A leadership dilemma: Maintaining the status quo or to cross the Rubicon
“When we least expect it, life sets us a challenge to test our courage and willingness to change; at such a moment, there is no point in pretending that nothing has happened or in saying that we are not yet ready. The challenge will not wait. Life does not look back. A week is more than enough time for us to decide whether or not to accept our destiny.”
The Ghana Health Service (GHS) has a new Director-General following the exit of Dr Anthony Nsiah Asare on November 1. I will leave a verdict on his stewardship for another day, preferring instead to look at what this crossroads brings.
I have never been a fan of how chief executives of important state institutions like the GHS are appointed at the discretion of the President and would rather prefer a competitive process using a search party. I have also wondered whether this role should continue to be the preserve of medical doctors and if so why?
My preference is as a result of the fact that in a competitive process clear visions of the applicants can be contrasted and the most appropriate candidate appointed. In the area of health, this allows the candidates understanding of the new frontiers of medicine to be explored as well as how they could leverage this to improve the fortunes of Ghana’s health delivery system. This will also allow those without a medical background but with a good understanding of healthcare to pitch their ideas and experience. Such opportunities have been given in many countries with brilliant results. For example, the current Chief Executive of the United Kingdom’s National Health Service Simon Stevens is a non-medic health manager with a wide range of experience in health delivery across the globe.
Secondly, the search party knowing the challenges in our health sector could have performance benchmarks that could be part of any service contract the appointee is given. These can then be used as a means of accessing performance periodically. It could also aid the appointing authority to make informed decisions as to whether the continuous stay of any appointee in office was beneficial or counterproductive. Finally, this could be the beginning of tenured rather than politically tied leadership and allow the Director-General the space to plan at least in the short and medium-term.
Unfortunately, the reality is we are a distance away from this form of openness mainly due to our winner takes all brand of democracy and must make the best out of our current circumstances.
Since it was announced that Dr Baffuor Awuah former Medical Director of Komfo Anokye Teaching Hospital will take over in an acting capacity, I have been wondering what this will bring to the quality of health that institutions under the GHS deliver. I have because many have argued that in most things’ leadership is the key and catalytic cause and that all other deliverables are a direct effect of this catalyst. I have also looked at how much time he has to make an impact knowing well that our next electoral cycle occurs in thirteen months and that he could be out of this job should the electoral fortunes of his appointing authority take a nosedive.
The new Director-General takes over at a time when Ghana has been sliding down in the world rankings of life expectancy and many of the other health outcome indicators. Childhood immunisation coverage is also on the decline with the percentage of eligible children immunised against measles by age two dropping to 92 per cent and diphtheria, pertussis (or whooping cough), and tetanus (DPT) down to 96 per cent all from a 99 per cent coverage just over two years ago. Geriatric care improvements have been abysmal over the years with the percentage of the population living above the age of sixty- five dropping marginally from a high of 3.5 per cent in 2010 to the current 3.38 per cent, whilst those over the age of seventy accounts for only 1.81 per cent of our population. Reports of poor-quality health service delivery across all ages are rife and health human resource numbers nothing to be pleased with.
On the surface, one would wonder why any sane human would want to accept this otherwise poisoned chalice? However, I strongly believe that he has a very good chance of making a mark and excelling in this new role as long as he realises the gravity of the task ahead. To start with he would have to work with virtually the same team he is inheriting and would need to find novel ways of understanding what their challenges are. He will then have to outline his vision and show how he wants to see this implemented.
In doing so, I hope he would have extensive discussions with ordinary Ghanaians as a means of understanding their views on the performance of the institution he is taking over. If he did, he would realise that the confidence citizens have in our health delivery system is very low. He would also hear horrifying stories of why this is the case. My advice to him is that he should not get defensive but rather take all this feedback in good stride. After all, he is here to make a mark and not to deliver business as usual.
In the end, he would have to make a judgement whether the health delivery model, especially in the area of primary health, is fit for purpose? He would then have to decide based on his answer to this question whether to stay the current course or to change direction. If he decides to stay the course, he should find little resistance from the team he is inheriting and would be easily accepted. If he chooses to opt for an alternative approach, he should realise that the fear of change will be his biggest headache.
Either way, he should remember this is his date with destiny, one that will put his courage to the ultimate test and know that his legacy will be defined by the choices he makes especially in the first three months of his stewardship. I hope he makes the right choices that will result in significant unlearning and relearning. Having said that I wish him well for it is in the entire national interest that he gets this one right.
By Kwame Sarpong Asiedu