The National Health Insurance Scheme (NHIS),
registers forty thousand (40,000) people daily, according to the
National Health Insurance Authority (NHIA). This figure consists of
registrations and membership renewals, undertaken by all NHIS district offices
and registration centres across the country.
Deputy Director of Communications at the NHIA, Selorm
Adonoo, who made this known said the NHIS has seen ample rise in its
membership, and the public interest in the scheme keeps rising.
According to him, “an average of 40,000 people enroll onto
the NHIS every day. 40,000 people coming through our offices every day, is
quite a number. I think it is an indication of high public confidence in the
NHIS. This explains why our registration centres and district offices are
constantly packed with people, some of whom come very early in the morning so
they can beat the high numbers,” Mr Adonoo mentioned. According to Mr. Adonoo,
the preoccupation of the NHIA is to ensure that, “the process of acquiring the
NHIS card is more convenient than it is now. “Ordinarily, it takes between 10
to 15 minutes to get a card when one sits behind the machine.
However, due to the numbers, we are introducing
innovations to make it more convenient. An example of what we are about to
outdoor is the multiyear renewal, where NHIS members will have the option of
enrolling for two to four years at a go, without having to come to the office
yearly to renew their membership. This will be more cost effective, time saving
and convenient for our members as they would save time and transportation cost
to the office annually,” he assured. Daily enrollment onto the NHIS in 2005,
was just about 3,500, but Mr. Adonoo says comparing this to the 40,000 people
a-day recorded currently, is evidence of the growing status of the scheme and
its popularity. Responding to issues about challenges facing the scheme, he
said the NHIA like any institution, has its fair share of challenges.
He was however quick to add that, the existence of
challenges rather strengthens the resolve of administrators of the scheme to
keep finding solutions to issues that may arise in the implementation of
programme.
The NHIS has been in full operation since 2005, and in
September 2015, a comprehensive review of the scheme was commissioned by
President John Mahama. Industry players say this is the first time such a
review has been instituted, and the process when completed, will among other
things propose reforms that will re-position the scheme to better take on the
challenges of the future. Membership of the NHIS stood at 11.3 million in
December 2015, from 1.3 million in 2005.
ADDRESSING UNCERTAINTIES AND RISKS IN DEVELOPMENT
PROJECTS IN SUB-SAHARAN AFRICA
 |
| Nigerian President Muhamadu Buhari |
By
John O. Kakonge
Any
project bears possibilities of unforeseen difficulties and surprises, but
adequate preparation, good governance and transparency are key to managing
these. Looking at a number of common mistakes from previous development
programmes can prevent repeating them and remind of important lessons often
taken for granted.
Development
projects, by their very nature, will always contain uncertainties and risks –
factors and circumstances not ascertained or anticipated, elements subject to
change or fluctuation, imponderables that may defy the best of planning and
project preparation. This notwithstanding, over the thirty years since Albert
Hirschman (1967) first endeavoured to analyse the project life cycle and the
nature of the uncertainties facing projects, numerous scholars have continued
this analysis in an effort to help project designers and practitioners to
minimize uncertainties and thus improve the chances of project success.
Discussed below are some of the common elements contributing to project risk
and uncertainty, including some insights from the Groundnut Scheme of southern
Tanzania (Tanganyika), which started in 1946 and terminated in 1949.
GENERALIZATION
IN PROJECT DESIGN
One
significant factor causing risks and uncertainties in projects is the tendency
of designers to generalize in their project proposals. In these proposals,
designers all too often make sweeping statements regarding issues about which
they actually have little hard and fast information. Their inclination to reach
for such generalizations is prompted by the assumption that a one-size-fits-all
approach will work, especially for externally funded projects (Harrin, 2012).
Responding to Harrin’s observations, Marcel D’Costa points out that “most
projects are designed in the office, they bear no relation to the reality on
the ground and are out of context” (Harrin, 2012).
