Jumat, 27 November 2009

Hidup itu kayak maen game

hidup itu kayak anak kecil yang lagi maen game. dia akan berusaha sebaik mungkin dan sekeras mungkin biar menang, kalahin semua yang dia lawan.
pesan positif dari ini: jadilah anak kecil itu, yang berusaha menjalani hidup dengan sebaik-baiknya, berusaha mengalahkan apapun yang tidak akan membawa kita pada kemenangan, yaitu Tuhan kita.

Sabtu, 14 November 2009

Fakta mengenai Kanker Serviks












Di negara-negara berkembang seperti Indonesia, penyakit kanker serviks merupakan penyebab utama kematian akibat kanker. Di dunia, setiap dua menit seorang wanita meninggal dunia akibat kanker serviks. Jadi, jangan lagi memandang ancaman penyakit ini dengan sebelah mata.
Berikut 13 hal yang wajib Anda ketahui tentang kanker serviks.

1. Apa itu kanker serviks?
Kanker serviks atau kanker leher rahim adalah jenis penyakit kanker yang terjadi pada daerah leher rahim. Yaitu, bagian rahim yang terletak di bawah, yang membuka ke arah liang vagina. Berawal dari leher rahim, apabila telah memasuki tahap lanjut, kanker ini bisa menyebar ke organ-organ lain di seluruh tubuh.

2. Seberapa berbahaya penyakit ini?
Badan Kesehatan Dunia (WHO) menyatakan, saat ini penyakit kanker serviks menempati peringkat teratas di antara berbagai jenis kanker yang menyebabkan kematian pada perempuan di dunia. Di Indonesia, setiap tahun terdeteksi lebih dari 15.000 kasus kanker serviks, dan kira-kira sebanyak 8000 kasus di antaranya berakhir dengan kematian. Menurut WHO, Indonesia merupakan negara dengan jumlah penderita kanker serviks yang tertinggi di dunia. Mengapa bisa begitu berbahaya? Pasalnya, kanker serviks muncul seperti musuh dalam selimut. Sulit sekali dideteksi hingga penyakit telah mencapai stadium lanjut.

3. Apa penyebabnya?
Kanker serviks disebabkan oleh virus HPV (Human Papilloma Virus). Virus ini memiliki lebih dari 100 tipe, di mana sebagian besar di antaranya tidak berbahaya dan akan lenyap dengan sendirinya. Jenis virus HPV yang menyebabkan kanker serviks dan paling fatal akibatnya adalah virus HPV tipe 16 dan 18. Namun, selain disebabkan oleh virus HPV, sel-sel abnormal pada leher rahim juga bisa tumbuh akibat paparan radiasi atau pencemaran bahan kimia yang terjadi dalam jangka waktu cukup lama.

4. Bagaimana penularannya?
Penularan virus HPV bisa terjadi melalui hubungan seksual, terutama yang dilakukan dengan berganti-ganti pasangan. Penularan virus ini dapat terjadi baik dengan cara transmisi melalui organ genital ke organ genital, oral ke genital, maupun secara manual ke genital. Karenanya, penggunaan kondom saat melakukan hubungan intim tidak terlalu berpengaruh mencegah penularan virus HPV. Sebab, tak hanya menular melalui cairan, virus ini bisa berpindah melalui sentuhan kulit.

5. Apa saja gejalanya?
Pada tahap awal, penyakit ini tidak menimbulkan gejala yang mudah diamati. Itu sebabnya, Anda yang sudah aktif secara seksual amat dianjurkan untuk melakukan tes pap smear setiap dua tahun sekali. Gejala fisik serangan penyakit ini pada umumnya hanya dirasakan oleh penderita kanker stadium lanjut. Yaitu, munculnya rasa sakit dan perdarahan saat berhubungan intim (contact bleeding), keputihan yang berlebihan dan tidak normal, perdarahan di luar siklus menstruasi, serta penurunan berat badan drastis. Apabila kanker sudah menyebar ke panggul, maka pasien akan menderita keluhan nyeri punggung, hambatan dalam berkemih, serta pembesaran ginjal.

Kanker Serviks

Kanker Leher Rahim Dr. Yohanes Riono
Dept of Surgery Holywood Hospital.
Tentu anda sudah tak asing lagi dengan istilah kanker servik (Cervical Cancer), atau kanker pada leher rahim. Benar, sesuai dengan namanya, kanker leher rahim adalah kanker yang terjadi pada servik uterus, suatu daerah pada organ reproduksi wanita yang merupakan pintu masuk ke arah rahim yang terletak antara rahim (uterus) dengan liang senggama (vagina). Kanker ini biasanya terjadi pada wanita yang telah berumur, tetapi bukti statistik menunjukan bahwa kanker leher rahim dapat juga menyerang wanita yang berumur antara 20 sampai 30 tahun.
Memang istilah "kanker" sendiri sudah pasti memberi kesan menakutkan dan menyeramkan. Laksana seorang terpidana menerima hukuman mati.

Bagaimana pula dengan kanker leher rahim?
Apakah juga sama menakutkannya dengan beberapa kanker lainnya?
Menurut para ahli kanker, kanker leher rahim adalah salah satu jenis kanker yang paling dapat dicegah dan paling dapat disembuhkan dari semua kasus kanker. Tetapi, biarpun demikian, di wilayah Australia barat saja, tercatat sebanyak 85 orang wanita didiagnosa positif terhadap kanker leher rahim setiap tahun. Dan pada tahun 1993 saja, 40 wanita telah tewas menjadi korban keganasan kanker ini.

Bagaimanakah kanker leher rahim terjadi?
Layaknya semua kanker, kanker leher rahim terjadi ditandai dengan adanya pertumbuhan sel-sel pada leher rahim yang tidak lazim (abnormal). Tetapi sebelum sel-sel tersebut menjadi sel-sel kanker, terjadi beberapa perubahan yang dialami oleh sel-sel tersebut. Perubahan sel-sel tersebut biasanya memakan waktu sampai bertahun-tahun sebelum sel-sel tadi berubah menjadi sel-sel kanker. Selama jeda tersebut, pengobatan yang tepat akan segera dapat menghentikan sel-sel yang abnormal tersebut sebelum berubah menjadi sel kanker. Sel-sel yang abnormal tersebut dapat dideteksi kehadirannya dengan suatu test yang disebut "Pap smear test", sehingga semakin dini sel-sel abnormal tadi terdeteksi, semakin rendahlah resiko seseorang menderita kanker leher rahim.
Memang Pap smear test adalah suatu test yang aman dan murah dan telah dipakai bertahun-tahun lamanya untuk mendeteksi kelainan-kelainan yang terjadi pada sel-sel leher rahim. Test ini ditemukan pertama kali oleh Dr. George Papanicolou, sehingga dinamakan Pap smear test. Pap smear test adalah suatu metode pemeriksaan sel-sel yang diambil dari leher rahim dan kemudian diperiksa di bawah mikroskop untuk melihat perubahan-perubahan yang terjadi dari sel tersebut. Perubahan sel-sel leher rahim yang terdeteksi secara dini akan memungkinkan beberapa tindakan pengobatan diambil sebelum sel-sel tersebut dapat berkembang menjadi sel kanker.
Test ini hanya memerlukan waktu beberapa menit saja. Dalam keadaan berbaring terlentang, sebuah alat yang dinamakan spekulum akan dimasukan kedalam liang senggama. Alat ini berfungsi untuk membuka dan menahan dinding vagina supaya tetap terbuka, sehingga memungkinkan pandangan yang bebas dan leher rahim terlihat dengan jelas. Sel-sel leher rahim kemudian diambil dengan cara mengusap leher rahim dengan sebuah alat yang dinamakan spatula, suatu alat yang menyerupai tangkai pada es krim, dan usapan tersebut dioleskan pada obyek-glass, dan kemudian dikirim ke laboratorium patologi untuk pemeriksaan yang lebih teliti.
Prosedur pemeriksaan Pap smear test mungkin sangat tidak menyenangkan untuk anda, tetapi tidak akan menimbulkan rasa sakit. Mungkin anda lebih memilih dokter wanita untuk prosedur ini, tetapi pada umumnya para dokter umum dan klinik Keluarga Berencana dapat dimintai bantuan untuk pemeriksaan Pap smear test. Usahakanlah melakukan Pap smear test ini pada waktu seminggu atau dua minggu setelah berakhirnya masa menstruasi anda. Jika anda sudah mati haid, Pap smear test dapat anda lakukan kapan saja. Tetapi jika kandung rahim dan leher rahim telah diangkat atau dioperasi (hysterectomy atau operasi pengangkatan kandung rahim dan leher rahim), anda tidak perlu lagi melakukan Pap smear test karena anda sudah terbebas dari resiko menderita kanker leher rahim. Pap smear test biasanya dilakukan setiap dua tahun sekali, dan lebih baik dilakukan secara teratur. Hal yang harus selalu diingat adalah tidak ada kata terlambat untuk melakukan Pap smear test. Pap smear test selalu diperlukan biarpun anda tidak lagi melakukan aktifitas seksual.

