By: Dr Makodingo Washington
Several doctors, yours truly included, responded with hue and cry when the President announced his pick for the Ministry of Health. What seems to be unanimous amongst doctors and most in the health profession is that a doctor should have been chosen to head the Ministry. Several people have taken to social media to make their disappointment known about this nominee. In my response to the nomination, I tweeted,Â â€œA Cabinet Secretary is a policy head. I think Health shouldâ€™ve had a Medic at the top â€“ then the PS (The actual manager) be that banker!â€
I now wish to withdraw those comments.
First of all, constitutionally, a Cabinet Secretary is very much different from our previous ministers.Â In the old Constitution, the work of a Cabinet Minister was to â€œaid and advise the President in the government of Kenyaâ€.
17.Â (1) There shall be a Cabinet consisting of the President, the Vice-President, Prime Minister, two Deputy Prime Ministers and the other Ministers.
(2) The function of the Cabinet shall be to aid and advise the President in the government of Kenya.
The Executive Authority of the Republic was vested ONLY in the President and could only be exercised by him or officers subordinate to him:
23.Â (1) The executive authority of the Government of Kenya shall vest in the President and, subject to this Constitution, may be exercised by him either directly or through officers subordinate to him.
Contrast this with the Current Constitution:
130.Â (1) The national executive of the Republic comprises the President, the Deputy President and the rest of the Cabinet.
In the current Constitution, a Cabinet Secretary has inherent Executive Authority derived from the People of Kenya through the Constitution. This is probably the strongest reason Cabinet Secretaries are required to not be members of Parliament as they will have their hands full in the day to day running of their cabinet portfolios. We expect our Cabinet Secretaries to be going to the office at 8am and leaving at 5pm like all other government officers.
A Cabinet Secretary will be the CEO of the Ministry. This is a major departure from the previous cabinets where the Minister was merely a titular head of the Ministry with the PS being the CEO. In fact, other than the Ministers for Finance and Local Government, no other Minister had executive powers. As CEO, the most important quality a Cabinet Secretary will need is the ability to manage not just people but also resources. The Ministry of Health, despite devolution, is still a behemoth that needs someone with high level CEO credentials to manage it.
Anyone who has interacted with the Ministry of Health at policy level will tell you its problem has never been lack of policy. In fact, the Ministry could easily be the one government ministry with the best policy documents in the Country. Take for example my professional interest, the Pharmaceutical Sector. We have one of the best Pharmaceutical Policies anywhere in the world with clear achievables. The problem is that consecutive Ministers have either ignored them or had their priorities upside down.
What the Ministry needs is someone who knows how to IMPLEMENT good and progressive policies. It needs someone who has a demonstrable experience in implementing a proper management and growth strategy.
I have heard the argument that a Medic deserves to be the Cabinet Secretary. In support of this argument, it is argued that the Surgeon-General in the US is a Doctor, and so is the Director General of WHO. That is well and good. The only problem with this argument is that the Surgeon-General is NOT the head of the Department of Health and Human Services in the US, that job is held by former Kansas Governor, Kathleen Sibelius â€“ a BA in Political Science and Master of Public Administration. Our equivalent of the Surgeon-General is the Director of Medical Services, a position that is and has always been held by a Medical Doctor. In other jurisdictions, the US case is repeated. The Minister for Health in the UK, Jeremy Hunt has Bachelors in Philosophy, Politics and Economics. The Federal Minister for Health in Australia, Tanya Joan Plibersek holds a Masters in Politics and Public Policy. The latter two jurisdictions have some of the best publicly funded health programs in the world. And finally, the man who revolutionized the Cuban Healthcare was Communist Party stalwart and revolutionaryÂ Jose Ramon Balaguer. Of course the actual control of funding for health was personally controlled by Fidel Castro â€“ a lawyer.
To claim that the heads of institutions should strictly be people of a relevant professional background has both no basis in practice and eventually limits the scope of professionals. In fact, such an argument would have stalled the careers of some of the greatest minds in the world.
The World Bank has DrÂ Jim Yong Kim, a career doctor as its President.Â He is the first Bank leader whose professional background is not in the political or financial sectors, and the first to have previous experience personally tackling health issues in developing countries.Â If the world was to have similar reasoning like my colleagues in the health sector, a great global leader like Jim Yong Kim would not be at the helm of The World Bank.
One of the biggest problems in the Ministry has been rivalry between the different professions in the health sector â€“ Physicians, Pharmacists, Dentists, Nurses and many more. These egotistic differences have largely contributed to the disharmony amongst the professionals and eventually to the poor coordination in service delivery to the patient. Of course they could have been cured by the many non-medical ministers we have had in the previous administrations. The problem has been that the people we put at the helm were easily intimidated by the medics into towing their lines.
The Ministry of Health, more than any other Ministry requires a person who can stand on their own two feet and tell medics he knows how to manage and can show a track record of that management. In fact, I am of the opinion that even the PS (the Equivalent of the Chief Operations Officer) need not be a medic either.