Generalization
continues to be a costly and embarrassing factor in the history of project
management. A case in point is the groundnut scheme of southern Tanzania
(Tanganyika) of the post-World War II years. A potential site for the project
was identified by representatives of Unilever Company and the Colonial Office
surveyed the site from the air and determined it was suitable for a large-scale
mechanized agricultural project (Myddelton, 2007). By 1949, the British
government had to swallow its pride and abandon the failed scheme, which by
that time had cost a whopping 49 million pounds sterling (present value £1.526
billion). The officers who recommended the project were fired and, as Myddelton
(2007) concludes, the venture was a complete fiasco.
Unfortunately,
the problems relating to generalization have been repeated time and again in
the history of project management in sub-Saharan Africa. They are costly and
should be avoided. For this reason, “projects need to be designed so as to
allow for flexibility and adjustments as and when needed, provided the changes
have the concurrence of all the stakeholders,” (Akande, 2003 and WHO, 2003), an
approach which certainly worked in the case of the long-running West African
onchocerciasis (river blindness) project, which endured from 1974 to 2002.
LACK OF RESEARCH AND
INFORMATION
Many
projects, especially in Africa, are supported by woefully insufficient baseline
data. The failure of the aforementioned groundnut scheme was due to lack of any
research to generate the data needed to make informed decisions and the
instigators’ dismissal of local knowledge. Specifically, Kimble (1960), and
Jarret (1979) identify as a major shortcoming in the project the complete lack
of information on climatic conditions, such as temperature, rainfall patterns,
wind patterns and soils, during the design of the groundnut scheme. In recent
years several studies, such as Falloux and Talbot (2009), have demonstrated
that environmental factors have extensively contributed to the failure of agricultural
projects in Africa.
Similarly,
according to Horta (1994), who quotes the World Bank Project Performance Audit
1990 report, the World Bank project managers of Bura irrigation scheme in Kenya
knew of earlier technical reports that identified a lack of suitable soils for
irrigation in the area but ignored them, going ahead to recommend the project
to the Board for approval, downplaying the risks and cost implications. This
cavalier attitude to the need for theoretical studies, which has vitiated so many
projects, is noted by Hyden (2013), writing about African rural development
projects in the 1980s. He observes that, during the design of most of these
projects, donors felt that carrying out academic research would take too long
and would end by producing unwanted, unnecessary information. Chambers (1983)
suggests that African governments may have collected the data required by
donors in a quick and untidy manner, instead of relying on conventional
academic research methods.
Despite
the various arguments that research work is too expensive in sub-Saharan
African, there are no shortcuts or easy fixes that will unlock the risks and
uncertainties in project design and implementation. This tallies with the
observation by the World Bank President on 4 October 2015, during the launch of
an initiative for data for Africa, that “collecting good data is one of the
most powerful tools to end extreme poverty”. African governments should
therefore work closely with their universities, scientists and development partners
to ensure that research activities and baseline studies are well funded and are
integrated into project design and implementation, especially for sensitive and
large scale projects.
DESIGNER BIAS
It
sometimes happens that project designers come to their task with an inherent
bias, causing them to overlook certain aspects of the project. As Mathews
(1975) argues, planners tend to be subjective about the things that they know.
In the past, most project designers focused their attention on economic rates of
return to the exclusion of everything else, and had a tendency to ignore the
socio-cultural aspects of a project, especially in Africa.
 |
| South African President Jacob Zuma |
Many
projects in sub-Saharan African countries are externally funded and the project
designers and implementers are forced to focus on the outcomes that the donors
want. Harrin (2012) argues that, to access donor funds, project designers
should focus on visible, short-term outcomes and the efficiency of their
projects. In addition, in some cases the designers of projects should not
assume that what has worked in one country will work in another. Ika (2012)
warns that, unfortunately, such replicability is not easily achieved in Africa
and recommends instead a home-grown approach to project management on the
continent that is based on African values and reality.
Given
the challenges that many African countries face, project designers and planners
need to consult target local communities before they start writing their
projects. Further, Harrin (2012), quoting Ika, stipulates that to avoid biases
externally funded project designers should refrain from using rigid
methodologies, adopt methods that allow for flexibility and take into
consideration local circumstances. In this case, the West Africa river
blindness project is particularly instructive.
