Original Research

Troubled municipalities, municipality troubles: An implementation of Back to Basics programme in the Eastern Cape province, South Africa

Xolisile G. Ngumbela

Received: 23 Apr. 2020; Accepted: 18 Mar. 2021; Published: 19 Nov. 2021

Copyright: © 2021. The Author(s). Licensee: AOSIS.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: This article outlines the implementation of the Back to Basics programme in the Eastern Cape Province within the Local Government Sphere of the Government which is a corner stone of reconstruction and development of our country and society.

Aim: The aim of this research article was to appraise the Eastern Cape Provincial Government on the progress made regarding the implementation of the Back to Basics programme.

Setting: This research further gives an insight into programme performance update of the period from 2012 to 2019 and a review of progress on the implementation of it thereof in the Eastern Cape Province.

Methods: The article used mixed-methods approach to arrive at its findings.

Results: The findings of this research article also serve as building blocks towards further evaluation studies to be undertaken by the Department of Cooperative Governance and Traditional Affairs as well as to shape the inputs by the province (Eastern Cape) in positioning the Eastern Cape Local Government for the Fourth Industrial Revolution.

Conclusion: Based on the findings it was recommended that for any meaningful development in the country and for the interest of good local governance, public participation should be the promoted corner stone for efficient, effective and sustainable delivery of basic essential services.

Keywords: local government; local governance; service delivery; Eastern Cape; protests.

Introduction

We live on a troubled local government, which is a huge paradox. Protests against service delivery are becoming more common, and service delivery crises are becoming more widely publicised. All is optimistic about the 21st-century service delivery crises. What is the reason for this? It seems that a series of challenges are to be blamed, and amongst those to be blamed are poor management skills, especially unavailable financial management skills, as well as meddling political leadership at the local level. Despite the lack of available expertise in local government, there are numerous interventions taking place in the local government space. The aim of this article is to look at how the Back to Basics (B2B) programme has been implemented in the Eastern Cape province since August 2016.

Problem statement

Despite the fact that it has been more than 27 years since the first democratic elections, which followed the transitional local governments that brought representative transformative local government, South Africa continues to face a number of challenges:

• The most deprived rural districts also lack access to government services. Many people still have to drive long distances to get to the nearest government service point.
• Government departments frequently plan service access enhancement projects in silos and on spatial maps, indicating that similar government programmes are not often located close together and collaboratively often without sustainable planned outputs.
• Many ratepayers and citizens also find it inconvenient to use various facilities in the same place but would have preferred a one-stop centre.

Literature review

Since 1994, local government has been the main location for the delivery of services in South Africa. South Africa’s vision of developmental local government was that it would be the foundation upon which the country’s and society’s reconstruction and growth would be founded, a place where people could interact meaningfully and directly with the state institutions. Because local government is where the majority of residents interact with the government, its culture must be based on serving people. In any nation, the sphere of government closest to people is local government. However, it is advisable that every single municipality employee must be aware of his or her duties in order to improve local government by having the basics correct – regardless of where they are stationed. The Back to Basics Strategy (Department of Cooperative Governance and Traditional Affairs [COGTA] 2015) is focused on a thorough examination of all 278 municipalities in South Africa. This appraisal took into account a variety of factors, including political stability, governance and service delivery. Chapter seven of the Constitution of the Republic of South Africa (Republic of South Africa [RSA] 1996:74) deals with local government and states that a municipality must organise and manage its governance, budgeting and planning processes to give priority to the community’s basic needs and to promote the community’s social and economic growth. If the above statement from our constitution (RSA 1996) is any indication, many municipalities in the Eastern Cape province need to be re-evaluated and realigned in order to better represent and provide services to the citizens of the Eastern Cape, as this research has revealed that they are failing miserably because of capacity limitations, complacency and incapacity.