Bagaimanakah Tanda-tanda Kanker Serviks?
Perubahan awal yang terjadi pada sel leher rahim tidak selalu merupakan suatu tanda-tanda kanker. Pemeriksaan Pap smear test yang teratur sangat diperlukan untuk mengetahui lebih dini adanya perubahan awal dari sel-sel kanker. Perubahan sel-sel kanker selanjutnya dapat menyebabkan perdarahan setelah aktivitas sexual atau diantara masa menstruasi.
Jika anda mendapatkan tanda-tanda tersebut, sebaiknya anda segera melakukan pemeriksaan ke dokter. Adanya perubahan ataupun keluarnya cairan (discharge) ini bukanlah suatu hal yang normal, dan pemeriksaan yang teliti harus segera dilakukan walaupun anda baru saja melakukan Pap smear test. Biarpun begitu, pada umumnya, setelah dilakukan pemeriksaan yang teliti, hasilnya tidak selalu positip kanker.

Pengobatan
Seperti pada kejadian penyakit yang lain, jika perubahan awal dapat dideteksi seawal mungkin, tindakan pengobatan dapat diberikan sedini mungkin. Jika perubahan awal telah diketahui pengobatan yang umum diberikan adalah dengan: Pemanasan, diathermy atau dengan sinar laser. Cone biopsi, yaitu dengan cara mengambil sedikit dari sel-sel leher rahim, termasuk sel yang mengalami perubahan. Tindakan ini memungkinkan pemeriksaan yang lebih teliti untuk memastikan adanya sel-sel yang mengalami perubahan. Pemeriksaan ini dapat dilakukan oleh ahli kandungan. Jika perjalanan penyakit telah sampai pada tahap pre-kanker, dan kanker leher rahim telah dapat diidentifikasi, maka untuk penyembuhan, beberapa hal yang dapat dilakukan adalah: Operasi, yaitu dengan mengambil daerah yang terserang kanker, biasanya uterus beserta leher rahimnya. Radioterapi yaitu dengan menggunakan sinar X berkekuatan tinggi yang dapat dilakukan secara internal maupun eksternal. Resiko untuk terserang kanker:
Setiap wanita yang pernah melakukan hubungan seksual mempunyai resiko terhadap kanker leher rahim. Sel-sel leher rahim mungkin mengalami perubahan sehingga sangat diperlukan melakukan Pap smear test secara teratur (baik yang telah ataupun yang belum pernah mendapatkan Pap smear test). Demikian juga bagi anda yang merokok kemungkinan untuk mendapatkan kanker leher rahim sangat besar.
Dijumpainya Human Papilloma Virus (HPV) sering diduga sebagai penyebab terjadinya perubahan yang abnormal dari sel-sel leher rahim.
Memiliki pasangan seksual yang berganti-ganti atau memulai aktifitas seksual pada usia yang sangat muda juga memperbesar resiko kemungkinan mendapat kanker leher rahim.
Apa yang harus anda lakukan untuk menghindari kanker leher rahim ?
Yang pertama, jika anda pernah melakukan hubungan seksual anda harus melakukan Pap smear test secara teratur setiap dua tahun dan ini dilakukan sampai anda berusia 70 tahun. Pada beberapa kasus mungkin dokter menyarankan untuk melakukan Pap smear test lebih sering.
Hal yang ke dua adalah melaporkan adanya gejala-gejala yang tidak normal seperti adanya perdarahan, terutama setelah coitus (senggama).
Hal yang ke tiga adalah tidak merokok. Data statistik melaporkan bahwa resiko terserang kanker leher rahim akan menjadi lebih tinggi jika wanita merokok.
Dengan melakukan beberapa tindakan yang dapat memperkecil resiko tersebut, mudah-mudahan kita dijauhkan dari kejadian kanker leher rahim ini. Semoga.
Dapatkah anda membayangkan, bagaimanakah perasaan anda jika mengetahui hasil pemeriksaan 'Pap Smear' anda memberikan hasil abnormal? Tentulah anda akan merasa kuatir dan cemas, manakala anda mendapati bahwa hasil pemeriksaan 'Pap Smear' anda abnormal. Tetapi janganlah terlalu cemas dahulu, karena tidak semua penampakan sel-sel yang abnormal tersebut berarti kanker. Memang 'Pap Smear' dapat mendeteksi kelainan-kelainan perubahan sel-sel leher rahim secara dini. Paradigma yang harus diingat adalah semakin awal ditemukannya kelainan-kelainan pada pemeriksaan 'Pap Smear', maka akan semakin mudah pula diatasi masalahnya.
Apakah artinya jika 'Pap Smear' anda abnormal.
Hasil 'Pap Smear' dikatakan abnormal jika sel-sel yang berasal dari leher rahim anda ketika diperiksa di bawah mikroskop akan memberikan penampakan yang berbeda dengan sel normal. Kejadian ini biasanya terjadi 1 dari 10 pemeriksaan 'Pap Smear'. Beberapa faktor yang dapat memberikan indikasi diketemukannya penampakan 'Pap Smear' yang abnormal adalah: Unsatisfactory 'Pap Smear'
Pada kasus ini, berarti pegawai di Lab tersebut tidak bisa melihat sel-sel leher rahims anda dengan detail sehingga gagal untuk membuat suatu laporan yang komprehensive kepada dokter anda. Jika kasus ini menimpa anda sebaiknya anda datang lagi untuk pemeriksaan 'Pap Smear' pada waktu yang akan ditentukan oleh dokter anda. Jika ada infeksi atau inflamasi
Kadang-kadang pada pemeriksaan 'Pap Smear' memberikan penampakan terjadinya inflamasi. Ini berarti bahwa sel-sel di dalam leher rahims mengalami suatu iritasi yang ringan sifatnya. Memang kadang-kadang inflamasi dapat kita deteksi melalui pemeriksaan 'Pap Smear', biarpun kita tidak merasakan keluhan-keluhan karena tidak terasanya gejala klinis yang ditimbulkannya. Sebabnya bermacam-macam. Mungkin telah terjadi infeksi yang dikarenakan oleh bakteri, atau karena jamur'. Konsultasikan dengan dokter anda mengenai masalah ini beserta pengobatannya jika diperlukan. Tanyakan kapan anda harus menjalani 'Pap Smear' lagi. Atypia atau Minor Atypia
Yang dimaksud dengan keadaan ini adalah jika pada pemeriksaan 'Pap Smear' terdeteksi perubahan-perubahan sel-sel leher rahims, tetapi sangat minor dan penyebabnya tidak jelas. Pada kasus ini, biasanya hasilnya dilaporkan sebagai 'atypia'. Biasanya terjadinya perubahan penampakan sel-sel tersebut dikarenakan adanya peradangan, tetapi tidak jarang pula karena infeksi virus. Karena untuk membuat suatu diagnosa yang definitif tidak memungkinkan pada tahap ini, dokter anda mungkin akan merekomendasikan anda untuk menjalani pemeriksaan lagi dalam waktu enam bulan. Pada umumnya, sel-sel tersebut akan kembali menjadi normal lagi. Jadi, adalah sangat penting bagi anda untuk melakukan 'Pap Smear' lagi untuk memastikan bahwa kelainan-kelainan yang tampak pada pemeriksaan pertama tersebut adalah gangguan yang tidak serius. Jika hasil pemeriksaan menghasilkan hasil yang sama maka anda mungkin disarankan untuk menjalani kolposkopi. Apakah kolposkopi itu?
Kolposkopi adalah suatu prosedur pemeriksaan vagina dan leher rahims oleh seorang dokter yang berpengalaman dalam bidang tersebut. Dengan memeriksa permukaan leher rahims, dokter akan menentukan penyebab abnormalitas dari sel-sel leher rahims seperti yang dinyatakan dalam pemeriksaan 'Pap Smear'. Cara pemeriksaan kolposkopi adalah sebagai berikut: dokter akan memasukkan suatu cairan kedalam vagina dan memberi warna saluran leher rahims dengan suatu cairan yang membuat permukaan leher rahims yang mengandung sel-sel yang abnormal terwarnai.. Kemudian dokter akan melihat kedalam saluran leher rahims melalui sebuah alat yang disebut kolposkop. Kolposkop adalah suatu alat semacam mikroskop binocular yang mempergunakan sinar yang kuat dengan pembesaran yang tinggi.
Jika area yang abnormal sudah terlokalisasi, dokter akan mengambil sampel pada jaringan tersebut (melakukan biopsi) untuk kemudian dikirim ke lab guna pemeriksaan yang mendetail dan akurat. Pengobatan akan sangat tergantung sekali pada hasil pemeriksaan kolposkopi anda.

