I firmly believe that the problem facing public institutions is not what to do but how to actually do what we know we must do.
A couple of years ago, I got to spend some time in the Nigerian Ministry of Health and one remarkable thing I found out was that Nigeria is up to date on most international policy recommendations. We have a social health insurance scheme; policies based on international best practices on all major diseases in the country. If written policy was indicative of good health outcomes, then I am confident that maternal and child mortality will be a thing of the past instead of what we have which is the regular occurrence of these horrors in our country. If all our policies are up to date then what is keeping Nigeria from becoming the real giant of Africa? I believe it is in the administration of our institutions.
We can all agree that Nigeria is incredibly poor in implementing the many good ideas and policy innovations its institutions and professionals come up with. The only way policy initiatives like NYSC, YOUWIN, and DAWN would actually get the proposed results is if it is conceived and managed efficiently. Ideas like these start out well, and our debates of the merits of ideas is rich thanks to new social media platforms. However, we run into trouble when it comes to execution of policies. Public administration is looked down upon and it is done so shoddily that when ideas are implemented, one is not sure what the idea was meant to achieve in the first place. Take our education system; if the ministry and state departments of education cannot manage and oversee schools, if the principals aren’t trained on how to manage school budgets, inspire underpaid teachers, and order teaching supplies on time, then you would have a shoddy education system with predictable results like 336,330 candidates scoring less than 169 in the 2012 UTME exams. It all starts with the management of institutions.
Whenever I am asked what I do and I reply that I help run seven health centers, the next question is often, are you a doctor, or a nurse? This is a sign of all that I think is wrong with our institutional cultures.
I am a manager. I went to school to be trained on how to manage public health institutions. I find my work incredibly rewarding and I am passionate about what I do. On a typical day, someone in my position must manage a health workforce using a deft combination of soft and hard human management skills. Health workers in resource-constrained areas are generally overworked and underpaid, thus a manager must find ways to inspire hard work and commitment to delivering the best quality of care to patients.
A manager must review clinical data to ensure the quality of care. Perhaps the data tells the manager that a delivery had to be referred to a different hospital late last night or that there were a couple of deaths in the health center. The responsibility of finding out why the deaths or referrals happened and preventing a reoccurrence lies with this individual. Perhaps the clinic ran out of gloves, or essential medicines, and then it is imperative that the supply chain system must be looked into. A manager must balance the hospitals budgets consistently, be a leader, and ensure that health workers follow clinical procedures.
These types of responsibilities are in every public institutions and it is incredibly important that as a country we start investing in the people who can do this job. I firmly believe that the problem facing public institutions is not what to do but how to actually do what we know we must do. And this is the playground of seasoned managers. Rather than constantly debating what to do, I charge that we start a conversation on how to clean up our public institutions and commitment to investing in administrators is the first step.