CAVALIER APPROACH TO
PROJECT DESIGN AND MANAGEMENT
The
“it doesn’t matter” mentality is nothing new in the history of project
management in Africa. It may be found everywhere. For example, if a donor or
development agency is under pressure to exhaust unspent funds before the end of
financial year, they develop proposals to spend the money very quickly without
asking too many questions. Specifically, areas targeted include training,
procurement of basic equipment like computers, vehicles and others. Thus, in
the case of the groundnut scheme, the Minister of Food was under pressure to
fill the shortfall in edible oil after World War II. It did not matter what
approach the field experts were to use to get the scheme started.
More
recently, some charities and individuals have given materials to Africa without
knowing whether these will be useful or not, or even injurious to the
recipients. This was the case with the Jason Saddler “1 million T-shirt”
project: according to Stupart (2012), Saddler had never been to Africa but
decided to donate the T-shirts anyway. It did not matter to him that he had no
first-hand experience of Africa or that Africa has 54 independent states which
are quite distinct from one another. Furthermore, he gave no thought to the
possible economic fall-out from his project and, after receiving unprecedented
negative feedback from everywhere, he simply threw in the towel.
It
is now well accepted that such activities can lead to unwanted – sometimes even
disastrous – results. The designers of such projects took shelter behind the
“it doesn’t matter” attitude because, first, they assumed that the perceived
negative feedback was too minor to warrant the time and money necessary to
quantify it, and, second, they believed that some elements of the project are
unimportant. In any case, externally funded development projects in Africa
often suffer the same problem – proponents mistakenly believe that the
one-size-fits-all approach is perfectly workable.
Project
donors usually follow standard procedures, although they sometimes allow for
flexibility when tailor-made projects do not fit the local environment (Harrin
2012). Harrin highlights dishonesty as the most important factor for failure in
some projects, especially the hiding of true facts and false reporting. Horta
(1994) stipulated that the World Bank staff hid the truth from the Board to
allow the Bura irrigation project to be approved. The truth of the matter is
that the soils were not homogeneous and therefore not suitable for irrigation.
However, this did not matter until after the scheme failed.
Similarly,
Flyvbjerg (2006), noted that in one study a planner admitted that he had
reluctantly but repeatedly adjusted the patronage figures upward, and the cost
downwards, to satisfy a local elected official who wanted to win a competition
for a federal grant. When the project was completed, and the patronage turned
out to be lower and the costs higher than the published estimates, local
politicians were asked by the press to explain the outcome. Their response was:
“It’s not our fault, we had to rely on the forecasts by our staff, and they
seem to have made a big mistake here”. Cases like this, where culprits blithely
manifest a “don’t care” mentality, are unprofessional and have expensive
consequences, and both the politicians and project management should be brought
to book. This was precisely the action taken by the new UK Minister of Food in
1950, who took full responsibility for the groundnut fiasco, terminated the
entire scheme and fired the responsible project managers (Myddelton, 2007).
POLITICAL PRESSURE
Projects
exist within a political system and politics dictates the development of
projects, externally financed or local. Experience shows that undue political
pressure can skew the design and implementation of projects. For example, the
impetus to start the notorious groundnuts scheme came from the UK Labour
Government’s problems with the continuing low level of fat rations after the
Second World War in 1945. According to Myddelton (2007), the Minister for Food
was under pressure to improve the weekly allocation but there was a worldwide
shortage of edible oils: he was keen to explore the possibility of groundnut
production in the southern part of Tanzania. So within a very short time, the
groundnut scheme was approved – without carrying out reconnaissance studies,
much less cost-benefit analysis (Middleton 2007).
Another
example can be found in Zambia, where Tangri (1999) notes that all the
activities of the Zambia Industrial Development Corporation were politically
motivated, rather than driven by economic or investment considerations, and a
number were started without feasibility studies. From the word go, the
politicians knew that some were clearly white elephants but they went ahead and
approved them (Tangri 1999).
