Technical areas: human resources, performance-based incentives, imker

By Iember Mker on February 12th, 2019

IAPHL’s first moderated discussion for 2019 began on February 4. The topic is on “The Role of Leadership in Advancing Health Supply Chain Accountability in the Public Sector”. The discussion is being moderated by Innocent Ibegbunam, a supply chain expert with the USAID Global Health Supply Chain Program – Procurement and Supply Management (GHSC-PSM) project in Nigeria. Here is a summary of the discussions from week 1 as provided by the discussion host, Innocent Ibegbunam.

“I am thrilled with the level of discussions thus far. These demonstrate the degree challenge faced by different schools of thoughts in advancing leadership views and crystalizing common approach for implementation as leadership discussions are often very broad. While public sector health supply chain space is unique as a result of political interferences (as noted by Farouq Kasirye), it is imperative we make efforts to identify what can work within the public sector space in support of the health supply chain program and/or dare to innovate/disrupt the current status, if there are significant gaps, in the leadership and accountability structures within the health supply chain system in the public sector. With the current mantra of “universal health coverage”, it is imperative the health supply chain systems, both in public and private sectors, are pushed to the next level, if this ambition will be achieved.

Let me first appreciate all the contributors to the discussion thus far with some summaries and reflections on their inputs:

* Alemayehu Wolde clearly identified with the essence of the definition of leadership by putting responsibility of health supply chain leadership on the shoulder of one individual in the top management within the Ministry of Health. This is very essential to promote accountability in performance of assigned mandate especially in cases where the role of leadership is further delegated to other individuals within the system that should be accountable at each level within their sphere of influence.

* Andrew Kaggawa further broadened the definition of leadership to be resting on an institution (i.e. NMS) while highlighting the lack of continuity for an intervention that was to be provided to that individual through a third-party support. This further highlights the importance of holding an individual responsible for providing leadership to minimize the “bystander effect-diffused accountability” (we will discuss this next week) that results in lack of accountability within the public sector health supply chain system.

* Joseph Wafula was more deliberate in his definition “the one who makes the ultimate decision as to what, when and why”. However, it is imperative to still identify the individual within that institution who can be described as “the one” to promote transparency and limits the hiding places for weakness within the supply chain system. This will be a very practical approach to promote accountability.

* Frank Okoye even made it very simple “the one who leads” while bringing in the followership dimension as well with regards to execution of the leader’s vision. The example of the private sector provided by Frank further highlights the importance of this discussion. If the policies exist in the public sector with skilled human resources, why is the public sector lagging behind? While corruption is an issue in many developing countries, is that all there is to the poor performance of public-sector supply chain? Corrupt practices are also often found in the private sector, but the system is functional, what can be done differently in the public-sector to promote leadership through accountability despite the unfavorable environment?

* Amir Majeed highlighted the importance of delegation of authority which is very essential, however, will the leader still be accountable or not?

* Timilehin Omole linked the discussion via John Maxwell’s postulation of a leader being the accountable person for both successes and failures. In so doing the leaders create enabling environments that will promote success which includes capacity building for those charged with various responsibilities and motivation to enable them to succeed. This is where enabling environment as a driver to achieve the vision of the leader becomes very essential as the success or failure of the followers may be, to a large extent, dependent enablers/incentives created by the leader.

* Similarly, Anthony Kirunda identifies a leader as “one” with power to motivate others. Furthermore, accountability tools exist at the various layers of the health supply chain system. The major question is whether these tools are used as designed and who is checking to confirm they are used accordingly to the laid down procedures. This is where the role of the leader becomes very essential in promoting accountability systems. Anthony further touched on the capacity of the leaders to implement accountability systems which is very essential for sustained performance and highlights the importance of having “square pegs in square holes”.

* Special appreciation to Benjamin Chinoko for taking the discussion a notch higher by going through all the questions in detail with the examples of the structures in Malawi. Benjamin further provided detailed job descriptions of the various actors that may serve at leader(s) at the various levels within the health supply chain system in Malawi. I am impressed with the acknowledgment that even though the roles are spelled out (which is a function of leadership), they are often not performed by the assigned positions as expected which is at the heart of the discussion for this week. Putting systems in place and ensuring follow-through via appropriate leadership institutions for sustainability is at the core of our discussion. I am particularly impressed with this comment “The public sector personnel should be the ones advancing the supply chain accountability systems”. If this is not happening, what can be done to reverse the trend; considering the need to commence the “Journey to Self-Reliance”? The recommendation of incentives through promotion is apt, however, considering the bureaucracies of the government systems, how will this be implemented promptly?

* Anthony Obieze included additional juice to the discussion bringing out the dimensions of “technical areas” and “governance systems” for the public sector supply chain system. While the technical areas focused on the health product characteristics, the governance process was on the health systems itself, which is mostly the core of our discourse. To what extent we use the governance structures to support the technical areas of safety and efficacy of the health products moving through the public-sector supply chain is critical in promoting the overall health outcome of the clients, which is the primary purposes of any health system.

* Farouq Kasirye touched on the sensitive parts, which I may regards as the major stumbling blocks in the public sector health supply chain; political interference; corruption, incentives, fear innovation. According to Aristotle, “man is by nature a political animal”, is there a way we can ever separate our daily lives from the political environment? If not, how can we work within the context of our environment (political or social) to make improvements? In addition, Steve Jobs said “People who are crazy enough to think they can change the world usually do” hence we need to start thinking about how, as supply chain professionals, we can disrupt the current realities of our environment and put in systems that can be more accountable for resources committed to health supply chain systems in the public-sector. While political interference may often be inimical to accountability, it can be a positive force to institutionalize accountability if transparency is promoted as a mantra within the system. These were the health supply chain professional can level of the civil society organizations to demand accountability within the system especially with excessive political interference that impacts on health outcomes through supply chain inefficiencies.

* Theophilus Faruna anchored his discussion on the institutionalizing capacity building systems for medical laboratory scientists in Nigeria as a strategy to develop more leaders that can shepherd the system. Good point, but is capacity building sufficient to enable leaders advance supply chain system performance in the public sector? I know many supply chain leaders in the public sector that very skilled, but the environment is a challenge to enable them to put their skills to use. How can these obstacles be addressed to improve the overall system?

* Nadia Olso added the stewardship dimension with focus on universal health coverage as a goal for the supply chain system. This is vital with the ministry of health being in the pole position to drive the national health agenda for the entire country beyond health supply chain both within public and private sector spaces. This also where ownership, acceptance and implementation of the roles becomes crucial if there is visibility and accountability structures in place.

* Paul Asante further touched on the skills of a leader’s ability to communicate clearly and concisely, establish and maintain relationships, and facilitate meaningful dialogue. The integrity question, which is often personalized, is also a key component of ensuring that the core values exhibited by leaders and/or required (of the followers) as an ingredient to promote success is maintained across the spectrum of the leader’s influence.

From the above, it is apparent we have a good understanding of what should be put in place to institute accountability through appropriate leadership strategies. We have also extensively addressed questions 1 and 2 of the first week. Let us focus the remaining period of this week (up to Saturday) to also give detailed attention to questions 3 and 4 around roles and incentives:

3. What are (or should be) the roles of leaders in advancing health supply chain accountability systems in the public sector?
4. What incentives can be put in place to motivate both the leaders and/or supply chain professionals to institute and implement accountability structures within the public sector health supply chain systems.

I look forward to more insights from the public sector, donor communities and private sector players as we wrap up the discussions for the first week.”

The Role of Leadership in Advancing Health Supply Chain Accountability in the Public Sector