Bagaimanakah dengan aktifitas seksual anda?
Pada tahap ini, anda tidak perlu kuatir dengan aktifitas seksual anda. Anda tidak perlu absen melakukan aktifitas seksual hanya karena pemeriksaan 'Pap Smear' anda positip, karena keadaan kanker atau pre-kanker yang anda derita tidak mungkin ditularkan kepada suami anda. Tetapi jika sedang dalam pengobatan penyembuhan, sebaiknya tanyakanlah kepada dokter anda kapan anda dapat melakukan hubungan sanggama lagi dan seberapa seringnya hubungan tersebut.

Perlukah dilakukan pemeriksaan lanjutan sesudah selesainya pengobatan?
Pemeriksaan lanjutan sesudah selesainya masa pengobatan adalah mutlak diperlukan untuk mendapatkan kepastian bahwa area yang telah diobati telah sembuh sama sekali. Biarpun metode pengobatan yang anda dapatkan sangat efektif, sel-sel yang abnormal kadang-kadang dapat kambuh lagi, bahkan dapat berkembang dengan derajat keparahan yang lebih tinggi. Jadi deteksi dini adalah hal yang sangat esensial sekali. Selama dua tahun pertama masa pengobatan anda, anda disarankan untuk menjalani pemeriksaan 'Pap Smear' setiap tiga bulan atau enam bulan sekali. Jika setelah tiga kali pemeriksaan berturut-turut hasil 'Pap Smear' anda normal, ini berarti anda telah dapat dinyatakan sembuh, dan anda dapat melakukan pemeriksaan 'Pap Smear' tersebut setiap tahun sekali secara kontinyu.

Love and Hate

Love n hate are neighbor. They live on the next door. When u can easy to love, u can to hate, too.

But you can't love n hate at same time, same like u can't see two person with different doors at

same time if they close their doors. (?????????)