President Jacob Zuma initiated the B2B initiative in September 2014 when he called a Presidential Local Government Summit. The intervention was proposed as a means of relief by the South African government to the local government, which was facing a slew of problems as a result of the poor governance of many of the municipalities, which was causing grave concerns. The summit agreed with the assessment presented at the 2014 summit that one-third of South African municipalities were doing well, one-third were doing well but facing difficulties and one-third were absolutely dysfunctional. Acting in collaboration with both communities and civil society, the South African government appears committed to ensuring local government change in order to improve the living standards of people in the province. This partnership is essential for the delivery of a basket of services that includes water, power, waste and refuse disposal, street lighting, recreational facilities, building lots, rezoning of land for commercial purposes and town planning for integrated developments. Despite municipalities’ continued lack of expertise, the government continues to intervene to help them with issues such as capacity growth, financial management, infrastructure development, revenue collection and debt management, billing, clean audits and scarce skills. The top tier consists of municipalities that, for the most part, get the basics right and execute their duties satisfactorily. There is a group of top performers in this group who are performing very well. The fundamentals are in place in these municipalities, and there are creative practices in place to ensure sustainability and resilience. According to the Back to Basics Strategy (COGTA 2015), the municipalities in the middle community are doing reasonably well. Although the basics are still in place and municipalities can perform typical local government roles, there are troubling signs of degeneration and deterioration in these municipalities. Municipalities in the bottom third are dysfunctional and face significant difficulties in fulfilling their statutory obligations. These municipalities need immediate assistance and action in order to get the basics correct. The 2015 B2B’s main aim is to boost municipal operation so that they can better serve their residents by having the basics correct.

Nel (2015) also agrees with former president Zuma in the assessment conducted in September 2014. The commissioned municipal review by former South African president (Zuma 2014) discovered, amongst other things:

• endemic corruption
• dysfunctional councils
• poor capacity by both officials and politicians
• no structured community engagement and participation systems
• poor financial management leading to continuous negative audit outcomes.

They still have a weak track record in terms of service delivery and management functions, such as pothole repair, refuse collection, public space preservation, streetlight repair and so on. The unabated situation culminated in the so-called service delivery demonstrations, which became a manifestation of community discontent and outrage over these shortcomings, creating a negative narrative and expectations for municipalities (see Figure 1 and 2).

FIGURE 1: Community member fetching water from the river in Raymond Mhlaba Local Municipality of Amathole District Municipality.

FIGURE 2: Service delivery protest at Nelson Mandela Bay.

This is exacerbated by pervasive instances of rent-seeking and corruption amongst public officials, representing a wider deterioration in the ideals and standards that should guide those we elect or nominate to lead our local government systems. The majority of the issues, as noted by the review of 2014 (B2B) ordered by the then state president, are the product of:

• a lack of capacity in administration
• poor leadership and oversight by councils
• political infighting and conflicts.

According to the then state president, it was clear that citizens of South Africa were being failed in these municipalities, and the national government through the Department of Cooperative Governance and Traditional Affairs must intervene immediately because the situation needs immediate and coordinated intervention. Institutional incapacity and pervasive poverty were amongst the obstacles that repeatedly jeopardised the viability of local government projects, resulting in a disastrous collapse of services in several cases. Some municipalities’ sustainability is a major concern. The low rate of revenue collection tends to jeopardise municipalities’ ability to provide services to their constituents. Our cities must also be driven by properly trained staff and their proper positioning. Communities’ lack of confidence in organisations and councillors is related to slow or ineffective responses to service delivery challenges. Our elected officials’ social distance is a significant source of concern. This represents a lack of public involvement and ward councillors’ and committees’ functionality.

Over the next 2 years, the B2B (COGTA 2015) approach seeks to drive troubled municipalities out of dysfunction, consolidate the status of those doing well and advance the condition of those doing well. In the local government environment, a B2B approach and an Action Plan were used as an instrument to resolve problems, delegate roles and develop a forum for measuring success. According to Nel (2015), B2B means working diligently to ensure that communities have sanitation, electricity, parks, street lighting, refuse collection, pothole repair and coping with frustrating service interruptions and billing system issues. It is needless to say that going B2B entails delivering basic essential services in a professional and caring manner that respects each resident’s human dignity. Nel (2015) said that the Government of South Africa exists to represent the people, not the other way around. Getting B2B for the government means active contact and engagement with the community in each ward. Nel (2015) further said that going B2B means combating bribery and corruption, as well as reviewing local government tendering processes.