In
contrast, pressure played a critical role in building a strong political will
to eradicate river blindness (onchocerciasis) in eleven West African countries.
Akande (2003) and the World Health Organization (WHO) (2003) acknowledge that
the river blindness programme that was executed by WHO with the collaboration
of 32 organizations, including the World Bank, United Nations Development
Programme (UNDP) and the Food and Agriculture Organization (FAO), was possibly
the most successful programme in the history of international cooperation in
sub-Saharan Africa. It started in 1974 and ended in 2002 with exemplary support
of the 9 out of 11 participating countries (Sierra Leone and Liberia were
affected by the civil war) in both cash and in-kind contributions (WHO, 2003).
Moreover, despite political differences between some of these countries at that
time (and delays to complete the programme in the two countries affected by the
civil war), the fight against river blindness united them until the end.
Sometimes, politics can have both positive and negative impacts in terms of
project design and implementation as shown by the examples above.
OVER- AMBITIOUS
PROJECT DESIGN
During
the design of projects several people are involved in the drafting and
follow-up discussions until an agreement is reached on the way forward. More
often than not, many assumptions are made, especially regarding the completion
of activities on time. Once the project starts, it emerges that the assumptions
are often unrealistic.
Thus,
Myddelton (2007), citing the report on the groundnut scheme in southern
Tanzania, shows that, by 1947 serious flaws had already manifested: planners
and designers had grossly underestimated the cost of related activities such
building roads, railway, airstrips, hospitals and water supplies and
sanitation. Besides, they had badly misjudged the transport, supplies and
workshops needed to maintain heavy tractors (Myddelton, 2007). After two years,
the British Government realized that the area cleared for cultivation was
negligible and the harvest, according to Myddelton, was 2,000 tonnes as opposed
to the 57,000 tonnes projected in the plan.
As
Kimble (1960) concluded in his book “Tropical Africa” the African physical environment
was complex with many unknown elements. The British Government should not have
moved forward and started a large-scale agriculture scheme without adequate
data on all important parameters. This serious shortcoming is unfortunately
being repeated even today. The project designers and planners should have been
modest and not over-ambitious, started with a pilot scheme and then rolled out
the project gradually.
The
recent World Bank evaluation of 2013 report also concluds that “project design
has been a major factor, especially in the form of over ambitious projects in
relation to limited and variable country capacity and deficient results
framework”. In fact, the report indicates that this could have been avoided had
there not been a marked lack of proactivity in supervision during the
implementation stage of these projects.
CONCLUSION
From
the foregoing, it is clear that there are many factors that cause uncertainties
and risks in project management. This brief paper has suggested some ways in
which these uncertainties and risks may be anticipated and prevented – or at
least remedial measures adopted. These observations are not new, but all too
often they are taken for granted. Clearly to address risks and uncertainties in
project design and implementation calls for good governance – transparency
(eliminating secrecy, e.g. the Bura irrigation scheme), accountability
(accepting mistakes, as in the case of the groundnut scheme) and inclusiveness.
For
a large agricultural project, starting with a pilot is the best way forward,
for this will make it possible to identify any shortfalls before rolling out
the project. The lessons drawn from the failure of the groundnut scheme should
not be repeated time after time but should instead serve as pointers on things
not to do when it comes to large-scale projects. As a general rule of thumb, in
the conduct of nearly all donor-funded programmes and projects, the
implementation procedures need to be made less cumbersome and complex. The West
African river blindness project covered a huge geographical area with a
multitude of risks. Fortunately, it had good management, which was transparent
and convincing and this in turn persuaded donors and participating countries
wholeheartedly to support the programme with funding over a period of almost
three decades (WHO, 2003). The project also embraced research and building
local capacity to ensure sustainability.