Selasa, 10 November 2009

Path-breakers and Pragmatists:
Manitoba and the New Public Management
By Curtis Brown (7597386)
March 20, 2008
Submitted to Prof. Karine Levasseur
POLS 4570 Public Organization Management
Department of Political Studies
University of Manitoba
Introduction
The final three decades of the 20th century spawned profound changes in how citizens
and governments interact with one another. After the state entered more aspects of people’s
lives during the 1950s and ‘60s, a retrenchment started to take shape in the 1970s as
governments struggled to finance the complex welfare state that had been built up. This
breakdown of the dominant economic and political paradigm was accelerated by the
emergence of new ideas on how governments should provide services to citizens. The new
ideological paradigm of “neo-liberalism” that gained prominence during the 1970s and ‘80s
emphasized individual liberty and the free market while forcefully arguing that government
intervention in people’s lives was coercive (Bradford 2000, 203; Howlett et al. 1999, 27-28).
According to neo-liberals, government intervention in the economy – once seen as necessary
to limit individual inequality and economic boom-and-bust cycles – was the cause of the
period’s economic hardships. Public choice theory, one of the many strains of neo-liberal
thought, contended that “budget-maximizing” government officials will seek to expand their
operations to the point that public-sector growth will crowd out private-sector investment
(Borins 2002, 5). Thus, neo-liberals believed governments should only provide the most basic
public goods -- for example, military and police protection -- while allowing entrepreneurs,
rather than bureaucrats, to provide other services to the population (Howlett et al. 1999, 27).
Neo-liberals argued that any remaining services offered by government should be delivered
according to free-market principles – for example, government agencies competing with
entrepreneurs or operating according to private-sector management principles (Aucoin 2002,
38).
2
Neo-liberal ideas crept into democratic dialogue in Canada and other English-speaking
countries during the 1970s, but scholars tend to identify their application with Margaret
Thatcher’s Conservative government of Great Britain (1979-1989) and David Lange’s Labour
government in New Zealand (1984-1989). The reforms undertaken by these two
administrations came to be described as “New Public Management,” or NPM (Aucoin 1995,
1). In Canada, New Public Management is most closely identified with Ontario and Alberta,
though some observers include Manitoba among the provinces that pursued these reforms
(Glor 2001, 128).
In 1977, two years before Thatcher came to power, citizens in Manitoba elected a
provincial government that was one of the first in the Western world to translate a neo-liberal,
reform-oriented philosophy into initial political success. The Progressive Conservatives under
Sterling Lyon championed government restraint, privatization and the idea of running
government like a business (Lee 1977a, 9). The Lyon government attempted to make these
changes after taking office; however, it found itself unable or unwilling to implement its
promised reforms in an ideological climate where people were not ready to abandon an active
role for government in the economy. Thus, it was left to another PC government under
Premier Gary Filmon to incrementally implement New Public Management (NPM) in
Manitoba.
This paper examines Manitoba’s experience with neo-liberalism and New Public
Management, following its evolution from the late 1970s to the end of the millennium. This
paper places Manitoba in a comparative context with initiatives undertaken by Alberta and
Ontario -- the two provincial governments most often identified with neo-liberalism and NPM
– to illustrate how Manitoba only bought partially into these policy paradigms. This paper
makes the case that the implementation of New Public Management reforms requires a
3
broader commitment to neo-liberal principles such as deficit reduction and privatization that
must take place before bureaucratic restructuring. Manitoba embraced and quickly abandoned
the broad tenets of neo-liberalism earlier than most Canadian governments, which meant that
the province’s transition towards NPM experienced arrested development. This hesitation,
perhaps the result of attempting to implement it in a province with “moderate” political
traditions (Thomas and Wilkins 1997, 119), meant that a milder, less ideologically-driven
form of NPM was ultimately introduced in Manitoba. Manitoba’s version of “NPM-Lite” may
offer an alternative path to public sector reform in other jurisdictions.
What is New Public Management?
It is difficult to separate what public administration scholars call New Public
Management (NPM) from the sociopolitical doctrine of neo-liberalism. The two concepts are
inextricably linked, as governments that followed the neo-liberal tenets of deficit reduction,
privatization and government downsizing also tended to pioneer NPM-style reforms to their
public sectors. While some governments, such as France, opted for a “neo-statist” or “strong
state” approach to public sector reform (Clark 2002, 778), NPM has been associated with a
neo-liberal “weak state” philosophy in most English-speaking countries with Westminsterstyle
governments, including Canada. This ideological framework found currency as the
welfare state came under attack in the 1970s. As Christopher Pollitt (1990, 44) writes, neoliberalism
“could only lead its believers towards policies for cutting the size of the public
sector and increasing the efficiency of what was left.” The Lyon government was no
exception to this, offering voters what Savoie would later describe as the “Big Answer” to
“real and imagined shortcomings in the public bureaucracy” (Savoie 1995, 113). Despite the
Lyon government’s rhetorical assertion that government should run more efficiently and
4
effectively, it failed to fully act upon the ideas later implemented in Great Britain and New
Zealand as part of NPM’s “first wave of radical government reform” (Pal 2006, 202).
Peter Aucoin (1995, 38-39) argues New Public Management contains the following
elements:
 Decentralization of government departments and decision-making autonomy for
subordinate civil servants
 Targets for service delivery, or “outputs,” that are established by contract, with
rigorous performance management and reporting regimes in place to hold public
servants accountable for meeting personal or organizational goals
 Separation of service delivery from policy-making within departments
 Open competition for public service executives
 Competition between public- and private-sector agencies for the right to deliver public
services, with a preference for privatizing government operations and/or contracting
out services to private-sector organizations.
Using these criteria, we shall see that neither the Lyon nor the Filmon governments
measured up on all counts. While Lyon’s rhetoric pointed to changing the way governments
did business, he didn’t reform government operations to the same extent as Great Britain or
other provinces later did. The Filmon government, on the other hand, devolved decisionmaking
authority while demanding greater accountability of government agencies, but did not
pursue privatization to the same degree as other jurisdictions. The next section tracks the
evolution of these reforms in greater detail.
The Lyon Roars
Sterling Lyon came to power in 1977 after waging a heated campaign against the
province’s first New Democratic government. While Ed Schreyer’s NDP practiced “a mild
form of social democracy” (Netherton 2001, 218), Lyon’s Progressive Conservatives accused
the NDP of mismanaging the provincial economy and bringing government into every corner
of Manitobans’ lives. “I want to suggest to you and other Manitobans that one of the basic
issues in this provincial campaign is freedom,” Lyon told Progressive Conservative Party
5
supporters shortly after the campaign began (Fitzgerald 1977a, 8). This theme was at the heart
of the speeches Lyon delivered throughout the province in the fall of 1977, as he repeatedly
attacked the NDP for the growth in government spending, the expansion of the bureaucracy,
management of publicly-owned Crown corporations and their policy of leasing governmentowned
farmland to producers.
In its campaign platform The Challenges Ahead for Manitoba, the PCs pledged to
implement “acute protracted restraint” in order to make government affordable to taxpayers:
We shall have to recognize and accept limits, primarily on what government can
achieve in the economy, limits on what citizens may expect of the government,
limits in the sense that choices will have to be made (Lee 1977a, 9).
While there were few specifics contained in the party’s election document, it did offer
variations on some of the solutions that later came to be associated with New Public
Management. First, Lyon called for a “considerable” reduction in the provincial civil service,
which at the time included about 14,000 employees (Winnipeg Free Press 1977, 1). The
Progressive Conservatives planned to cut a wide range of taxes which would be financed by
“cutting fat” from the present government budget. There were plans to privatize governmentrun
businesses and create “partnerships” between the public and private sectors, though this
was not explained in great detail. The Manitoba Liberal Party also made similar promises
during the campaign to trim the public-sector payroll, cut the number of cabinet portfolios
from 29 to 12 and allow private businesses to compete with the Manitoba Liquor Control
Commission in the retail sale of alcohol (Kreuger 1977, 12). This emphasis on private-sector
solutions and bottom-line-driven government put an “acceptable face” on radical reform:
For that wider constituency, ‘better management’ sounds sober, neutral, as
unopposable as virtue itself … Yet simultaneously, for new right believers,
better management provides a label under which private-sector disciplines can
be introduced to the public services, political control can be strengthened,
budgets trimmed, professional autonomy reduced, public service unions
6
weakened and a quasi-competitive framework erected to flush out the ‘natural’
inefficiencies of bureaucracy (Pollitt 1990, 49).
As Netherton notes, Lyon’s neo-liberalism “marked the end of the period of consensus
on the essentials of state interventionism” in Manitoba (Netherton 2001, 220). On the night of
the election – which resulted in Lyon’s Progressive Conservatives capturing 49 per cent of the
popular vote and 33 of 57 seats in the Manitoba Legislature – Lyon vowed to return “sane,
common-sense government” to Manitoba (Lee 1977d, 1). After eight years of NDP rule, a
large number of Manitobans had voted for a new approach. But as the next four years would
