcing critical infrastructure. Further, barriers that governments face when procuring cloud computing services including data localization restrictions, difficulties in comparing costs to traditional IT services, and ill-suited contract templates designed for traditional IT-outsourcing being applied to cloud computing services.
The chapter also explains that since operations or services are outsourced to cloud, governments must have the means to monitor them in order to retain a certain level of control over the operations they are outsourcing. The chapter examines government procurement programs in the United States, United Kingdom, and European initiatives to adopt cloud computing at the government level.
In Government Cloud Procurement, Kevin McGillivray explores the question of whether governments can adopt cloud computing services and still meet their legal requirements and other obligations to citizens. The book focuses on the interplay between the technical properties of cloud computing services and the complex legal requirements applicable to cloud adoption and use. The legal issues evaluated include data privacy law (GDPR and the US regime), jurisdictional issues, contracts, and transnational private law approaches to addressing legal requirements. McGillivray also addresses the unique position of governments when they outsource core aspects of their information and communications technology to cloud service providers. His analysis is supported by extensive research examining actual cloud contracts obtained through Freedom of Information Act requests. With the demand for cloud computing on the rise, this study fills a gap in legal literature and offers guidance to organizations considering cloud computing.
China's overseas financing is a distinct form of patient capital that marshals the country's vast domestic resources to create commercial opportunities internationally. Its long-term risk tolerance and lack of policy conditionality has allowed developing economies to sidestep the fiscal austerity tendencies of Western markets and multilaterals. Employing statistical tests and extensive field research across China and Latin America, Stephen Kaplan finds that China's patient capital endows national governments with more room to maneuver in formulating domestic policies. The author goes on to evaluate the potential costs of Chinese financing, raising the question of how Chinese lenders will react to developing nation's ongoing struggles with debt and dependency. By disaggregating the structure of international finance, Globalizing Patient Capital has significant implications for the rise of China in Latin America, offering new insights about globalization and showing the costs and benefits of state versus market approaches to development.
Chapter 4 employs an originally constructed data set, the China Global Finance Index, to conduct cross-national tests spanning eighteen Latin American countries from 1990 to 2017. The index characterizes Chinese policy loans by their ?nancing channel (state-to-state vs. market-based) for each national-level investment project.The chapter ?nds that China’s state-to-state loans, as a share of a country’s external public debt, are positively correlated with budget de?cits, supporting the primary hypothesis that China’s patient capital expands governments’ ?scal policy space. In exchange for this lack of policy conditionality, however, policymakers tend to have more extensive commercial conditionality. Notably, when Chinese ?nancing is instead directly booked with corporate enterprises through private procurement in the marketplace, these commercial conditions are less extensive. China’s patient capital behaves more like long-term equity capital given the underlying private sector competition promoted by domestic procurement laws. National governments do not gain additional ?scal space and are more likely to comply with policy conditionality.