Overall,
as shown by this brief article, the implementation of any project is invariably
full of unforeseen eventualities and surprises – and surprises, by definition,
are always uncertainties. As one risk is dealt with, others may develop: this
is perhaps truest of all in Africa. Accordingly, throughout the entire project
cycle, risks and uncertainties should be treated with the utmost caution and
without any generalization. As Kimble (1960) concluded, the African operating
environment is very complex and nothing should be taken for granted. It is
clear from major evaluations of African projects that, to address the risks and
uncertainties in projects and programmes, there is need for well-funded regular
monitoring and evaluations and research, supported by a strong network in which
successes – and failures – can be shared and lessons learned from these
experiences for the design and implementation of future projects and
programmes.
*
Ambassador Dr. John O. Kakonge is an independent consultant.
REFERENCES
Akande,
L. (2003).“Victory over river blindness”,Africa Recovery, vol. 17, No. 1.
Chambers, R. (1983). Rural Development: Putting the Last to First, Harlow:
Prentice Hall, UK.
Falloux, F., and M. Talbot (1993). Crisis and Opportunity: Environment and
Development in Africa, Earthscan, London.
Flyvbjerg, B. (2006). “Megaproject
policy and planning, problems, causes and cures”.
Harrin, E. (2012). “Why projects are failing in Africa (part 1)”. http://pmtips.net/Blog/projects-failing-africa-part-1
Hirshman, A. (1967). Development Projects Observed, Brookings Institution
Press, re-issued (2014).
Horta, K. (1994). “Troubled waters: World Bank disasters along Kenya’s Tana
River”,http://multinationalmonitor.org/hyper/issues/1994/08/mm0894_08.html
Hyden, G. (2013). African Politics in Comparative Perspective, Cambridge
University Press, UK.
Jarret, H.R. (1979).Africa, MacDonald and Evans Ltd, Plymouth, UK.
Kimble, G.H.T. (1960). Tropical Africa, vols. I and II, Twentieth Century Fund,
USA.
Mathews, W.H. (1975). “Objective and subjective judgements in environmental
impact analysis”, Environmental Conservation, vol. 2, issue 02, pp. 121–131.
Myddelton D.R.C. (2007). They Meant Well: Government Project Disasters,
Institute of Economic Affairs, London.http://www.iea.org.uk-Research.
Stuppart, R. (2012). “7 worst international aid ideas”, Matador network. http://matadornetwork.com/change/7-worst-international-aid-ideas/
Tangri, R. (1999). Politics of Patronage in Africa, James Currey Publishers,
UK.
World Bank (2013). Results and
Performance of the World Bank Group 2013, An Independent Evaluation.
Vol. I: Main Report, Independent Evaluation Group (IEG), World Bank, IFC, MIGA,
Washington DC.
World Health Organization (2003). Success in Africa:The Onchocerciasis Control
Programme in West Africa 1974–2002, WHO, Geneva, Switzerland.
MOROCCO’S
EXPANSIONIST DREAMS
 |
| Morocco King Mohammed VI |
By Malainin
Mohamed Lakhal
For the first time ever, a Moroccan king delivers a
nationalist expansionist speech from a foreign country without any obvious
reason that would explain this choice. The king is not a victim of a coup nor
is his country threatened by any peril that may have explained such a choice.
King Mohamed VI delivered, from Dakar- Senegal, this
November 6 a speech on the occasion of his father’s invasion of Western Sahara.
The speech contained many messages to the African Union and Africa first, to
the Saharawi Republic of course, and implicitly sent serious messages to Mauritania
especially and also to the people of the Rif and to the Moroccans, who are now
demonstrating massively against their authorities’ violations of their most
basic human rights.
Message to the African
Union
Mohamed VI simply declared that his country would become a
member of the Union without giving up colonizing Western Sahara.
“When we announced our return, we were not asking for
anyone’s permission to exercise our legitimate right. In any case, Morocco is
returning to its natural place and is supported by an overwhelming majority to
reclaim its seat within the African institutional family,” he haughtily stated.
Worse, the king openly declared his determination to keep
up with his country’s colonization of Western Sahara, and threatened all other
states who support the decolonization of the last colony of Africa to stop them
from implementing all OAU/AU and UN decisions on this conflict.
