Paradigm Change in Managing Healthcare in Africa
Do you think that lack of money is the largest barrier to saving children’s lives in Africa or stopping AIDS? Wrong! Money has been flowing into health and development programs in unprecedented levels but it can’t be properly spent. One of the main reasons is the lack of professional managers in the health system, hospitals, and clinics. Without professional managers, needed medications languish in customs houses or central storehouses and don’t make it out to rural areas where life expectancies in many countries has been cut in half in recent years. Equipment that breaks doesn’t get repaired or replaced. Without adequate numbers of qualified managers to provide them with support supervision, the remaining health workers become demoralized and productivity drops or they move from public clinics to better managed private clinics or out of the country entirely. Current managers in African health systems are well-meaning doctors or nurses who usually have little or no management training and struggle to keep their institutions running.
Europe and North America made the shift to professional health managers in the 1980s. As pressure grew to increase health systems efficiency and provide better care with shrinking budgets, many European national health systems such as the UK’s National Health Service and private American hospital networks turned to the well-proven private sector model of professional managers. The results were amazing. After some initial resistance from health workers who feared they would be ruled over by heartless bean-counters, hospital and health systems were run more efficiently. Waste was cut, expenses were rationalized, and care actually improved. Africa is now posed to repeat this success.
One step toward making the paradigm shift toward professional health management is being made by MERC (Management Education and Research Consortium) and its partners, including African business schools, the World Bank, the International Finance Corporation, and North American and European business schools. On July 12 in Washington DC, MERC convened a high level meeting on the crisis in health system management in Africa and other developing countries. Out of the meeting came a strategy for the professionalization of health managers in developing countries. The strategy is presented below and we’ll address each of the four elements in later blogs.
Framework for Professionalization of Health Management in Developing Countries
1. Elevate the Value of Health Management and Leadership
• Encourage the foundation of an “African College of Health Managers” as a professional
• association.
• Encourage the establishment of an accreditating agency for health management training programs in Africa.
• Encourage countries to create new health management cadres.
2. Increase Health Management Training Capacity
• Integrate basic health management training into all clinical and public health pre-service training.
• Integrate informal leadership and management mentoring into health system support supervision
• Establish in-service and certificate programs in health system management
• Establish degree programs in health system management
3. Create Incentives within the Health System to Seek Management Training
• Integrate management incentives into national health workforce plans
• Write and disseminate a case study of the Ceara, Brazil, model of health management training required for promotion to management positions
4. Encourage a Focus on Efficiency in the Management of Health Systems
• Create and promote a set of health management indicators appropriate for low resource settings
To find out more about MERC and it’s programs to improve management in developing countries, visit www.mercnetwork.org. To learn more about the World Bank’s activities to address the Africa health workforce crisis visit www.AfricaHRH.org.