In addition, the National Development Plan (NDP) (Republic of South Africa [RSA] 2012) explicitly states that reforming local government is a priority, as well as a commitment to the creation of more efficient municipalities and competent local machinery. And, according to Nel (2015), we need to get the basics correct in our municipalities if South Africa is to adopt the National Development Plan. Different regional support approaches are evolving, and the B2B intervention should take into account the complex circumstances in each province as well as the particular support needs of individual municipalities. Ward-based preparation and geographic mapping of Annual Performance Plans (APPs) are being implemented in a number of municipalities because of the directive inherent in the B2B strategy that the citizens must come first. Municipalities receiving disclaimers, as well as those who owe Eskom millions of rands, will benefit from the B2B financial monitoring tool that is currently being introduced. Furthermore, municipal B2B reporting reveals inadequate accounting and financial management, as well as bribery and corruption, as the rule, which appears to be a free for all for those in control in those municipalities.

The B2B intervention initiative aims to compel municipalities to maintain tight relations with communities by providing efficient services. Municipalities are encouraged to keep track of the services that are offered to the public. Let it be, rather than running a talk show, if we promise to provide shelter. This intervention tends to be a technique in which local government leaders communicate with residents and seek input on the services they offer. Mayors from across the Eastern Cape were forced to sign a pledge, pledging to adopt the Back to Basics strategy and ensure the delivery of high-quality services. However, no one seems to be overseeing or evaluating the commitment, which should have been included in the mayor’s performance agreement with each province’s premier, rather than making it an occurrence that is not monitored by anyone between the premier, provincial member of the executive council (MEC), National Department Cooperative Governance and Traditional Affairs (COGTA)minister and/or the country’s president.

Theoretical consideration

The reason for the analysis, the problem statement, the intent, the importance and the research questions are all supported by the theoretical context in a study. According to Grant and Azadeh (2014:12), the theoretical structure acts as a basis or anchor for the literature review, methods and study. Both the theory of change and the theories of rationality, efficacy, performance and control serve as adequate foundations for this research. All of these theories offer theoretical reasons for how individual needs can be conceptualised and contextualised. The theory of change describes how a given intervention, or a series of interventions, as in the case of local government, is supposed to contribute to real development change (outcomes) whilst also being driven by sound evaluations, consultation with key stakeholders and learning from other collaborators on what works and what does not (monitoring reports and evaluation findings). It also aids in the identification of strategies for effectively addressing the causes of issues that impede development, as well as guiding decisions about which path to take in order to achieve long-term solutions. This theory also assists in defining the underlying assumptions and risks that must be understood and revisited during the process (monitoring reports) in order to ensure that the methodology used leads to the desired change both throughout and after the intervention. Although rationality theories are efficient, efficiency is the degree to which resources are minimised and outputs are maximised in the pursuit of achieving the desired goals. Whilst efficacy focuses solely on the end results, productivity focuses on reducing the cost of achieving the group’s objectives.

Ethical considerations

Gatekeeper’s permission was obtained from both the Provincial Department of Cooperative Governance and Traditional Affairs and sampled district municipalities. Interview respondents voluntarily participated in the research and were not coerced or bribed in anyway. All research participants in this research have been anonymised and no institutions have been exposed to protect their identities. This was done in the light of confidentiality and anonymity if they wished to remain anonymous.

Research methodology

During the investigation, the researcher collected data from a variety of sources, including 30 open-ended interviews, both formal and informal. Experts on the topic of local government service delivery were interviewed with open-ended questions to gain a broader perspective on service delivery issues. Despite the fact that there is no way to escape objectivity, the researcher chose to avoid leading questions, which can be seen as compromising legitimacy and therefore reliability, as Newton argued (2010). According to Newton (2010), semi-structured interviews encourage respondents to express their opinions in their own words and can also provide the researcher with new insights on the subject as there is no strict guideline to restrict the flow of questions. Three focus group interviews, numerous informal conversations, archival searches and consultation of records such as municipal and Department of Cooperative Governance and Traditional Affairs annual reports, APPs, operational plans, quarterly performance reports, management performance assessment tool and literature reviews were all part of the process. I would say right away that my professional experience as an employee of the Eastern Cape’s Office of the Premier, monitoring and evaluation manager for more than two decades, played an important role but did not influence the respondents at all. This study, on the other hand, pays attention to a variety of theoretical formulae that purport to frame ‘knowledge creation’ – at best, this work is an eclectic intervention. This study has carefully avoided what Nauta et al. (2011) refer to as ‘insider perspective’, or being stuck within pre-determined discursive frameworks. And I would like to state unequivocally that my participation in this project has always been impartial and objective.

