Public Health sector needs organisational overhaul

Dear Editor, According to the article on page 16 of Stabroek News of July 5, 2018, our Regional Health Services are in an unhealthy state. Could it really be so for all ten Regions! Are there no exceptions to the under-performance reportedly described by the Director, Regional Health Services?

The following is the reported list of wide-ranging delinquencies: i) ‘theft and wastage of drugs and medical supplies’ ii) ‘bad behaviour among some Regional Health Officers’

iii) ‘low circulation of critical items – because of pilfering’

iv) ‘piles of expired drugs in the health care system because of poor forecasting’ v) ‘RHOs unnecessarily absent from duty’ vi) ‘RHOs who dress inelegantly for work, others who smoked and/or were drunk on the job’

vii) ‘some RHOs allow some health programmes to collapse completely under their watch, while others are on the verge of fragmenting’

viii) ‘RHOs…. allowing public health facilities to operate without proper licensing’

If all the above allegations are accurate, then by any standards they constitute a totally unacceptable level of an organisational performance deficit that cannot be redressed (simplistically) by the police, as appear to be suggested.

When one relates this grim pattern of indiscipline to those complained of by the Minister of Public Health not so long ago, one is driven to observe a case of substantive chaos that in turn reflects upon the quality of the existing leadership corps.

So that the quote of “Put people in strategic positions to help monitor programmes (and) ensure there is succession planning” if correctly reported, is not only an innocuous bit of ‘counselling’, but refers to activities which should more appropriately be undertaken at the level of the complainant.

The fact is that cumulatively, what the above portrays is a substantive organisational mal construct, compounded by a serious lack of articulate policies and procedures – all to which appointed RHOs should, for starters, be exposed in a carefully coordinated and intensive induction programme.

Amongst other more specific issues, such a programme should attempt to portray – - The Mission of the Public Health Sector - Its overall organisation structure - The Role of the Regional Health Services within the organisation, with - Identification of specific deliverables - The related staffing; with specialised and generic accountability relationships required - A well-articulated communication procedure - Professionalism at work, including time keeping, dress code - Conformity with required behavioural norms - Development of a Disciplinary Code, against which discipline can be objectively administered – aimed at creating a culture of discipline

- Consideration of including some of the above behavioural expectations in the employment letter

- Insistence on agreed periodic reports that will allow for meaningful performance evaluation; and timely remedial action

- Provision for complaints/suggestions from (aggrieved) patients to be reviewed at the appropriate decisionmaking level.

Bear in mind that one truly critical ingredient in managing organisations is the quality of leadership which the managed can trust; and therefore learn to accept the former’s guidance. Example therefore speaks louder than words.

So that the glib reference to ‘succession planning’ would be news to RHOs and others, if in fact such a programme is not organised at the senior management level, since it must be a follow-through to an effective performance appraisal procedure – one that is not recognisably observed in the Public Service. But even this last assumes that each incumbent is served with what should be a relevant Job/Position Description.

The above and more should help to contribute to the

environment of productivity which appears to be desperately needed. But on reflection on all the foregoing, what is not, nor could not have been, captured in SN’s article were the responses, if any, from the target group. It is difficult to conceive that indisciplined, as the latter were reported to be, that they would not have engaged in discussion, if only in self-defence.

This brings around the question of the frequency or otherwise of staff meetings (that is allowing for the vast geographical spread of the personnel involved). The point, however, is to strive for opportunities to have engagements in which manager and managed can interact with one another on a level playing field. Talking to, or down, belongs to the age of grandparents. One critical objective is to make everyone feel a useful member of the same team.

Jim Collins, in his highly acclaimed book ‘Good to Great’ made this very relevant observation:

“Yes, leadership is about vision. But leadership is equally about creating a climate where the truth is heard and the brutal facts confronted. There’s a huge difference between the opportunity to ‘have your say’ and the opportunity to be heard…. and ultimately, for the truth to be heard.”

In the instant case, for example, who knows what actual working conditions are for RHOs and company? Yours faithfully, E.B. John