Successful public policies and programs are rare because it is unusual to have progressive and committed politicians and bureaucrats (saints) supported by appropriate policy analysts with available and reliable information (wizards) that manage hostile and apathetic groups (demons) and consequently insulate the policy environment from the vagaries of implementation (systems).
Prof J.R.A Ayee (2000)
When Prof Ayee outlined his famous systems model, I doubt that he anticipated my kind of health demon. Maybe he did. But my kind cannot be wished away.
It is neither about chronic industrial unrests nor the unchanging disease burden that I speak. It is something far more delicate- a tricky demon. It is the demon of blame, accusations and counter accusations that characterizes the relationships among and between different categories of health professionals. It is the subtle and sometimes not so subtle destructive and suspicious ways health professionals view each other, the comparative importance some attach to their work and the extent to which some look down on the contributions of others.
It appears that an otherwise positive attribute of advocating for improved systems would become corrupted to the extent that frustrations of professionals seem to find negative expression in some professionals deriding the efforts of others with an equally great stake in improved healthcare delivery.
Prof. Irene Agyepong, occupant of the Prince Claus Chair digs deeper, “I think a large part of the driving agent for the "demon" you describe is our own different professional conceit and the chronic mistrust within the health system of each other as well as of the powers that be. Also the failure to sufficiently appreciate how interdependent we are - the truth is that none of us can do without the other - but we continue to enjoy pretending and imagining that we can. In doing that we sometimes also open ourselves to people using the 'divide and rule' tactic to keep the sector 'under control'.”
This demon makes different categories of health professionals overvalue their own contributions to the health system and to talk as if, if everything else about others and not themselves were corrected, the health system would at once become perfect.
Nurses run down doctors for their know-it-all attitude while berating administrators for not appreciating that it is clinical work not pushing paper that funds the hospital. The technical field officers couldn't agree more, “One day in my community, the new district doctor came on a visit. Immediately he saw me attending to cases of yaws, he angrily queried 'who is that?' and started advocating for the facility to be shut down. The next time I got a case of yaws, I sent it to him for his opinion. He had never seen a case of yaws before and had no idea what to do. After that, he was more appreciative of the services I was rendering to sufferers of yaws in my community.”
In comes the non-medic management type who castigates the doctor-managers for being the bane of the health sector on account of seriously deficient leadership and management expertise. Is it time then to allow corporate managers to take charge of our health systems?
The doctors would have their say, “What kind of hopeless administrator would sit down and tolerate this chronic cycle of water shortages knowing just how crucial water is to our work? They just sit in their air conditioned offices watching television as if nothing has happened while we sweat it out here in overcrowded emergency rooms and unending patient queues?”
The doctors do not spare each other either! A Specialist Neurosurgeon would say disdainfully to a junior doctor contemplating a research career in Public Health, “I stand on my feet for over eight hours doing one surgery and you want the easy life?” The Public Health doctors shall have recourse to a rejoinder, “The problem with these clinicians is their narrow-minded perception that the solutions to all our health problems can only be found in their consulting rooms. What they don't realize is that by adopting community-wide preventive approaches, we can have better outcomes through better utilization of operational research. These clinicians have such poor research habits and yet think the world revolves around them…”
Often, having probably the greatest leverage, the politician would widely be blamed by the technocrats for lacking what it takes to fundamentally transform the system. Talk to the named politician and the blame ball is tossed yet again. “My actions were informed by the advice of the technocrats. You are the technical people! I am only a political head!”
This is my health demon. It is poisonous, it is distasteful and it is destructive. It makes everyone else the problem and none the solution. It prevents professionals from valuing and harnessing each other's resources and contribution to team effort. What is needed in the health sector is the Holy Spirit. Indeed any efforts to find solutions that start with the automatic assumption of the guilt of others except us will be limited and ultimately fail. It is time to shed the language of blame for one of appreciation, goodwill and good intent. It is the sum of the parts that make the whole. Indeed systems theorists will have it that the sum of the parts can sometimes be bigger than the whole as in synergy!
The sooner we get this, the better things would be for us all.
Dr. Sodzi Sodzi-Tettey is a columnist of www.AfricanLiberty.org and General Secretary for Ghana Medical Association
Development / Ghana / Africa/ Modernghana.com