Findings and discussion

The situation was not much better in the Eastern Cape, where key public infrastructure systems have failed in some communities, resulting in either no services or services delivered at unacceptably low levels. Bad infrastructure leads to inefficient or ineffective responses to service delivery issues, which is related to community distrust of institutions and councillors. The fact that there is a social divide between elected officials and residents is relevant to the situation. This expressed itself in a series of standoffs between the municipality and ratepayers in the form of service delivery demonstrations, as well as a lack of civic involvement and weak ward committee functioning. The long-term sustainability of certain municipalities seems to be a major concern. Furthermore, several municipalities in the province have registered a poor revenue base because of their failure to raise revenue from corporations and other government agencies and organisations. Also, the ill-advised amalgamation of impoverished municipalities created a slew of problems that appeared as community dynamics on the surface but were really a lot of mistrust and misalignment. A lack of technical expertise is one of the problems that these municipalities face across the world. In municipalities, in crucial areas such as leadership offices – Municipal Manager, Chief Financial Officer (CFO) and support areas such as Supply Chain Management – there are often inappropriate placements and inadequate skills. According to the Auditor General’s Report (2019), the status of audit results continues to be a difficult concern, with 36 of the province’s 39 municipalities being placed in the Intensive Care Unit (ICU). As if that is not bad enough, there is also a higher risk of poor corporate governance and a strong anti-corruption culture amongst municipal councils. Rent-seeking and corruption are rampant amongst elected officials, as well as amongst business owners who fail to pay for municipal services. This represents a wider deterioration in ideals and good governance standards that should guide those we elect or nominate to manage local government, as well as those who do business with government. The role of a developmental local government and its contribution to the Provincial Development Plan looks like it is complicated by rurality, underdevelopment and political economic disparities in most municipalities. As a result, these factors continue to jeopardise the ability of municipalities to offer services to their residents.

The findings of this article also reveal that, according to the Provincial Back to Basics team, only two municipalities in the Eastern Cape are doing very well, 15 are doing OK and 15 are dysfunctional. This condition necessitates immediate and coordinated intervention. The lack of contact with residents is especially worrying. On the contact front, a recent study conducted locally by Government Communication and Information System (GCIS) (Republic of South Africa [RSA] 2018) yielded some interesting results. According to the 2014 B2B founding summit, the aim of the B2B strategy is to move the bottom third of municipalities into the second category, the second category into the first category and those in the first category to stay there. The B2B strategy is focused on five pillars, according to the National Department of Cooperative Governance and Traditional Affairs: (1) putting people first, (2) delivery of a basket of basic services, (3) ensuring good governance, (4) ensuring sound financial management and (5) building capable and resilient institutions.

Priority 1

For those municipalities that are in a broken state, the aim is to get them to fulfil at the very least the basic functions of local government, according to the B2B approach. This can be accomplished by enforcing existing policies and regulations, as well as consistently managing their efficiency and transparency and ensuring that administrative repercussions for underperformance are managed by all levels of government, from the executive director to the clear level of all the municipalities in the province. The proper functioning of council systems and procedures, the provision of essential services and the hiring of professional personnel based on agreed-upon norms and standards are all minimum performance criteria that should be rendered non-negotiable. In the Eastern Cape, it must be agreed with the provincial executive that certain municipalities, such as Enoch Sotonga, Ingquza Hill, Senqu, Port St Johns, Emalahleni, Sakhisizwe, Amahlathi and OR Tambo, need intensive political and administrative attention as they seem to be in a state of disrepair (COGTA 2019). Between 2016 and 2018, the Eastern Cape government held a series of community engagement sessions in most municipalities, for example, in the towns and cities of the Eastern Cape via its IziMbizo and Exco-outreaches, Buffalo City Metro, Senqu and Elundini municipalities. These community engagements were facilitated in order to reduce service delivery demonstrations, and the MEC met with communities at their request in some cases. Despite the goal of resolving root causes of uncertainty and reacting to reports of impropriety and irregularities plaguing these jurisdictions, little appears to be producing meaningful results because of a slew of problems challenging local government across the province.

Priority 2

A support programme was designed to help municipalities that are functional but are not doing enough in crucial areas of operation to advance to a higher level. The emphasis here was on developing strong municipal administrative structures and processes, as well as ensuring that administrative positions are filled with skilled and dedicated individuals whose performance is closely monitored. The local government’s oversight mechanism can be strengthened by implementing real-time monitoring systems. Municipalities will be expected to communicate properly with their communities, and steps will be taken to ensure that this happens.

