Health system change starts with good leadership

image_galleryThis post was originally published in Business World on the 26th January 2015. To see the original article, click here.

 

India needs leadership in public health now more than ever. Poor distribution and low numbers of health workers, low public spending, an unregulated private sector and poor inter-sectoral coordination all cripple the health system, leading to high infant and maternal mortality. This means that problems such as child-undernutrition are allowed to continue without any kind of coordinated or sincere response.

 

Only visionary leadership can help people exit their official silos, to coordinate inter-sectorally and identify durable solutions. Leaders with the ability to empower and inspire health workers, create partnerships, and build a shared vision, all make universal health coverage seem like a real and proximate possibility. All of which makes Visionary Leadership in Health a very timely addition to the public health literature.

 

The absence of public health leaders is a hard gap to fill. Public health is a relatively new profession in India, and public health was neglected for the first 60 years of the country’s history. In the public sector, medical doctors run the health system in most states (Tamil Nadu being an exception). Doctors are trained in clinical service delivery — not managing programmes in a complex systems environment. Some excel, but that is luck, not training or preparation. The result of is poor management and poor health outcomes — and too few doctors available to deliver clinical services.
This highlights a need to ensure all people within the system have the right skills to perform their job responsibilities, especially when there are too few health workers.
There have been recent efforts to build public health capacity, with the establishment of the Public Health Foundation of India in 2006. However, we still lack senior leadership at all levels of the health system. The book offers a framework for public health leadership, with details of the different competencies and actions required. The four components of the framework are: create and communicate a shared vision; see the big picture to analyse the vision-reality gap; find the path and; inspire and empower stakeholders.
It is illustrated with case studies and lessons learned from all over the world, mostly from resource poor environments. Some of the highlights include Thailand, Ugandaand Senegal’s local responses to the HIV/AIDS crisis, all of which were locally driven and cost effective. In all cases, there was strong political commitment, multi-sectoral and multi-level coordination, effective monitoring and data use, large scale implementation and integration between prevention and care. None of these success factors are possible without strong leadership. These cases provide a great overview of the state of global public health. This global perspective is refreshing. India’s public health challenges are urgent, the global knowledge base of ‘what works’ is an important resource.
The second section of the book focuses on the personal attributes of a leader, including team building, negotiation, communication, conflict management, creating partnerships and working collaboratively. While this is a shorter and latter section, it is possibly the most important content — key to building leadership ability is to know yourself well, know your weaknesses and constantly improve.
This book would be useful as a textbook for public health degree courses. However, it also incorporates analysis tools useful for problem solving and thus, could also be a handy professional guide. While it’s too dry for reading on the plane, it is an important and timely book. Hopefully it will help build the public health leadership the country so urgently needs.
 
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