reveal, Manitobans weren’t quite ready to embrace the changes Lyon had in store for them.
Premier Lyon and his new 15-member cabinet were officially sworn in on Oct. 23,
1977. In crafting his cabinet, Lyon displayed his taste for smaller, more-efficient government
by reducing the provincial cabinet from 17 to 15 members and giving three of his cabinet
ministers extra responsibilities (Fitzgerald 1977b, 1).1 However, Lyon did leave extra room at
his cabinet table for three “ministers without portfolio” who were given responsibilities other
than running government departments. One of these ministers, Sidney Spivak, would play a
prominent role in the Lyon government’s agenda for reforming government operations.
Blueprint For Change: The Report on Government Organization and the Economy
Spivak -- whom Lyon had pushed out as party leader two years earlier -- was asked to
lead a new task force of businesspeople, government officials and experts charged with
finding government efficiencies and boosting economic growth. Spivak’s work was
symptomatic of the time: in 1977, the federal Liberal government appointed Allan Lambert to
lead a royal commission examining the government’s financial management and
accountability. Meanwhile, a similar commission in Australia reported a year earlier on ways
1 Three Tory ministers – Harry Enns, David Banman and Bud Sherman – held portfolios that had been previously
been divided up between nine NDP cabinet ministers.
7
that Commonwealth country could reform the operations of its public sector, though its thrust
was to open up the public sector to new approaches rather than impose neo-liberal restraints
on its operations (Polidano 1995, 458).
The “Keynesian” economic consensus (named for British economist John Maynard
Keynes) that shaped post-war government thinking in Canada held that governments should
act as a counter-cyclical economic stimulus during periods of economic slowdown (Bradford
2000, 198). The Task Force on Government Organization and the Economy, however, saw
government as “the source of the problem” in terms of the province’s economic woes (Spivak
1978, 23). As well as identifying instances of “duplication, waste and other inefficiencies,”
the task force was asked to recommend ways government could carry out ongoing program
evaluation and examine “the cost effectiveness of administrative policies and procedures”
(Spivak 1978, 4). One of its recommendations was to create a Treasury Committee, a board of
six cabinet ministers with the premier serving as chairman, which would meet each day to
discuss government operations. It was argued that this committee would allow the broader
cabinet to deal with policy issues while this specific group concentrated on day-to-day matters
(Spivak 1978, 61-62). This separation of policy-making from administration meets one
criterion of Aucoin’s concept of New Public Management, though an obvious overlap would
continue to exist as this system would have given certain cabinet ministers both policy and
administrative responsibilities. The committee was to meet periodically to review short- and
long-term budget forecasts, capital investment plans and staffing levels in both departments
and Crown corporations (Spivak 1978, 62). While this was supposed to give government
greater control over expenditures, it actually went against the key features of NPM in that it
centralized control and did not empower individual departments to be responsible for their
own operations.
8
By and large, the commission’s findings stressed the need to put a central agency in
charge of saving money rather than offering new ideas on how to efficiently manage
government departments. This was evident in its focus on the bleak economic situation facing
Manitoba: government spending had more than tripled and the public sector’s ranks increased
by 43 per cent during the NDP’s eight years in office (Spivak 1978, 16). The province was on
track to post a $129-million deficit for 1977-78, a fivefold increase over the projection made
earlier that year (Spivak 1978, 19). While this was mainly due to the substantial tax cuts
delivered when the Progressive Conservatives took power, the province’s debt had ballooned
from $774 million in 1966 to $3.5 billion a decade on. Even with Lyon’s “acute protracted
restraint” and centralized control of budgeting, the task force concluded that debt and deficits
would be the order of the day for the foreseeable future (Spivak 1978, 19). Sure enough, they
were right, as the Lyon government posted deficits for each of its four years in office, thus
raising the province’s general purpose debt higher.
Attack on the Crowns
Progressive Conservative attacks on the previous NDP government focused on two of
its initiatives in particular: Manitoba Hydro’s construction of hydroelectric dams, and public
auto insurance. During the 1977 campaign, Lyon assailed dam construction as particularly
exorbitant, citing the $300-million Jenpeg dam on the Nelson River as “… one of the greatest
pieces of political incompetence and wastage of taxpayers’ dollars that has ever taken place in
the history of Canada (Lee 1977c, 8). Lyon appointed Justice George E. Tritschler to examine
Hydro’s operations. The Tritschler Report, released in 1979, did not lead to a significant
change in the way Hydro operated, nor did it reach any conclusions about privatizing part or
all of the Crown utility. A separate commission tasked with studying auto insurance, on the
9
other hand, did make important recommendations that fit with the neo-liberal, New Public
Management-oriented ethos. The following section examines that report in more detail.
The Burns Report (Report of the Ministerial Insurance Review Committee)
In July 1979, the Lyon government appointed a three-member committee chaired by
Michael Burns to review how auto insurance was provided to Manitoba motorists. In 1971,
Ed Schreyer’s NDP administration passed legislation making public automobile insurance
mandatory and created a new Crown corporation, the Manitoba Public Insurance Corporation
(MPIC), to deliver this service to Manitobans (Schulz 2005, 60). The then-opposition
Progressive Conservatives voted against this measure, and during the 1977 campaign they
promised to let private insurers compete with MPIC -- though Lyon himself doubted
insurance companies would return to Manitoba as long as MPIC remained in the marketplace
(Lee 1977b, 10).
The Burns Commission was given the following mandate:
1. To review the operations of, and services provided by, the Manitoba Public
Insurance Corporation
2. To examine the principle of no-fault automobile insurance and its possible
extension to include injury and property damage
3. To review compulsory automobile collision coverage
4. To study the “respective roles of the private and public sectors in providing
insurance coverage” (Burns et al. 1979, 1).
While the terms of reference were neutral in tone, the composition of the threemember
commission suggested its findings would be biased towards neo-liberal conclusions.
Commissioners James F. Cox (an insurance agent) and David W. Stone (a chartered
accountant) represented business interests, while the chairman, Michael Burns, was a former
IBM executive who had been serving as the executive-in-residence with the Vancouver-based
Fraser Institute, a newly-founded neo-liberal think-tank (Burns et al. 1979, 2-3). Sure enough,
the commission’s findings and recommendations were couched in the same language of
10
efficiency that later came to be a hallmark of New Public Management rhetoric. According to
the commissioners, the Crown corporation had been “plagued by political interference”
during the Schreyer era, with the government interfering by arbitrarily setting insurance rates,
hiring people based on political whims and subsidizing its operations (Burns et al. 1979, 7-8).
The commissioners believed MPIC had to be “set as far apart from Government as was
possible” by turning it into a private, policyholder-owned mutual insurance corporation
(Burns et al. 1979, 9). Under this arrangement, MPIC would not only stand alone from
government, but it would also compete with other insurance providers in the open market.
Monopolies, the commissioners argued, lacked the “sharp cutting edge” to provide superior
service to their clients. “Without the nagging spur of competition or opposition, the incentive
to improve wanes and the pursuit of excellence slows,” they said (Burns et al. 1979, 10).
The commissioners also contended that MPIC’s monopoly had robbed Manitobans of
their “freedom of choice” when it came to insurance. “There has been no argument presented
that justifies a government compelling persons to insure their own property,” the
commissioners noted (Burns et al. 1979, 14) as they recommended that Manitoba drivers be
given the option of purchasing automobile insurance. As well, the commissioners
recommended that drivers should have the right to pursue greater damages in court if they
sustained a bodily injury, something that fit their biases towards individual agency and
freedom of choice.
The commission accused MPIC’s management of failing to plan and improve the
company’s operations. Furthermore, they argued the company’s union structure created
inefficiencies, noting that “a bureaucratic attitude had taken hold in the organization” (Burns
et al. 1979, 11). The commissioners believed with a “major revamp” of its board of directors,
management structure and operating practices, the company could compete as a private
11
company in a competitive marketplace (Burns et al. 1979, 16). The government would remain
responsible for regulating the insurance industry – as well as for driver licensing, road safety,
etc. – through the creation of a Motor Vehicle Authority (Burns et al. 1979, 15). Fitting the
NPM logic, however, this new authority would not be a line department of government but
would instead have “semi-autonomous status with strong public representation” (Burns et al.
1979, 15). What this meant was not exactly clear, but it was quite obvious that the Burns
Commission’s preference was to retrench rather than expand government bureaucracy.
The commissioners tabled their report in late 1979, only for it to be rejected. Lyon
appeared on television to announce that “the eggs cannot be unscrambled” and Manitoba
drivers would not buy their auto insurance on the open market (Schulz 2005, 503). Whether
this change of heart was inspired by Lyon’s earlier feeling that private insurance companies
would not re-enter the Manitoba market or simply because of MPIC’s overall popularity with
Manitoba drivers is not exactly clear. However, public auto insurance would remain in
Manitoba and the Lyon government’s major opportunity to impose New Public Managementstyle
reforms on an area of its operations had passed it by. With the economy worsening and a