Priority 3

Municipalities that perform well need to be rewarded with more flexibility and leverage over their services and grants, as well as motivation to go beyond the basics and transform the local space economy, as well as incorporate and densify their cities, in order to boost sustainability. B2B also entails ensuring that our municipalities have the basic infrastructure needed to handle South Africa’s rapid urbanisation and change apartheid-era spatial patterns. Apartheid forced the majority of our people to live in rural areas with minimal economic and social opportunities. This history of division, exclusion and alienation must be overcome. For our various areas, we need a new contract in order to overcome racial divide and inequality.

The challenges of rapid urbanisation and the legacy of apartheid spatial trends must be tackled by integrated urban growth that is connected to the development of rural areas. We must acknowledge the inextricable relationship between rural and urban growth in order to do so. We must de-racialise societies in order to create a modern, more cohesive community. The benefits of construction must be shared equally by all people, black and white. To ensure successful coordination of national economic, environmental and social policies with local programmes, the Integrated Urban Planning System and the National Spatial Development Framework will be implemented.

Priority 4

There will be a targeted and vigorous response to corruption and fraud, and a zero tolerance approach to ensure that these practices are rooted out. Supply chain management practices in municipalities will be closely scrutinised. Where corruption and mismanagement have been identified, we will not hesitate to ensure that these are decisively dealt with through provisions such as asset forfeiture and civil claims. CoGTA and its stakeholder partners will also work to change practices in the private sector and enlist the support of civil society to change the national morality. For everyone deployed in government, B2B means working tirelessly to ensure that municipalities provide water, electricity, parks, street lighting, refuse removal, repairing of potholes, dealing with the frustrating interruption of services and problems with billing systems. Getting B2B means providing these services in a professional and caring manner that recognises the human dignity of each resident. We are here to serve the people; the people are not here to serve us. Getting B2B means actively communicating and interacting with the community in every ward. Getting B2B means fighting fraud and corruption and reviewing tendering systems in local government.

Slowly but surely, these objectives are being achieved. However, the most recent report on local government audit outcomes by the Auditor General shows a steady trend towards good governance and sound financial management. The B2B approach needs now to move into a new phase during which the focus will be on the implementation of actions, which will result in an improved citizen experience of local government. Although B2B seems to be well known and accepted, it must obtain traction within and outside the government, as it has touched most municipalities in the province by now. The constitution authorises national and provincial executives to intervene in provincial administration and local government, respectively, within certain constitutional constraints. The B2B needs to draw up action plans with clearly identified projects that were developed for these municipalities. The district municipalities should be strengthened through the implementation of a Shared Service Model of district municipalities, and the implementation of an Inter-Municipal Co-operation arrangement at one of the districts, as a pilot for best practices for the local municipalities with no skills and revenue base to draw from. Some municipalities are faced with challenges of infighting like Nelson Mandela Bay in Port Elizabeth, whilst some are dysfunctional with administrators who are nothing else but money dripping walls for administrators like Amahlathi in Amathole and Makana in Sarah Baartman. It has identified the issue of improperly qualified municipal managers as one of the areas that requires urgent government attention. District municipalities should be supported through the strengthening of business plans, and the reporting on the implementation of the Disaster Management and Fire Services grant, the appointment of skilled and competent senior managers and increasing the capacity in the finance and technical sections to replicate assistance to locals.

Amongst the findings of this research, it was found out that a number of municipalities in the Eastern Cape are based on their geographic and lack of tax base, are not financially viable with poor revenue collection strategy.

Often, the financial unviability of municipalities correlates with the inability of such municipalities to provide services according to the right quality and standards on a consistent basis. We need to stress that it is not the only response to the issue of non-viable municipalities. Government needs to explore a greater role for district municipalities to pay a shared services role to boost the revenue of the weak local municipality that falls within their ambits. These municipalities need to also work with Treasury and South African Local Government Association (SALGA) to review local government funding formula as one size cannot fit all at the same time. B2B should be regarded as nothing else but to ensure harmonious relations between traditional leaders and municipal councils. A joint working group has been established by CoGTA and the National House of Traditional Leaders to attend to this important question should be strengthened and capacitated to by both government and civil society. And, getting the basics right and right from the onset requires a strong vibrant leadership and commitment at all levels of our municipalities and across all government spheres. Councillors should be made accountable at all times and must be at the forefront of mobilising all sectors of society in a campaign to get B2B working for all to push back all the inequalities of the past. Neglect, poor maintenance of infrastructure, theft and damage to infrastructure have devastating consequences for local government and the provision of basic services such as water, electricity, transport and health. However, the introduction of the Criminal Matters Amendment Bill 2015 as a further measure of government’s efforts to protect the nation’s essential infrastructure from organised criminal activity seems to be yielding no results so far in most municipalities as there are no visible recorded convictions in any of the municipalities under study.

