Medical Leadership

Ram Bahadur Tamang

Doctors are assumed as god. Dedication, kindness, selflessness, and responsibility makes medical profession decent and noble. Dedicated doctors sacrifice their lives to save lives others. During this COVID-19 pandemic more than 1000 doctors have died. They are frontline warrior of this pandemic. In case of Nepal, in the beginning doctors and health workers have afraid of the pandemic due to lack of PPE. Debate between concern authority and medical professionals came into the floor. However, efforts against the pandemic are not so bad as criticized.

For the first time, Nepal Health Service Act was enforced in 1996 that constituted Health Service separated from Civil Service. During this period doctors and other health workers are seen confined within the perimeter of hospitals and wall of the operation theatre. It can be analysed that either medical professionals have less interest in leading the medical administration and reform healthcare system in the country or they are over dominated by generalist bureaucrats and policymakers. It can easily guessed that the ministry of health and population is being frequently leading by the secretary from non medical background. The reasons may be as;

First, medical doctors including other health professionals working at government service are not competent to lead the ministry.
Then, they have less attention to their career path. They have single mission to make more money by engaging extra hours in private hospitals and clinics.

After then, they have been extremely over dominated by non medical bureaucrats and policymakers who do not truly understand the medical sensitivity.

Next, they have weak professional unity and power of collective bargaining to raise their voice before decision makers. 

Finally, medical education is emerging as an industry to make money fast. Medical education and healthcare system became extremely expensive. Such type of unjust situation diverted the mind of medical mafia, politicians, and medical professionals to run behind the money. 

Medical career
There are two secretaries in the ministry of finance, ministry of industry, commerce and supply, ministry of energy, water resources and irrigation, ministry of agriculture and livestock development, and ministry of education, science and technology. Similarly, office of the auditor general and office of the attorney general each has four secretary. But matter of great surprise is that ministry of health and population is not ensured single secretary from medical background. It shows that medical career is one of the most neglected professions in Nepal.

According to seniority list published last year by the ministry of federal affairs and general administration the total number of 8th level health professionals is 791 (medical doctors 666, ayurved doctors 86, dental surgeon 37 and homoeopaths 2). Whereas 4602 gazetted 3rd class section officers (administration 2890, account 1133 and revenue 579) are working. Similarly, 1190 under secretary (administration 846, account 174 and revenue 170) and  218 joint secretary of administration are working. Whereas 9th/10th level and 11th level medical officers are working (487 and 150 respectively). But those 11th level doctors or health workers are not seen to be promoted to secretary of the ministry. About 500 plus section officer (administration) has been annually advertised but medical doctors and health workers has not been recruited regularly.

The above data shows that we are focusing on distributing citizenships, issuing passports, and keeping records of birth and death, marriage and migration certificates and other clerical jobs instead of protecting the life of citizens by building hospitals and health clinics, mobilizing adequate health professionals with necessary healthcare equipment. 

This is one example of our structure of bureaucracy and the nature of bureaucrats. We can see the same miserable situation in other important technical professionals such as engineers working at building houses, constructing roads, and canals, as well as agriculture and forest technicians, and so on. It means we are generalizing the bureaucracy, highlighting clerical jobs and less prioritising medical as well other technical professions. But in reality we have to focus on better healthcare system, infrastructure development and inducing robust technology in service delivery system.
Paradox in medical sector

According to Nepal Medical Council, there are more than 23,000 registered medical doctors in Nepal. Out of them about 1500 doctors are working in government institutions.

Medical profession is still equally popular among vibrant students in Nepal. More than ten thousand students have been involving in MBBS/BDS entrance examination per year. There is no more than 500 seats are available in scholarship and 2000 seats under donation scheme. Private medical colleges offer seats to those students who can pay more donation. So, medical education is being inoffordable and out of access of ordinary citizens. 
We have no required ICU beds, ventilators, operation theatres and other healthcare facilities in government hospitals. Private medical institutions have been extremely exploiting the people. Private hospitals and medical colleges are seen as profit making machines. They closed their gate during the COVID-19 pandemic. This situation is enough to show the miserable condition of our healthcare system. Why the stakeholders are reluctant to this burning issues? The present COVID-19 pandemic has slightly drawn the attention of concern authorities as well as medical professionals. Now, they have to cooperate and collaborate to fight against future health hazards to save the life of citizens. 

Health administration covers hospital management, mobilization of medical professionals to control and treatment of disease and successfully fighting with epidemic and pandemic, building competent human resource, maintaing medical ethics and medicolegal provisions. By contrast, we are practicing general administration in healthcare administration by deputing non medical leadership in the ministry of health and population. 

Way forward
Public healthcare system will be improved when public health institutions become stronger. Smart, young and dynamic medical students should be welcomed in the healthcare system by conducting recruitment on the regular basis, providing them equal opportunities to domestic and foreign education, training, exposure and ensuring clearcut career advancement. Well funded and well equipped public hospitals and health institutions can play vital role in this respect. Medical professionals have to develop their leadership competencies such as hospital management, medical speciality, renovation of traditional healthcare system, strengthening team work, networking, cooperation, coordination, and collaboration with stakeholders, improving financial and clinical performance, maintain medical ethics and medicolegal compliance, strategic fighting against epidemic and pandemic. Formulating practical policies, programs, projects and conducting supporting activities to accomplish goal and objectives are key success factors for leadership. Motivating and tactfully mobilizing medical experts, practioners, and supporting staffs are the core functions of medical leader

-(Tamang is Section Officer, Government of Nepal)

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