I am often asked what are the requirements to manage public health services or a public health facility? What qualifications are ideal? Is a health background essential? What about a health related MBA? I wrote on this topic in a post dated 21st December 2021 and if these are questions that still entertain you that post is worth another read.
Previously my recommendations in that post were:
- Time spent in the health services either as a health professional or employed in another capacity within the health services is essential. Particularly, if one is not a health professional a postgraduate qualification in public health to provide an understanding of the field would be an advantage.
- Possible employment in a health facility in an administrative position to understand the workings and systems of administration in health whether in the public or private sector, given that there is a difference between the two.
- Consider enrolling for an MBA or equivalent qualification focused on the health sector.
- Understand that you are entering an area of management that is in many ways one of the most challenging positions possible that will continue to test your resolve and commitment.
My concern regarding the significant cost of obtaining an MBA degree does temper my recommendation of enrolling for a health-related MBA as this may be beyond the reach of many unless the qualification is employer funded. There are less expensive and in some aspects more practical management training options.
I am also often asked why public health services in South Africa are in the state that they are in. Many of the posts that I have written since I commenced this health blog in July 2020 have analysed those issues and the focus has often been on the challenges of health service management.
Approaching the issue from another perspective, I am struck by the fact that in my work as a consultant in the South African public health sector since 2015, I have encountered departments and health facilities where those in management positions indeed fulfilled what I have recommended above and yet the state of the department or health facility left much to be desired. While there were many reasons for the failures encountered, some unique to the department or facility, I have now reflected on what in my view despite what appeared to be adequate managerial capacity, could have been been the reasons for these failures?
Here are some of my thoughts:
Firstly, management in general and in the healthcare sector in particular is not solely an office-based endeavour although time in offices and boardrooms is required to ensure that operations run smoothly. Engagement with the services, in another parlance the “shop floor”, is a prerequisite for effective management. I have repeatedly seen facilities where if management had simply walked the corridors and grounds many of the challenges would have been identified and hopefully addressed. It should not have required advanced management qualifications or indeed a consultant to point this out.
Secondly, while leadership and strategic planning workshops are important and in many instances occupy the valuable time and energy of management, these require to be followed by decisions and action. In my work I have come across numerous reports originating from similar sessions that identify problems and propose solutions which metaphorically “gather dust” in hard drives without subsequent action to implement what has been proposed. Paid as a consultant, I have identified the same issues often made similar proposals but as a consultant I am unable to implement a recommendation which must be done by management. Action and decision oriented management is what is needed to ensure that action is taken and that solutions to problems and do not, as frustratingly some of my reports have done, similarly “gather dust” awaiting the attention of another manager or consultant. It is the nature and personality of the manager and not necessarily qualifications that are key to the successful implementation of decisions and the resolution of challenges.
Thirdly, managers must focus on and understand the systems and processes that make a health facility or department function effectively. I have at times been surprised by how little attention is paid to these by management. Certainly reports are tabled but often the veracity of the data in these reports is accepted without question despite at times very obvious inconsistencies in what is presented. While every manager cannot be an expert and qualified in every area, it is essential that there must be an understanding of the principles involved and therefore an ability to interrogate apparent inconsistencies. Often for example management is prepared to accept without question a request for more staff of a particular category despite the fact that the personnel system is in chaos and there is uncertainty of exactly how many staff of that category are employed. Management much be prepared and able to rigorously drill down into the data when necessary. This can only occur when there is an understanding of the underlying systems and processes, which is not necessarily dependent on the management qualifications of the managers concerned.
Finally, as I have written before, in my experience there is a lack of understanding of the importance of logistics in ensuring that a department or health facility functions effectively. It would seem that a strong enough focus on logistics, which in itself is a specialty, may be lacking in the various management courses. As a consultant, for example when I interrogated in detail the logistics related to, for instance the supply of pharmaceuticals, the failures in the logistics and supply chain and the solutions became apparent. It was surprising (or possibly not!) that despite these deficiencies being known to lower levels of management, that this had not filtered through to senior management. As a result the necessary action had not been taken. A lesson to be learned from this is both the importance of logistics but also that senior management must remain open to views from all levels in the organisation. Often, in my experience as a senior manager, the solution to a problem came from employees lower down on the “pecking order” who when given both the opportunity and acknowledgement were able to resolve the issue!
These are some thoughts, and certainly not exhaustive, to which I am sure others may wish to add or disagree. It could be valuable to entertain a session with those who have experience of the public health system in South Africa to identify management related factors, other than qualifications and experience, that lead to the challenges faced by the public health service and in addition practical solutions to those challenges.
