I certainly have never seen an op ed in English that so bravely puts out the problems of the Ministry of Health into print. The author lists bureaucracy and lack of vision in management, few human resources, low wages, and brain waste as issues to be tackled. Those of us who work in health have seen all of them cripple the health sector.
Her suggestion of 'brain globalisation' is a sound one. She lost me when she mentioned Israel.
Jamie
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Health ministry burdened by skills crisis
Phyu Phyu Thin Zaw
Tuesday, 19 January 2016
Victory has rewarded the National League for Democracy, led by Daw Aung San Suu Kyi, after years of effort. However, there are many challenges for the incoming government, including the need to revitalise the economy; bring peace, education and health to the people; and reform the corrupted justice system.
Most of the ministers in the outgoing government were retired military officers, often criticised for lacking professional management skills and resisting innovation. A major challenge for the incoming government will be finding ways to work around the militarised bureaucracy and adopt a new vision in management.
In particular, the Ministry of Health (MOH) is under tremendous pressure to bring health and equity to the people. Indeed, there have been significant improvements since 2011. But the MOH has been particularly afflicted by the militarisation of its bureaucracy. Last August, healthcare professionals started sporting scraps of black ribbon to proclaim their resistance to what they saw as the dumping of unqualified senior military officers into healthcare jobs.
The Black Ribbon Movement is so far inclined to be optimistic about the incoming government’s intentions. The criteria for selecting the next minister of health are being widely discussed on doctors’ Facebook pages. Most healthcare professionals expect that the new minister will be a competent technocrat with sufficient knowledge of, and expertise in, health system reforms. At the very least, he or she is expected to be able to fully utilise the knowledge and expertise of various technocrats in the healthcare field.
On the other hand, the MOH is currently facing the biggest challenge in its history. There is a severe shortage of healthcare workers in Myanmar. In 2014, there were a total of 75,076 health workers, including 18,871 medical practitioners, 817 dentists, 28,568 nurses and 12,042 midwives. There are 1.46 health workers – doctors, nurses and midwives – per 1000 people, far below the World Health Organization minimum recommended threshold of 2.3 health workers per 1000 people. Acknowledging this crisis, the MOH established the Health Workforce Strategic Plan (2012-17) in 2012. The plan emphasises the country’s basic health staff (BHS) and offers strategies that include incentives for healthcare workers in hard-to-reach areas, training of BHS and volunteers in different fields, and so on. Promoting the quality of BHS workers seems appropriate. But the plan does not fully address the critical shortage of competent healthcare technocrats at the central office of the MOH in Nay Pyi Taw.
Currently, very few well-qualified staff are available to deal with a wide range of technical issues at the ministry. The process of rehabilitating a ruined health system requires skills ranging from redefining healthcare financing mechanisms to strategic planning and evidence-based policy- making. All the processes involved require the contribution of highly competent technical experts, but there are not enough of them. For instance, there are only two health economists for healthcare financing; seven to 10 epidemiologists for research, disease control and other epidemiological functions; and very few health policy specialists currently working for the MOH. Likewise, government hospitals are in need of healthcare specialists such as radiologists, microbiologists, mental health specialists and so on. Technical assistance from the developed world is still insufficient.
In addition, most technical experts working at the MOH are facing various career dilemmas. They see themselves as people who bear the burden of hard work for comparatively little reward. Professional satisfaction is very low and the salary for healthcare professionals – ranging from US$150 to $500 a month – is the lowest among all ASEAN countries.
Even if the salary is not a problem, some professionals find the centralised management system very frustrating. Some argue that the present management at the MOH leaves no room for innovative ideas. Some professionals whose talents are ignored or misplaced feel that they are good examples of “brain waste”. The criteria for promotions are often based on years of service, not on the degree or specific expertise of the applicant. Any movement of intellectuals from one national setting to another is treated as “brain drain”. Some restrictions may even violate basic human rights and the individual’s freedom to choose where to live and work. They also prevent the dissemination of knowledge and the broadening of cultural horizons among professionals. As a result, the MOH is losing its already limited intellectual capital day by day.
There is obviously an urgent need to develop practical plans for delivering a competent, motivated and adequately staffed body of healthcare specialists at the MOH in Nay Pyi Taw. Raising wages is just one effective measure, however; financial considerations are not always a major factor in most cases of “brain drain” or “brain waste”. Social and political incentives, along with the desire for greater intellectual freedom, could be more important. Evidence also indicates that preventing the most talented people from leaving the country would not help either, if they feel their talents could not be effectively utilised at home. Some could even end up being depressed and unproductive due to frustration or lack of opportunity. The best solution could be to create a better working environment and to promote intellectual freedom.
From a broader perspective, the incoming government’s measures to attract more healthcare technocrats at the MOH should focus on the idea of “brain globalisation” rather than on the phobia of “brain drain”. In this new millennium, globalisation presents opportunities to break down traditional boundaries and allow participation in the global family more easily and effectively than ever. The idea of “brain globalisation” could be defined as the creation of new and innovative environments where professionals can interact freely. Such environments could attract healthcare experts from both developed and developing countries. International mobilisations of technical experts are inevitably required in the process of “brain globalisation”.
Taking the example of China, the government could try to attract Myanmar-born experts now living overseas to come back to their native land and contribute to the reform process. It can also learn from Israel’s “Birthright Israel” program, which has been effectively putting to work the outstanding talents of its diaspora community without bringing them home, by creating exchange programs. Lastly, the new government should invest more in the training of new and young generations in the various healthcare fields, especially in financing, public health, health legislation and policy, food and drug administration, and health informatiown technology.
Dr Phyu Phyu Thin Zaw is a physician epidemiologist at the Department of Medical Research under the Ministry of Health. She is a former visiting scholar in the Asia Health Policy Program at Stanford University’s Walter H Shorenstein Asia-Pacific Research Center. Her research areas are current trends in Myanmar’s health policy, reproductive health, equity and gender issues.
http://www.mmtimes.com/index.php/opinion/18524-health-ministry-burdened-by-skills-crisis.html
