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B N W: Biafra Nigeria World News |
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Headship of hospitals: The issues at stake
THE current debate about reforms in the healthcare sector avails us an opportunity to radically restructure the institutions that are most critical to the delivery of our healthcare objectives as a nation. And contrary to the belief of most practitioners in the healthcare system, healthcare is too important to be left to Doctors, Pharmacists, Nurses and Laboratory Scientists alone. Everyone should be encouraged to contribute to this debate.
The evidence of the rot in our healthcare system is too obvious for anybody to ignore. Very low life expectancy, one of the highest infant and under-five mortality rates and the highest maternal mortality rate in the world-indices that are worse than that in countries like Afghanistan, Sudan, Palestine, Chad, Burkina Faso, Democratic Republic of Congo, Rwanda. These are all countries that are either in a perpetual state of war or are so poor that they survive only on the benevolence of other countries through aid.
The standard refrain of most practitioners in our healthcare system is that poor funding and the civil service bureaucracy stifle initiative and inhibit performance, this assertion can however be faulted by the data in the state of world health report released by the World Health Organisation in the year 2000 which showed that the average Nigerian spends more on health than the average Ghanaian, Camerounian and Ivorien and his health status is poorer as evidenced in the critical statistics that measure this index. This is a stinking indictment of our healthcare system. It is grossly inefficient, such that even if more money were poured into the healthcare system, the leadership cannot be trusted to provide commensurate value.
It is difficult for doctors not to take this indictment personally, afterall, they are occupying the leadership of every institution in the healthcare system, from the department of health in all local government areas, to General Hospitals, Teaching Hospitals and virtually all directorates in the Ministries of Health (State and Federal). If in spite of this, the only star they can point to in their firmament is Prof. Rogers Makanjuola it is time to challenge the claim that only doctors can successfully run health institutions in Nigeria.
Globally, there is an area of knowledge called Health Administration. Qualifications for practitioners are a first degree in any discipline with post-graduate training in Health Administration. Practitioners often rise to Chief Executive positions of hospitals, hospices and care homes. At the city of Connecticut, United States, the largest hospital in the city, which also serves as the teaching hospital for the Yale University School of Medicine, has a Mr. Joseph Zaccagino as the Chief Executive Officer. He is not a doctor and he heads a governing board that has in its membership a heart surgeon, a peadiatrician, a politician, a lawyer and other sundry professionals. As at 2003, the hospital had 944 beds (LUTH has 900), a staff strength of 6,000 had 2,200 doctors in 100 different specialities and generated a revenue of $644m (N93 billion).
Going outside healthcare, at the nadir of IBM existence, Louis Gerstner Jr., then CEO of RBR Nabisco was invited to lead the company out of the doldrums although his previous work experience was in an information technology company. Yet in the course of his work as Chief Executive Officer of IBM, he had to lead a team of computer engineers, programmes, advertising executives, financial experts and other sundry professionals. His previous work life had seen him working in RBR Nabisco, American Express (financial services) and McKinsey and Co (Strategy Consulting). He succeeded and proved to us that success of any enterprise is about generic leadership skills and not specialist skill sets.
Sir Paul Girolami, an accountant led Glaxo (as it was then known) from a relatively obscure 19th largest pharmaceutical company in the world to the second largest. He left as the Chief Executive of the company in 1990 with the unique distinction of creating the most value for shareholders in the world. With only a training in accounting, he had to lead a team comprising molecular biologists, neuro scientists, drug designers, dosage formulation scientists, IT professionals, engineers, medical doctors to achieve a most remarkable feat. I am sure running Hammersmith hospital or LUTH would not have provided a more difficult challenge. I have gone to this great length to prove that leadership and management of any institution is not about having specialist skills in a technical area. But rather it is about organising, planning, execution, motivation and optimising resources. As it is in Globacom, Guaranty Trust Bank, NAFDAC and FCT Abuja, so it is in LUTH, UCH and Orthopaedic Hospital.
The tragedy of our nation is our warped value system that attaches so much importance to the perks and pageantry of office. The most important man is the one with the largest office and the biggest four-wheel drive. That is why a professor of paediatric surgery will see the office of the chief medical director as his highest professional achievement and not the discovery of a new method of repairing a hernia.
I sometimes imagine the kind of transformation LUTH will experience if a Mr. Fola Adeola can be convinced to serve as its chief executive for five years. With his experience in Guaranty Trust Bank and Fate Foundation, he will bring to bear leadership skills, credibility and managerial acumen that will motivate performance, attract funding and build the highest standard of medical practice that can stand the test of any challenge. Even clinicians and medical researchers will benefit. Leadership of health institutions is about my health and it is too important to be left solely in the hands of physicians. Let the best man occupy the post.
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