re-election campaign on the horizon, further reforms would have to wait.
Transformation Stalled
As Netherton notes, one of the Lyon government’s chief weaknesses was its
management of the economy. “The basic problem facing the government was that once the
public spigot had been turned off, private investment did not jump in to take its place”
(Netherton 2001, 220). So, the government followed the path trodden by previous
governments and invested public dollars in “mega-projects” such as an aluminum smelter, a
potash mine and – ironically – Manitoba Hydro’s Limestone generating station (Netherton
2001, 221). As a result, the Lyon government was unable to balance its books, with the deficit
12
growing from $37.9 million in 1979-80 to $82.7 million in 1980-81. On Nov. 17, 1981,
Manitoba voters put an end to the Lyon government’s short-lived neo-liberal experiment as
the NDP under new leader Howard Pawley won 34 of 57 seats in the Manitoba Legislature
and the Progressive Conservatives retained just 23 seats. Manitobans had rejected the
premises of neo-liberalism, but these ideas did not die – rather, they hibernated until another
Progressive Conservative administration was in a position to put them into practice.
The NDP interregnum
After taking office in late 1981, the new NDP administration returned Manitoba to the
old Keynesian style of interventionist government to which the province’s citizens had grown
accustomed (Netherton 2001, 225). However, the economic climate of the early 1980s was
not favourable to a government committed to counter-cyclical budgeting during difficult
economic times. The provincial deficit ballooned during the Pawley years, growing from $55
million in 1982-83 to a high of $321 million in 1984-85. Though some budgetary restraint
measures were introduced following the 1986 election, which returned a NDP minority
government, the budget deficit still hovered at $256 million in 1987-88, the Pawley
government’s final year in office.
The Pawley government’s legislative agenda was also gridlocked during this period,
preventing much in the way of government reforms. The Legislature was paralyzed for nearly
a year after the opposition Tories refused to debate government legislation making Manitoba a
bilingual province (Doern 1985, 182-183). As well, the NDP’s managerial skills were under
attack after it came to light that MTS, the publicly-owned telephone company, had lost $27
million on a bad investment in Saudi Arabia (Pawley 1996, 303). The ideological climate had
also shifted, as neo-liberalism caught on elsewhere. By the mid-1980s, the Pawley
government was the last NDP administration left in Canada, watching as neighbouring
13
Saskatchewan began privatizing Crown corporations and transforming its public service along
NPM lines (Michelmann and Steeves 1985, 10-14). The 1986 election preserved the NDP’s
majority in the Legislature by a thread, with the party holding 30 seats. Two years later, a
disgruntled NDP backbencher, Jim Walding, voted against the government’s 1988 budget,
triggering the election that brought the PCs back to power under new leader Gary Filmon.
Moderate Evolution: The Filmon Years
While Filmon and the PCs came to power at a time when neo-liberal parties preaching
new approaches to government management were in vogue, the new premier and his
government did not follow their predecessors’ approach of trying to impose radical change
overnight. This was due to the fact that Filmon’s hold on power was tenuous: the PCs had just
25 seats in the 57-seat Legislature, forcing it to rely on other parties to pass legislation. The
political landscape had been altered, with the resurgent Liberal Party now the official
opposition and the NDP reduced to third-party status with 12 seats. Thus, the shift to NPM
began with “pragmatic incrementalism” (Netherton 2001, 226). The minority government
period was also dominated by the debate over the Canadian Constitution and the Meech Lake
Accord – which died in the Manitoba Legislature in 1990 -- rather than matters concerning
government management (Dyck 2006, 80). Filmon’s popularity increased after the failure of
Meech Lake, and in 1990 his party managed to form a majority government with 30 seats.
The Filmon Tories started their 11-year run in power by keeping in place the
expenditure control measures implemented by the Pawley government, and took some small
steps to centralize control of the health and education systems, including a standardization of
the school curriculum (Netherton 2001, 226). The government’s first major step toward NPM
policies was its failed attempt to privatize home-care services for senior citizens. The Filmon
government proposed contracting out this service, which had been established by the Schreyer
14
government in the early 1970s, but significant public opposition to the move led them to
shelve the plan (Netherton 2001, 226-227).
The recession of the early 1990s and new limits on federal transfer payments forced
the Progressive Conservatives to begin imposing restraint (Dyck 2006, 80). No longer
constrained by the need to rely on the opposition Liberals and NDP for support, the PCs set
out to eliminate the annual deficit within five years while searching for new solutions to allow
government to live within its means. Starting with the 1991 budget, it froze the wages of
48,000 public sector workers and cut 1,000 jobs from the civil service (Dyck 2006, 80). After
cutting 300 more civil service jobs in 1992, it imposed further restraint on civil servants in
1993 and 1994 by forcing them to take 10, then 20 unpaid vacation days – so-called “Filmon
Fridays” – each year (Dyck 2006, 80-81).
At the same time, the government began to experiment with the methods it used to
deliver services. In 1992, it created its first Special Operating Agency (SOA), the Manitoba
Fleet Vehicles Agency (MFVA). The agency, responsible for owning and maintaining the
government’s inventory of nearly 3,000 cars, trucks and vans, was set up as an arm’s-length
agency separate from any government department. The agency was run by a director, who
answered to an advisory board made up of senior civil servants and two private
businesspeople. As Thomas and Wilkins (1997, 112) note, this agency and the others that
followed it “… meld[ed] the benefits of public policy direction under a line department with
the benefits of operating in a more businesslike way.” The MFVA was governed by an
operating charter, a public document that outlined the terms and conditions under which it
would be run. It was expected to develop multi-year strategic plans with annual budget targets
and financial projections subject to Treasury Board approval (Thomas and Wilkins 1997,
113). Its goals included a pledge to “increase the latitude for innovation” in service delivery
15
and ensure “clearly-defined accountability for results” (Manitoba Fleet Vehicles Agency 1992,
9). Its annual report would be tabled in the Legislature, and the agency would be subject to an
“effectiveness review” every three years to see if it was meeting anticipated results (Thomas
and Wilkins 1997, 113).
Almost immediately, the new agency delivered positive results. In its first year, the
agency posted a $4.1 million profit. It eliminated 287 underused vehicles from commission in
its first year and eventually cut the size of the provincial fleet from 2,746 vehicles in 1991 to
2,212 in 1996 (MFVA 1995: 36). This reduction in fleet size allowed the government to save
$3 million annually (Thomas and Wilkins 1997, 114). The MFVA’s internal audit group
conducted its three-year review in 1995 and found “many positive changes and
accomplishments” that had created “a more business-like operation focused on client service”
(MFVA 1995: 9). In fact, the SOA experiment would be replicated several times during the
Filmon years, with 15 new agencies in place by 1997 (Thomas and Wilkins 1997, 114). While
these agencies were scattered throughout government, their presence allowed the government
to save money and deliver services in a business-like manner where appropriate to do so. In
that sense, they were manifestations of New Public Management, modeled somewhat on
Britain’s Next Steps2 agencies (Borins 2002, 9). However, the Filmon government did not
take the next step – market-testing these agencies and government departments against the
ability of the private sector to deliver the same services – thus making SOAs an example of
internal administrative transformation rather than reform stimulated by outside forces.
According to Thomas and Wilkins (1997, 119), this was to be expected in a province with
“moderate traditions” and a civil service “… largely in catch-up mode with respect to internal
2 In 1988, the British government began creating “Next Steps” agencies that were given greater decision-making
autonomy while requiring adherence to specific aims and objectives set out in an annual framework document.
These agencies, which were run by a chief executive hired from an open competition, numbered 138 by 1997
(Borins 2002, 9).
16
reform.” During Filmon’s first term, change came incrementally. It would take the next four
years to bring about a more-radical transformation of Manitoba’s bureaucratic institutions.
Post-1995: The Evolution Gains Speed
On the eve of the 1995 election, the Progressive Conservative government announced
that it had reached its goal of a balanced budget one year ahead of schedule. Thanks to
restraint measures, savings on program costs and increased gaming revenues, the provincial
government projected a $48 million surplus for 1995-96 (Information Services 1995, 1). On
the same day it announced its first surplus in 22 years, the provincial government also
introduced legislation requiring future governments to balance the annual operating budget
and re-pay a minimum amount of debt each year. The Balanced Budget, Debt Repayment and
Fiscal Accountability Act, modeled on legislation enacted in several American states, was far
more restrictive than other fiscal control measures introduced in other Canadian provinces
during this period (Kennedy and Robbins 2001, 13). Not only did it force the government to
retire at least $75 million of its general purpose debt each year, but it forced cabinet ministers
to take a 20 per cent pay cut if they overspent their budget and a 40 per cent reduction if they
ran a deficit for two or more years. It also required the government to hold a referendum on
any future tax increase, thus limiting any future governments’ ability to raise funds. This law,
a prominent feature of the 1995 PC re-election campaign, led to a sea change in Manitoba
fiscal policy. After running deficits for more than two decades, surpluses became the norm in
the late 1990s and early in this century.
Filmon and the PCs increased their majority during the 1995 campaign, gaining two
