Daily Independent (Lagos)
David Eboh Deboh
19 November 2008
opinion
The misconception in the leadership of the nation's health service is directly related to the situation in the Central Bank of Nigeria until Segun Adeniyi published his article titled "Who can save the CBN?" in THISDAY newspaper. That publication created the awareness that brought an end to the stereotype which incredulously reserved the position of the Chief Executive of CBN for Accountants only at the exclusion of economists and others with finance management knowledge and skills. The emergence of Chukwuma Soludo, an economist, brought the needed changes that improved the productivity of the CBN in the micro and macroeconomic management of the nation's economy
Despite the high number of intellectuals in our diverse population, there is a mountain of ignorance across the boundaries of the literate and illiterate, employed and unemployed, private staff and public servants, old and young, male and female. This article aim to initiate a discourse about why public-funded healthcare institutions, such as Health Centres, General, Specialist, District and Teaching Hospitals etc are hugely compromised and underperforming
To the best of my knowledge, it is only Chief Gani Fawehimi that has spoken publicly about medical tourism of our prominent Nigerians and the negative impact it has on our national integrity. The dependence on the healthcare provided in overseas countries by the leadership signifies absolute nonchalant attitude to developing this particular public service locally. It is obvious that the attractions for receiving treatment abroad are primarily the quality value obtainable in the foreign countries. The proper organisation of the services there, application of division of labour, adequate funding and research and development are the creation of rational thinkers that place the drivers for continuous improvement and the realisation of common goal well above the narrow gains or pride of individuals.
The ideas for development of a healthcare system are championed by politicians based on the desire of the public and delivered by trained managers through the collective effort of all clinical and non-clinical employees. In Nigeria, management of the healthcare services remains the offspring of 19th century leadership model and mentality. This is the history which establishes in the mind of doctors and the wider public that one needs to be a doctor in order to head the nation's healthcare institutions. Even the infrastructures are also the remains of 19th century hence delivery of services lack quality and standards and undermines the ability of many clinicians to become more productive.
In any democracy, essential public services like healthcare and education must not be allowed to become or remain status symbols, where the privileged get what they want at anytime and anywhere they wish to have it delivered for them. The quick shuttles to the UK, USA, Germany and Spain etc, for minor and major medical concerns make it impossible to commit resources into the country's healthcare system. As the recommendation to travel abroad for the treatment is usually made by the local doctors, what then are the Chief Medical Directors achieving in the management and leadership of the service institutions? Our media has reported about trips for medical check-ups, genotype screening, liposuction, and x-ray, etc. Those financially-incapacitated are subjected to depend on God through the pastor, imam and native doctor for their healing.
Health centres lack management structures and hospitals are run from the centre, in the name of Health Management Boards, with doctors being the heads on both clinical and corporate administrative departments, combining core training in medical services with core management. The emphasis is that core corporate management is not a job doctors are trained for or best qualified to do. This is part of the reasons our healthcare delivery system is open to abuse. Unfortunately, the media which are the voice of the public appear to be less informed about the need to separate and define the roles of clinicians and that of management. This is not a suggestion that doctors, nurses or other clinicians could or should not go into management. Actually, there should be basic management training for all senior clinicians. It intends to raise awareness about what needs to be considered. If a clinician moves from clinical duties to non-clinical job role, this should be considered absolute career change, whether it is temporarily or permanently. At that point, those that go into management could be assessed for their management development needs and be given appropriate training by management consultants in order to fit appropriately into the job and deliver good results.
The absence of management in the country's healthcare industry is to a very large extent responsible for the inertia in assessing, prioritizing, researching, reviewing, service development, employees training, funding, marketing and delivering healthcare services in ways that best promote accountability, productivity, profitability, patient/public satisfaction.
Unless the media develop interest on this controversial issue, there will always be a misconception about who should or should not be the core corporate leader of the country's healthcare establishments.
Management is a specialized career, and the complex nature of healthcare industry requires competency based management that should be led by well trained and qualified people in the field. There is no doubt that there is little known about Health Service Management training and degree qualification in Nigeria. Some may argue that there is no big deal about managing, which in Nigeria is correct. But the most successful organisations are those that employ career managers and invest huge amount of resources in management training.
To be continued Tomorrow
*Eboh is a Health Management Consultant.
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