My case for proper health managers

How times have changed! Gone are the days when acute of shortage of doctors meant that the only doctor in the lucky district that had a doctor hat to fit many hats. We now even have the luxury of one or more doctors being exempted from clinical duties to a as the district health managers. We even have others who are attached to the provincial medical officer’s office as RRI (Rapid Response Initiative) Coordinators and other roles that I have not been able to grasp. And it is not because we have achieved the desired (and the elusive) patients to doctors ratio yet. If anything, more doctors (and pharmacists) are concentrating on what I will call ‘dead space’ jobs where they merely play supportive and advisory roles to a razor thin workforce. They will (or will be helped by a statistician to) set targets that are only realistic if all the health workers in the public service were doing the actual service delivery.

While this is a positive development, it should now give way to the final stage for proper management of health services and systems support. We now need to go the whole hog and have a new brand of health managers in Kenya.

The DMoH of the yesteryears was the resident doctor at the public hospital, as well as the head of a team of health workers involved in community health. This managerial post was essentially a compromise and consolation for the demoralized doctor, as it was an extra burden for them, for lack of alternative options by the policy makers. Things have now changed.
The DMoHs of today are under a lot of pressure to perform just like other managers of today. They are not only involved in community health activities, but they are the accounting officers charged with the management of health care financing as well as participating in the annual tendering for the provision of supplies and services in the district along with other departmental heads of the district. They DMoHs can draw up proposals for health projects that can be as grand and as beneficial as their individuals abilities to manage one. They draw up and defend district strategic health sector plans (usually for 5 year periods) as well as the annual operation plans for its implenmetation.
A few motivated ones actually manage to make some headway in this area they were ill prepared for in the first place, but the unfortunate majority fail miserably in their duties. But can you really blame them with only a lean resume in management, if at all? And can you equally put to chance the management of health services just because one odd medical officer is able to perform in a sea of non-performers? No, this will not be fair to the majority rural poor who depend on the public health system for their survival-not in this era where there plenty of capable and more realiable individuals with graduate degrees in public health.
The only loosely associated background these officers, as currently constituted, can lay a claim on is that of community health, a common course and a limited module learnt in passing and barely examined in the medical school or not at all, depending on the university where one was trained. Even if it were comprehensive, the community health program is too inadequate anyway, for the new roles faced by health care managers. Public health officers and nursing schools curricula even delve into this module more deeply at a diploma level and that is why they are seen to be performing better for their level.

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Now that is as much as I can say about the need for the right kind of people for the right kind of jobs. The era of anything goes just because one is a medical officer is no more, just as the pharmacist cannot get away with the non-performance that had been the hallmark of those in the public service. Now I have beef with people who go back to school for the wrong reasons.

Why do we go to school, most of the time at the government expense, to specialize in clinical pharmacy, surgery, obstetrics and gynaecology, paediatrics, pharmaceutical analysis etc , and etc, yet we know that all we want to do thereafter is sit behind a desk in a public office doing nothing? If you are a trained garduate analyst, and you are not doing analysis or your are not reviewing analysis protocols then to me you went for the wrong training. Why didn’t these people just specialize in the public health and policy or something else that is relevant?
Where did we get this notion that the only way you can be recognised is by pulling you out of your real calling (when you are just gaining the relevant experience) and send you to an office in Afya house or the other offices that clutter the capital, in the name of ‘promotion’? Why don’t they just promote you, reward you generously from where you are, and allow you to be the voice of your specialty from your private offices and your work station(s).

Is it cost effective to have tens of doctors in a division of let’s say reproductive health, if no one is providing their level of care at the districts? In the reproductive health division, we do not need OB/GYNs sitting there doing what they were not trained to do. We need them to roll up their sleeves, give the best possible care to their patients and be allowed to regularly offer advisory services to the division to guide policy. It is a pity that one goes for an advanced degree only to start collecting statistics on what junior doctors who have less training do, instead of doing the work themselves. This is the crisis that we are in; we are not leading from the front and we specialize so that we can be exempted from the work we pledged to the humanity under oath that we will do .