“Morocco’s return to its continental institutional family
will not change our unwavering position regarding the Moroccan Sahara. On the
contrary, it will enable us to defend our legitimate rights and correct the
fallacies peddled by opponents of our territorial unity, particularly within
the African Union. We will also foil their attempts to insert such fallacies
into resolutions which are contrary to the base set by the United Nations for
the settlement of this fabricated regional dispute and to the stances adopted
by most African states,” the king says.
So, the kingdom is seeking re-admission in the AU but
refuses to respect the borders of other member states, refuses to accept
peaceful solutions to the conflict, and refuses to respect the right of the
SADR to complete sovereignty over its territory. Now, it will be very
interesting to see how the African Union and individual African states answer
this new Moroccan arrogance.
Message to the
Saharawi Republic
The king’s speech simply warned the Saharawi leaders and
people and called on them to get ready for hard times from inside the AU. To
believe his own words, Morocco will as he said, “foil their (Saharawi and their
allies’) attempts to insert such fallacies into resolutions which are contrary
to the base set by the United Nations for the settlement of this fabricated
regional dispute and to the stances adopted by most African states.”
So basically, the aim behind the Moroccan search for
re-admission to the African Union is not to participate in the integration and
emancipation of our mother Africa; it is rather a determined will to break it
from inside by fueling conflicts and pushing some African states to support a
colonial regime, Morocco, in its expansionist and colonialist goals in Africa
in general and in Western Sahara in particular.
Message to Mauritania
Now, coming back to the king’s choice of delivering the
speech from Dakar, we can only deduce that he wanted to read this speech of
expansionism from behind the borders of Mauritania to warn it against the
possible future wrath of Rabat against Nouakchott if the later continues to
refuse Morocco’s interference in its internal affairs.
Everyone knows that Rabat is angry with the current
President of Mauritania, Mohamed Ould Abdelaziz, because he refuses to submit
to the Morocco-French will and holds a position in favour of the complete
political independence of his country.
It seems that the King’s aim of delivering his speech from
Dakar to say to the Africans that the political borders of Morocco/France go
beyond the Moroccan geographical borders. It reaches other countries that are
willing to defend the Moroccan expansionist claims in Western Sahara now, in
Mauritania and maybe in some parts of Algeria some coming day.
Messages to the people of the Rif and the Moroccan people
The king chose, as he said, to deliver his expansionist
speech from Senegal “because of the special status it enjoys in Africa, thanks
to its historically democratic model, its political and social stability, as
well as its economic dynamism.” In other words, he chose that country because
it has some features he couldn’t possibly find in his own country, which is
burning these days because of his people’s demonstrations and uprising against
the violation of their rights by the authorities of the king.
The king wanted to say that he had to give the speech from
Dakar because Morocco is not democratic, doesn’t enjoy a special status in
Africa (since many countries look at it as a colonial regime), lacks political
and social stability as well as economic dynamism.
The king didn’t give a single thought to the thousands of
Moroccans and Rif population who are currently demonstrating against some of
his own subordinates’ abuses against the people. In fact, he didn’t express a
single position against the cold and criminal assassination of the victims by
his own subordinates.
Conclusion
The king of Morocco in this speech is openly describing
his new strategy towards Africa and the African Union. This strategy is simply
based on buying allegiances of some high African politicians, bribing them with
money and maybe some economic promises in exchange for blind and shameful
support for the colonization of the last colony in Africa.
The king, further, targets the African Union aiming at
stopping its support to the Saharawi Republic or if he can’t do that, then blow
the organization from inside by splitting it in two because of this issue.
It is time for Africa and Africans to make choices. Should
they stick by the founding principles of their organization and continue
defending the goals and objectives of the AU Constitutive Act, or will we be
hearing voices that will praise a colonial regime, expressing support to
murder, human rights violations, natural resources pillage, despise and
disregard of African principles, and support of the colonization of a fellow
African nation? The coming days will bring the answer, and they will certainly
draw the picture of the future Africa we will live in.
