Ensuring health care quality in LMIC is not easy: My observations---

Ensuring health care quality in LMIC is not easy. Considering inconsistency and scarcity of key resources like Competent/compassionate human power, supplies/drugs/equipment, clean and well-constructed infrastructure, essential utilities like clean water/electricity/connectivity/transport, and leadership ambition/commitment/optimism. There is a lot of inefficiency in the system. There is a lot of waste in the system. There are a lot of reasons for disappointments/dissatisfaction in the system. But there is still huge room for improvement. Here are some tips from my experience

©Localization of interventions

Most of the time either public health interventions or system improvement interventions are coined at the international or national level. We don’t give room for local experts to make recommendations based on their local experience and observations. This is completely wrong. The experts on the ground at the national and international levels are not this close to the community. The closest you are to the problem, the closest you are to the solution. Let us give some room for local experts to take care of their facilities

©Empowering health facility leaders

The health sector has a client called “Patient” or “Customer”. Whichever we call it, the service point for the health sector is health facilities. Having a well-functioning, a well led and well-organized health facility is irreplaceable in improving the health status of a population. Health facilities leaders are the ones responsible for making this a reality. I believe they need freedom of thought, freedom of decision-making, and freedom of budget spending with a strong compliance regulations system in place. We can’t just dictate to them what to do. They are the frontline leaders. They are very close to our customers. They are very close to community health problems and I believe they are very close to the solutions as well. Our role at national and international levels must be availing financial resources, and evidence and helping them with tools. Let us empower the leaders and focus on the outcomes instead of the process

©Correct the healthcare spending

At least at the national level, the majority of healthcare spending is directed to drugs/supplies/equipment. This is right and worth the spending. There is a significant amount of money spent on less effective and fewer priority interventions like meetings, in-service training, conferences, visits, and numerous document development. This may be wrong. As a former CEO of a hospital, I feel that the poorest institution in the health sector is a hospital. Sometimes a director of a very huge hospital may run out of a flexible thousand birr to make a critical decision. This has to change. Hospitals/health facilities must be the richest institution in the sector. The vast majority of health spending is at the health facilities level while the vast majority of the money is in the bureaucracy. I feel health facilities should be a budget contact point to receive donor money and loans from the government.

©Engage professionals in the decision-making process

Clients are felt by professionals. Services are provided by professionals. Resources are used by professionals. Day-to-day operations are on the shoulder of professionals. Life and death choices on the patient side are made by professionals. There is no way to sideline professionals during resource allocation decisions. It will not be logical to exclude professionals during policy drafting. They must be the ones to draft any healthcare-related policies. It will not be right to prescribe decisions from national and international communities. We have to value the worth of our professionals in the countryside during all stages of decision-making and policy development. Let the professionals lead the health facilities and the bureaucracies as well

©Introduce pragmatic leadership at the federal and regional level

Leaders at the National and Regional levels must have a gut to listen. Leaders must understand first and then ask to be understood. Leaders should say we can make a difference instead of saying I made this and that change to make the difference. Leaders must practice fairness during resource allocation including their time. Leaders should be available when needed most. They have to decentralize power, trust the middle and lower-level leaders and evaluate the outcome. As a leader spending a lot of time in the health facilities and being obsessed with the process is like killing precious time. Leaders should capitalize on expertise power, relationship power, and friendship power instead of fear and authoritarian power. Leaders at national and regional levels don’t necessarily need to be technocrats themselves rather surround themselves with smart technocrat people

©Evaluate the outcome, not the process

We are obsessed with the process. We give awards and recognition for good report writing. We are amazed by the garden in the hospital compound. We are investing a lot to match the color of uniforms. We invest a lot during the development of guidelines and strategies. We celebrate and cheers on documents. The health sector is established to prevent preventable and premature deaths, alleviate suffering and productivity loss from the community, and improve quality of life and life expectancies. Instead of evaluating the very few important outcome measures, we spent day after day evaluating the process. If deaths are prevented, sufferings are alleviated, and people live longer and people lived a long productive life then are we interested in the how part? Maybe yes to scale up the experiences

©Proactive policy formulation and legal backup

The policy development process in the health sector is very slow and stagnant. The policy and the policy development process are not progressive or updated. Our health policy is almost 30 years old. We are waiting for the new policy coming soon. 30 years ago the population’s health conditions, socioeconomic situations, and global health priority agendas were far different from the current. As a country, we must have up-to-date and timely health policy and supporting legal backups for emerging ideas and healthcare reforms

©Minimize the role of politics in the sector

The threat of political infiltration and ethnic trends in the health system are emerging quickly and they are huge compared to the current progress of any epidemic. When the role of politics gets deep then it may provoke incompetency, non-professionalism, and networking in the system.  The result is that the epidemic spreads unchallenged. At the rate at which it is consuming the emotions and ambitions of young professionals in the sector, one wonders if the very survival of the professionals in the sector is not in question. Sooner rather than later, a politically motivated network will be one of the largest health crises in the history of the country.

©Educate community about health and health system literacy

The center of public health intervention must be a household and a family. The family must play a key role in preventing communicable diseases and family members should ensure a family free from non-communicable diseases. Building health literacy in the community through health extension workers, community volunteers, school health programs, and religious institutions. The community must aware of health system components like referral networks, the scope of professional practice, good clinical care practice, and being part of the care process.