extra seats as Liberal support sagged. That same year, Ontario’s Progressive Conservative
Party returned to power after promising to reform government and cut spending. A parallel
reform effort was already underway in Alberta (Peter J. Smith 2001, 297) and the federal
17
government had just started its push towards deficit elimination. As Dyck (2006, 58) notes,
governments across Canada “were all constrained to the orthodox view that they should not
only balance their budgets, but also reduce their taxes, usually in that sequence.” Doing so
would be difficult after the 1995 federal budget slashed transfer payments to the provinces,
but Filmon and the PC government now had the political capital to step up their neo-liberal,
New Public Management mini-revolution.
As noted earlier, privatization of government agencies is one of the central features of
New Public Management (Aucoin 2002, 39). The Filmon government preferred to establish
SOAs during its first full term rather than privatize government assets – home-care services
being the notable exception -- but that changed soon after the 1995 election. In 1996, the
government announced plans to sell the publicly-owned Manitoba Telephone System (MTS)
after promising not to do so during the campaign. Filmon argued that the Crown corporation
did not have the financial capacity to adapt from a public telephone monopoly to a
telecommunications services firm that could compete in a fast-changing, technologydependent
and very competitive market (Netherton 2001, 227). The sale of MTS brought the
publicly-traded firm needed investment capital and allowed the government to put $500
million from the sale into the newly-created Fiscal Stabilization Fund while at the same time
shedding the Crown corporation’s debt. However, the sale was assailed on several fronts.
Critics argued that its share price was undervalued, that friends of the government made the
most money off its sale3 and that the PCs acted undemocratically to using closure -- cutting
off debate in the Legislature -- to pass the legislation approving the transfer (Doug Smith
2003, 1).
3 Among those eventually appointed to the MTS board were Tom Stefanson, brother to Tory finance minister
Eric Stefanson; Ashleigh Everett, wife of future Tory leader Stuart Murray and eventually, former premier Gary
Filmon.
18
The sale of MTS provides an interesting case study in NPM principles. After MTS was
sold, New Democrats argued -- and continued to argue long after the Tories lost the 1999
election -- that the sale of Manitoba Hydro was next on their agenda (Welch 2007, 5). Yet the
Filmon Tories made no such move to sell the publicly-owned power company or other Crown
corporations. Instead, Hydro became a greater monopoly in the provincial energy sector after
it purchased the assets of Centra Gas, the province’s largest natural gas supplier, in 1999. This
move suggested that “there were significant political and economic limits to the Filmon
government’s “neo-conservatism”4 (Netherton 2001, 228) that once again reveals a pragmatic
rather than an ideological approach to reform.
These limits did not prevent the Filmon government from pursuing other reforms,
however. Between 1990 and 1995, it examined and restructured the two most-expensive
features of the provincial welfare state – the education and health-care systems.
Education
The provincial PC government did not act immediately to reform the education
system. During the 1990-95 term, the PCs appointed a commission to examine the Public
Schools Act (the Panel on Education Legislation) and struck another to examine school
division boundaries (the Norrie Commission). Few of the recommendations made by these
commissions – for example, the Norrie Commission recommended reducing the number of
school divisions from 60 to 21 – were carried out (Levin and Young 1997, 24). Instead, the
changes to come were inspired by the 1994 release of New Directions, a Department of
Education document that called for standardized testing, changes in teacher training and the
creation of parental advisory councils for schools. It followed the lead of Alberta, New
Zealand and Britain by giving parents greater freedom to choose which schools their children
4 “Neoconservatism” and “neo-liberalism” are used interchangeably by some authors. When not citing from a
direct source, this paper uses the term neo-liberalism to describe this particular political philosophy.
19
could attend, though it did not replicate Alberta’s experiment with “charter” schools5 or
pursue Ontario’s policy of offering parents vouchers for private-school tuition (Levin and
Young 1997, 25).
Most of these changes were implemented after the 1995 election. Of them, the
introduction of standardized testing proved to be the most controversial. Students in Grades 3,
6, 9 and 12 wrote province-wide assessment tests in Math and Language Arts and the results
were published by the Department of Education. These tests were tied to the broader goal of
making the education system more accountable for the dollars put into it. In its 1996
discussion paper Enhancing Accountability, Ensuring Quality, the provincial education
department made the case for “formal performance measurement” of teachers in order to
“ensure the provision of quality educational services to students” (Manitoba Education and
Training 1996, 22). Some of these ideas included a merit-based system of remuneration and
tenure for teachers, based in part on evaluations by students and fellow educators similar to
“feedback models that are being introduced by a number of private employers” (Manitoba
Education and Training 1996, 23). Clearly, the Manitoba classroom was no longer immune to
private-sector management practices, even if the school system would not be forced to
compete in the marketplace.
As for universities and colleges, the government attempted to reform them as well, but
did so to a lesser extent. The University Education Reform Commission, headed by former
premier Duff Roblin, reported in December 1993 on the state of Manitoba’s universities and
colleges. The report’s authors concluded that universities would have to “so order their affairs
as to make the best use of present resources” in light of the fiscal situation in the early 1990s
(University Education Reform Commission 1993, 1). Yet as Dan Smith notes, the rate of
5 Public, non-profit, autonomous schools that offer unique learning opportunities and are operated by a special
advisory council that enters into an agreement, or “charter,” drawn up between parents, educators and the Alberta
government (Alberta Learning 2002: 1-3).
20
administrative change at the University of Manitoba was relatively slow. For the most part, U
of M and other universities and colleges responded to government cutbacks by simply raising
student tuition fees rather than radically restructuring their operations. Smith notes that it is
more difficult for governments to enact reforms in semi-autonomous organizations like
universities due to the fact that government demands are just one of many pressures
autonomous institutions must contend with (Dan Smith 2004, 299). This “agency problem”
may have led to fewer reforms at the post-secondary level. Another factor that may have
played a role was the Filmon government’s 1996 decision to create the Council on Post-
Secondary Education (COPSE), an arm’s-length agency responsible for funding universities
and approving new programs.
Health
Since the introduction of Medicare in the 1960s, health-care costs had risen to the
point that they accounted for the highest share of the Manitoba government’s budget by the
1990s. In 1995, the province spent 33.8 per cent of its $4.8-billion budget on health care, with
the proportion of health-care costs rising as the decade went on (Manitoba Finance 1995, 1).
With the provincial government anxious to balance its budget, it was clear that it had to trim
spending on health care. The question was how to do this without triggering a backlash from
Manitobans who relied on the service.
In 1992, the provincial health department released its action plan for restructuring the
health system. Its goals included commitments to securing “the delivery of alternative and
less expensive services” and finding “mechanisms to assess and monitor the quality of care,
utilization and cost-effectiveness” (Manitoba Health 1992, 2). One of these was a
commitment to a “total quality management” system – a model of service delivery that
imitates industrial quality control processes by examining “underlying work processes”
21
(Shortell et al., 1995, 378) – in order to continuously improve health service delivery
(Manitoba Health 1992, 36). Adopting the language of New Public Management, the report
frequently referred to patients as “customers” and “clients” whose needs and expectations
must be met. In the same vein, the report argued there must be “reasonable public
expectations” of the services the system could provide, arguing that Manitobans must take
responsibility for their health and lower their expectations on the system (Manitoba Health
1992, 2-3). The report stated: “More health spending does not equate with improved health or
more effective health services … or higher quality of care” (Manitoba Health 1992, 5).
The government moved first to decentralize services. It started with mental health
care, transferring patients from institutional settings to assisted-living facilities in the
community (Manitoba Health 1992, 35). As well, it emphasized the idea of care closer to
home by introducing a wide range of clinics and community health centres to keep people out
of hospitals, which were more expensive to operate (Manitoba Health 1992, 3). After the 1995
election the government introduced a new managerial tool to the system by creating regional
health authorities to oversee the delivery of health services in a given area. These authorities
largely replaced the multitude of autonomous hospital boards scattered throughout the
province, and were expected to save the system money by efficiently co-ordinating service
delivery. While a recent investigation of regionalization concluded that the system delivers
services more efficiently under the RHA model, it argued that the system is neither as efficient
nor as accountable for the dollars it spends as it could be (Gray, Delaquis and Closson 2008,
13). Specifically, the report points out that the system lacks valid performance indicators and
has blurred the lines of accountability between the provincial health department and the RHAs
(Gray, Delaquis and Closson 2008, 14). However, the report’s authors note that these
22
problems have also been experienced in other jurisdictions that have implemented
regionalization in their health-care systems.
In 1999, the provincial health department released a new action plan that further
expanded on the New Public Management notion of patients as customers. Stung by