Envisaged local government

This article strongly maintains that if government is serious about development right at the local level, it must seriously look at having partners both from civil society and big business, as well as the citizens as watchdogs. There should be a fully developed framework (Figure 3) for a good municipality that can be emulated by all as a best practice to copy from. This article proposes some fundamental traits that can be used to define a ‘good municipality’:

• Political and administrative stability.
• Functional council and council structures and healthy political and administrative relations and interfaces.
• An alignment of its spending profile and its Integrated Development Plan. Furthermore, their percentage of Capital Expenditure spent, and the budget for maintenance and repairs are adequate to ensure adequate maintenance to prevent breakdowns and interruptions to services.
• Sound financial management which is characterised by consecutive clean or unqualified audit opinions, effective internal controls, a prudent spending profile and successful revenue generation measures
• The delivery of services is consistent, and there is a continuous improvement in the quality of service rendered.
• Sound institutional management, clear policy and delegation frameworks, capable staff, transparency, accountability and consequence management and an intolerance of corruption.
• Consistent community involvement and a high community satisfaction record.

FIGURE 3: Organizational workflow matrix.

Conclusion

For local government to be meaningful and developmental as envisioned in the constitution (RSA 1996), municipalities, they all need a citizen-centric development whose key principle is the inversion of power away from the experts who always seek to save communities, to the citizens themselves as designers and co-creators of their own future destiny. Citizens need to take an active part on their development without being dictated by the experts who are often outsiders and know little about the area most of the time and had little or no interest at all rather than getting the monies they had been hired for to do what the municipality had asked them to do on their behalf instead of involving community they serve. In order to be successful in properly managing the local government, it is necessary to shift perceptions of communities and technocrats from that of poverty, scarcity and brokenness to one of skills abundance, resilience to political influences, gifts, talents and possibilities. Positioning of local government for the Fourth Industrial Revolution is indeed not an easy task to handle; hence, this article strongly suggests that let us all hold hands together because a community based on scarcity, dependent on systems with citizens competing and living in isolation from one another, threatens the very same democratic foundations that our constitutions stands on.

What we need in our local government sphere are politicians who are astute and whose purpose is to promote good governance and service delivery with democracy on top of any development agenda. Finally both politicians and technocrats should join hands with the community to share on their gifts in mind and become the principal producers of our future fully knowing that we have a power to define our own possibilities, decide what choices reside in our own hands and choose our development destiny. The destiny we wish to see is the one where we no longer require great leaders, not even a strong, developed economy, but only each other coming together with our gifts in mind.

Recommendations

For any meaningful development in the country and for the interest of good local governance, public participation should be the promoted corner stone for efficient, effective and sustainable delivery of basic essential services, for example:

• Deepen professionalism in the public service.
• Build resilience in administration.
• Achieve balance between mastery and basics (compliance vs. innovation).
• Stabilise the relationship between political and administrative leadership.
• Strengthen government collaboration (Inter-Governmental Relations [IGR], Inter-sphere).
• Promote active citizenry.
• Build capable leadership, strengthen governance and accountability.
• Promote social change.
• Identify a long-term future goal with necessary steps to achieve that goal (visually mapped into an outcomes framework).
• The process of change outlining causal linkages in an initiative, that is, the shorter-term, intermediate and longer-term outcomes.
• Map identified changes (outcomes pathways) showing each outcome’s chronological flow and logical relationship with others.

Acknowledgements

We would like to extend our appreciation and profound gratitude to all those who directly or indirectly participated in and contributed to this study.

The author declares that he has no financial or personal relationships that may have inappropriately influenced him in writing this article.

X.G.N. declares that they are the sole author of this research article.

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

The author confirms that the data supporting the findings of this study are available within the article.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of any affiliated agency of the author.

References