By OBWOGO SUBIRI
Debate is whether a Cabinet Secretary for Health requires a medical degree to oversee healthcare. But the real question is how to re-invent our healthcare system to meet the needs of the 21st century and what competencies are needed? Why is it that 50 years after the founding fathers declared war on disease, only a few Kenyans can access affordable and quality healthcare?
To succeed in this historical role, the Cabinet Secretary will need to be a transformative leader. He will need to change mindsets, processes and systems for healthcare delivery. He will have to drive everybody from comfort zones. He should not succumb to the refrain, “this is the way we do things here.” He should not limit his mandate to opening conferences and reading pre-written speeches. He will only succeed by asking the right questions and insisting on right answers.
Where should Mr James Macharia start? First, he should review all health strategic plans, mid-term plans and targets for the last 15 years. These plans propose to reduce under-five child and maternal deaths by a half or quarter in succeeding five years.
National strategies basically rationalise the resources, capacities, know-how and willingness of a country to act on its problems, and then proceed to define what is humanly possible to achieve in future.
Often, because the public is not consulted, these plans lack a sense of urgency to act on problems.
Second, the Secretary should personally travel either to Nyamira in Nyanza, or Kilifi and call for a community baraza. These counties have some of the highest deaths from childhood illnesses, HIV and maternal complications. He should ask community members to volunteer whom among them they would wish to let die in the next five years in order to meet the health targets set by planners at national level.
I would insist he does the same for all other health targets in HIV, tuberculosis, malaria, road accidents, high blood pressure, diabetes and cancers. These discussions should include other improvements in health service delivery like patient waiting times, availability of drugs, costs, cleanliness and health workers’ morale.
Findings should be made public.
Third, he should assemble a team of medical and public health experts in the country. The purpose is to seek their advice on how the country can meet these ‘new’ health targets and improvements agreed on with the affected communities.
These discussions should be very candid and avoid the tendency to shoot the messenger. The managers who support the status quo in the country should be politely advised to seek jobs elsewhere.
Now surrounded with an extraordinary political and leadership mandate with shared commitment to better health performance and improvement, Macharia then develops a picture of a future healthcare system that should surpass the numbers found in the five-year plans. This vision should be clear, simple and should be understood by the public.
As a rule set by one John Kotter: “If you can’t communicate the vision to someone in five minutes or less and get a reaction that signifies both understanding and interest, you are not done”.
The Secretary is advised not to move to the next step until this vision is clear (I am not referring to the sector wider vision and mission statements for the ministry).
A vision needs a strategy to be executed. The good news is that simple, effective and affordable interventions to address many of our healthcare challenges exist. The bad news is that these interventions, for some reason, do not reach every patient, on time and in every corner of the country.
Investments in family planning services reduce the overall cost of maternal and newborn healthcare, saving more lives, and there are significant savings in education, immunisation, water and sanitation, and malaria.
Mr Macharia should ensure the national strategy identifies no more than six priorities to rapidly improve health outcomes countrywide. All healthcare resources should follow these priorities. He should communicate his vision and strategy widely and empower the healthcare workers and managers to act on it.
Empowering people to act includes setting clear goals and expectations, creating incentives and disincentives to performing poorly, ensuring feedback on performance, building competencies, and improving work environment, materials and tools.
The remuneration and performance appraisals of all national and sub-national leaders should be in line with his vision and strategy.
Because the task of transforming the health system will take years, the Secretary should from the very onset identify and support any successful and innovative models for delivering healthcare in the country that are already addressing the new national aims and priorities.
This will create short-term wins and ensure that the public doesn’t give up on his change agenda. The next move will be to consolidate improvements by changing all systems, structures, policies and laws that undermine his vision. Employees who implement the agreed national vision should be publicly recognised and promoted.
Technocrats and donors will approach the Secretary with elaborate programme evaluations showing significant improvements and reduction in deaths across the country.
However, while celebrating pockets of success here and there is good, the Secretary should guard against declaring victory too soon.
Dr Obwogo is a medical doctor working for an international organisation.
bobwogo@hotmail.com
