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Strong Leadership: A Key Priority of Health Sector Reform in Ghana
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The pivotal role of strong leadership in effective health service delivery needs no emphasis. Effective leadership is both a critical and an indispensable component of any functional healthcare system. However, in the preface to the 2007 Ghana Health Service Annual Report, the then Director General of the Ghana Health Service (GHS), Dr. Elias Sory, identified lack of leadership and management skills, team building and team-work, as two critical factors militating against delivery of effective health services in the country.


This is a serious wake-up call to all health professionals and the nation at large. It points to leadership crisis in the health sector, and underscores the urgent need for fundamental change in the appointment criteria of healthcare leaders in the country. The global shortage of transformational, visionary, and servant healthcare leadership is real, and the appointment strong leaders must be given topmost priority in all health sector reforms in the Ghana.


This is because leadership is the central feature of organizational performance; if the blind leads the blind, both will fall into a pit. One of the most dangerous things in life is to be led by a blind guide. Organizational success depends ultimately on the qualities of its leaders, and state of an organization is a reflection of the dynamism of its leader. History has showed that normally prudent, ordinary calculations can be overturned by extraordinary personalities. In other words, it is personalities, not circumstance, that shape events.


Leadership, especially in the health sector, is no child’s play. The myriad changes and challenges currently facing the health sector require exceptional leadership to confront these threats. External drivers such as globalization have influenced the healthcare industry as it has all other organizational environments. The strategic policy focus of all healthcare policy reforms including improving access, ensuring quality, and controlling cost requires both creative and innovative ideas. Currently the greatest challenge facing every healthcare executive is finance. In the health industry, it is said however that what is lacking not funds but rather shortage of innovative ideas.  Measurements of key performance indicators, establishing new trends, identifying various policy options, and development of proposals for reform to move the sector forward requires out-of-the box thinking. Globally, world-class healthcare organizations have been created only through transformational leadership and change. Doing things because that is the way it was always done must be replaced with dynamic solutions to old and new problems. We must no longer hold on to the old ways of doing things. The most risky thing to do is to do nothing new. For he that will not apply new remedies must expect new evils; for time is the greatest innovator.

Traditionally, most health systems including that in Ghana, have been led by physicians. This was because national health systems were built around hospitals, and patient care was perceived to revolve around only medical practice. With today’s changing healthcare environment and economics, healthcare goes way beyond clinical management of patients. Thus, healthcare leaders must among other things, demonstrate a practical understanding of the larger and broader context in which health services are delivered. For instance in Ghana, health insurance is currently the main vehicle being used to finance healthcare. This implies every healthcare manager must be apt with health insurance issues. Another critical area is the strategic management of the rich and powerful human resources of the sector, who are first-class knowledge workers and remain the greatest assets of the sector, but continues to increase in number and complexity each passing day. Not to mention the approach to policy making and planning which hitherto has been piece-meal, uncoordinated and usually reactive.


Although medical practitioners constitute a vital segment of the healthcare delivery system, the contributions from other health-related disciplines are absolutely essential for achieving goals of any health care system. Thus, leadership in healthcare has to be earned from demonstrated ability and performance and not granted as a matter of course to the individual with a medical degree. In Ghana, most of the distinguished and outstanding health ministers we have had were non-medics. Notable are Mr. Alban Bagbin, the late Captain (Rtd) Courage Quarshiga, Mr. Samuel Nuama Donkor, and Commodore Steve Obimpeh. It is noteworthy, and also not surprising that, the late James Grant, a lawyer by training, led UNICEF at the peak of its achievement. Currently, some of the finest DDHS and DDCCs are non-medics. Not to mention some exceptional General Managers of some CHAG institutions. A case in point is the Agogo Presbyterian Hospital, which is one of the oldest CHAG facility in Ghana, and is currently headed by a General Manager who is an accomplished pharmacist. Even though the Act 525 limited the position of Medical Directors and Superintendents to medical officers, the few non-medics who acted in that capacity have distinguished themselves; providing the proof that if given the chance, they would do even better.


It’s in the light of the above developments that the proposal by Health Bill - currently at an advanced stage in parliament and most likely to be passed before the end of the year - to limit both the headship and the clinical coordinator of public hospitals to only medics needs to be looked at again. It must also be emphasized that most of the proposed changes in the Bill are actually changes in the surroundings of care rather than changes in the care itself. It’s rather sad to note that in Ghana most of the reforms that are embarked upon usually take us rather backwards. Why are these two key positions in Hospital the sole preserve and monopoly of medics? Competition brings out the best in every organization and society, and the health sector should not be an exception; a sector which can among other things, boast of the most well-educated and diverse of all labor groups. This move would by no means stifle healthy competition in the Sector. In the public universities, which train Medical Doctors among other things, the Vice Chancellorship is not limited to any category of professionals, so why is it that headship of hospitals are been limited to only medics.


Ironically, almost all the key Directorates in the Ministry of Health, Teaching Hospitals, GHS headquarters and RHAs are headed by Medical Doctors. It’s therefore logical that if the sector has leadership crisis, as was purported by the immediate past Director General of GHS, then it stands to reason that the current cohort of leaders, who are predominantly medics, have been unsuccessful; a clear indication that the sector must widen the leadership net to encompass non-physician clinicians and administrators. Until the enactment of the Act 525, districts were headed by District Medical Officers. The decision to extend headship of DHD to include all categories of health workers in the Act 525, has afforded some non-medics the opportunity to rise to the occasion and are performing extremely well. Most of the DDHS in the country are non-medics presently.


As a country, we must develop a new orientation to both policy making and legislation. A revolution is needed in our approach to appointment of healthcare leaders. A totally new approach is needed. Great changes are taking place in the world today. The frontiers of healthcare administration and management are daily expanding. Modern healthcare has become so complex, with no single profession having antidote to the challenges.


As we bring this discourse near conclusion, the question we genuinely need to ask ourselves is this: is pharmacy as a profession prepared and ready to take on the mantle of leadership in the health sector if given the chance and opportunity? Given our performance at our respective workplaces, and contribution to the overall delivery to healthcare in the country, would the other healthcare professionals and society at large repose their confidence in us and accept us as leaders? This may not be easy to answer since the great profession of pharmacy has been anaesthetized for so long and it’s time she wakes up and shake herself out of slumber. We salute those colleagues who are sparing no effort in making serious in-roads into healthcare delivery at their respective places.


Globally, 12th May is set aside and celebrated as  international nurses' day, in remembrance of Florence Nightingale, also known as the " with the lamp," for her outstanding contribution to nursing. She arrived in Crimea with 37 female nurses during the Crimean War (1854-1856) and was first opposed by army doctors. However, through determination, courage, and hard work, she was able to create the new identity of the female nurse. Leadership in the health sector is and must not be limited to any particular professional group. Every group has a unique contribution to make to move the sector forward. The time to break that age long precedence is now. For all who have blazed new paths of civilization have been precedence breakers. The battle cry of be strong and courageous is louder now that ever. There is no force, however impregnable, that a united and determined people cannot overcome.

Looking forward earnestly to the day we shall have the  first DG of GHS or CEO of a Teaching Hospital who is a Pharmacist. Long live PSGh! Long live GHOSPA!!


Pharm. Dominic Korsah Otchere

Published on 25th May, 2016