criticisms about overcrowded hallways and substandard food in hospitals, the government
pledged to implement a “Patients’ Bill of Rights” that would guarantee in-patients a bed,
nutritious food, access to personal health information and quick treatment (Manitoba Health
1999, 10). An independent “patients’ advocate” and patient satisfaction surveys would ensure
compliance with these rights (Manitoba Health 1999, 11).
What is interesting to note is that the government’s attempts to revamp the system
were once again largely driven by internal reforms, not by efforts to introduce private-sector
competition to the health system. While some tertiary areas were contracted out to private
companies – for example, food services at Winnipeg hospitals (Howard and Willson 2000, 4)
– the level of actual privatization in the health-care system was relatively low compared to
other jurisdictions. While the Canada Health Act is intended to make the delivery of private,
for-profit health care illegal, it has not stopped some provinces from allowing private-sector
providers to deliver publicly-funded medical services (Deber 2002, 6). Furthermore, the
Manitoba government did not impose the same degree of spending restraint on its health
system as other provinces. Saskatchewan’s NDP government, for example, closed 52 rural
hospitals in 1993 as a cost-cutting measure. Manitoba, on the other hand, closed none, opting
instead to convert 200 acute-care rural hospital beds to other, less cost-intensive uses such as
long-term care (Manitoba Health 1992, 36).
Despite the Filmon government’s incrementalist approach to health-care reform, the
cutbacks had taken their toll. Internal government polling showed that Manitobans were not
23
happy about health-care cutbacks and restructuring (Lyle 1999, 2). In response, the
government increased health-care spending in the 1999 budget and launched an advertising
campaign about its efforts to improve the system. After the election was called, Filmon
unveiled a pledge to cut $500 million in taxes while increasing spending on health care and
education by $500 million. After a decade of cutbacks, this “50-50” pledge contradicted
earlier calls for austerity, and was attacked by the NDP for being unrealistic. As Netherton
(2001, 230) notes, “a government that had been dishing out restraint for a decade by
embedding an orthodox zero-sum view of public finances … could not credibly state that it
could find one billion dollars to get re-elected.” Manitoba voters agreed, and on Sept. 21,
1999, Gary Filmon’s Progressive Conservatives were defeated by the NDP after an 11-year
run in office.
NPM Elsewhere: Alberta and Ontario
Alberta
Alberta, along with Ontario, is said to have embraced the gospel of New Public
Management more than any other Canadian province (Pal 2006, 81). However, the province
was a relatively-late convert to this administrative creed. Alberta’s current governing party,
the Progressive Conservatives, came to power in the early 1970s at a time when the
government had plenty of resource revenue from oil royalties to spend on state expansion.
Under Premier Peter Lougheed, the Progressive Conservative government “… demonstrated a
much greater willingness to use the power of the state to obtain its policy objectives” (Peter J.
Smith 2001, 286). As part of this province-building strategy, the Alberta government
quadrupled public spending within 10 years, nearly doubled the number of civil servants in its
employ and established a publicly-owned energy company and airline (Peter J. Smith 2001,
287).
24
The early 1980s brought a decrease in world oil prices and tougher times for Alberta.
In response, the PCs privatized state-owned companies like Pacific Western Airlines and the
Alberta Telephone System and started leaving vacant civil service positions unfilled (Peter J.
Smith 2001, 291). However, serious reforms did not take place until 1992, when Ralph Klein
took charge of the Tory dynasty with a sense that Albertans no longer wanted the government
to run deficits and lose money in state-financed business ventures (Peter J. Smith 2001, 294).
Seeking to “reinvent” a government that had been in power for two decades, Klein appointed
an independent financial reform commission that included private-sector members to examine
the province’s finances. This commission “drove home the message” the government wanted
delivered to Albertans: that the province was spending too much money and cuts needed to be
made (Peter J. Smith 2001, 295).
Klein called an election in 1993, and with a renewed mandate his government set to
work implementing NPM reforms. The 1994 budget set the goal of eliminating the provincial
deficit in four years. To do this, government departments experienced an average spending cut
of 20 per cent while civil service positions were cut by a similar percentage between 1994 and
1996 (Clark 2002, 784-785). Liquor sales and motor vehicle licensing were privatized, while
many industries were left to self-regulate themselves. Further, the Klein administration made
private enterprise the model for judging government performance. It became the first
Canadian province to introduce performance indicators for measuring government
effectiveness (Peter J. Smith 2001, 299). Despite the radical transformation, Klein could point
to success – the government balanced its books in 1997, paid off its debt and boasts huge
annual surpluses.
25
Ontario
Like Alberta, Ontario was ruled by a dynastic Progressive Conservative government
that was initially reluctant to impose the new neo-liberal, New Public Management
philosophy on its citizens. Under Premier Bill Davis, the Tory government intervened
forcefully to combat the unemployment and inflation of the 1970s through industrial
strategies and market intervention, including its purchase of a 25-per-cent stake in the Suncor
Oil Company following the 1973 OPEC oil shock (MacDermid and Albo 2001, 175). When
Davis retired in 1984, the race to succeed him was framed by the debate between traditional
Tories and neo-liberals, with Frank Miller – who advocated neo-liberal policy prescriptions
during the leadership race – winning the party’s crown. However, he presented a traditional
interventionist platform to the electorate during the 1986 election, vowing to spend more
money on daycare, impose rent controls, etc. (MacDermid and Albo 2001, 177). The Tories
eked out a narrow minority win over the Liberals, but were quickly thrown out of power when
the Liberals and NDP collaborated to defeat the government’s throne speech and formed a
coalition government.
The short-lived Liberal government mostly governed according to the same principles
that had guided Tory administrations during the 1970s (MacDermid and Albo 2001, 182). In
1990, Liberal Premier David Peterson called a snap election to seize on favourable poll results
and was defeated by the NDP, which had not been expecting to seize power. The NDP
attempted to implement promises that reflected its social democratic character -- including
pledges to introduce public auto insurance, raise minimum wages, increase social assistance
rates and impose rent control on landlords -- but economic circumstances forced the party to
abandon these goals and move in an opposite direction (MacDermid and Albo 2001, 187).
The 1992 recession, coupled with a freeze in federal transfer payments and resultant increases
26
in welfare costs, forced the NDP to impose $4 billion in spending cuts, which made it
unpopular with its traditional supporters and the electorate.
Meanwhile, the Tories under new leader Mike Harris developed a new neo-liberal
policy framework that it started to articulate well ahead of the 1995 election. The Tory
platform, entitled the Common Sense Revolution, embodied many New Public Management
principles (MacDermid and Albo 2001, 189). The party platform packaged these changes as
“common sense” principles to reverse a decade of high taxes, mounting debt and fiscal
mismanagement associated with the Liberal and NDP governments. It promised to cut taxes
by 30 per cent, balance the budget within four years through a 20 per cent cut in spending,
downsize government and contract out several public services (Clark 2002, 785-786).
When the Tories defeated the NDP in 1995, the party quickly made good on its
promises. It slashed 10,000 public-sector jobs within two years and contracted out services
such as wastewater treatment and highway maintenance while forcing remaining government
ministries to run themselves more like businesses (MacDermid and Albo 2001, 191). On the
health-care front, it imposed new user fees, closed hospitals, allowed private-publicpartnership
(P3) health centres to open, regionalized services and appointed an arm’s-length
commission to track and implement reforms. The new government forced municipalities and
school districts to amalgamate; introduced standardized testing in schools and eventually
offered vouchers to parents who wished to send their children to private and/or faith-based
schools. It privatized many services, such as the Highway 407 toll road and some parts of
Ontario Hydro, yet did not carry out a full-scale sell-off of other Crown corporations, such as
the Liquor Control Board of Ontario (LCBO) and TV Ontario (MacDermid and Albo 2001,
192). In 2003, the PCs were defeated by the Ontario Liberal Party, which reversed earlier
27
policies on private education and private-sector delivery of health services, though not to the
extent promised during the campaign (Dyck 2006, 78).
Conclusion:
Few jurisdictions were immune to the wave of public-sector reform sweeping the
world at the end of the 20th century. While some national and sub-national governments
pursued reform in different ways, the most-radical transformations occurred in states that tied
reforms to neo-liberal promotion of individual freedom, limited bureaucracy and the free
market. Manitoba followed the ideas which came to define the New Public Management
paradigm to a large degree, though the evolution of these principles came about in a rather
disjointed way. After being the first Canadian province to elect what appeared to be a truly
neo-liberal government in 1977, Manitoba mainly resisted this ideological framework for
more than a decade until embracing some of its doctrines in the 1990s. By this point, other
provinces were blazing a path towards New Public Management, and Manitoba did not fully
buy into the full range of NPM ideas despite accepting the need for fiscal restraint. Whether
or not this is a good thing depends on one’s ideological persuasion. However, by examining
the evolution of New Public Management in the Keystone Province, other jurisdictions
looking to overhaul service delivery may be able to use the Manitoba experience as a guide
towards a more practical and pragmatic path to public sector reform.
28
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