When you write a blog it's easy to forget that it's like writing a letter and nailing it to a tree - you have no idea who might read it or how they might interpret it. The volatility surrounding the healthworkers strike makes me wary of making any comment at all. But it has been a huge factor influencing everything
that has been going on in the Ministry over the past 10 days, as you
will realise if you listen to yesterday's report from the BBC World Service or the report on the BBC website.
All I will say is that, unsurprisingly, this is all a massive distraction from the operational task of implementing the Free Health Care Initiative that should have been the focus of our work now. Making rapid changes from such a baselineof poverty and devastation was always going to painful, fraught with risks and with huge potential for mistakes to be made, so maybe none of this should be surprising. But deadlines are so tight now that there is no room for things to slip, and expectations relating to HR aspects of the plan are high.
On a personal note, I am pleased to report that I am writing this from the Simple Goal Guest House, that my bed is very comfortable. And that late last night, sitting at a beach bar with a cold beer, the pressures of work did not seem like too high a price to pay for being here.
http://africannewslive.com/?p=1788
Saturday, 27 March 2010
Wednesday, 24 March 2010
The Simple Goal
The pressure on the Ministry of Health and Sanitation to achieve the objective of launching free health care by 27th April is exposing how much work there is to do on fundamental organisational issues - communication, delegation, focus on execution etc etc (i.e. the challenges that face pretty much every government organisation and health system, only much more so).
Most days, something happens that give me a vertiginous feeling of just how close to the wind we are sailing: Yesterday, we were preparing for a team to go on a tour of Districts to validate payroll information and finalise recruitment of new staff, whose applications have been pending for months in the central office. The visits were due to start today, following an 8 day schedule, but yesterday at about 3pm we heard that the dates clash with National Immunisation Days over the weekend, which means that the staff we need won't be available. So there had to be rapid re-scheduling and all the related challenges of communicating that to Districts. That done, at that 5pm, we were still trying to track down the appropriate combination of drivers, vehicles and fuel for the trip. Under other circumstances, the visits could have been delayed, but if they don't happen now, then deadline of sorting out the payroll and recruitment of additional staff before 27th April will not be met.
On the subjct of deadlines, it looks like my (self-imposed) one of finding myself somewhere to live before the weekend will be met: The Simple Goal Guest House is a ten minute walk from work, in a quiet spot with water, electricity, aircon, and a small balcony from my room with an open view. I met the landlord this morning and am due to move in tormorrow. To maximise the chances of this happening, I am now using the estabished management technique of keeping my fingers crossed.
Most days, something happens that give me a vertiginous feeling of just how close to the wind we are sailing: Yesterday, we were preparing for a team to go on a tour of Districts to validate payroll information and finalise recruitment of new staff, whose applications have been pending for months in the central office. The visits were due to start today, following an 8 day schedule, but yesterday at about 3pm we heard that the dates clash with National Immunisation Days over the weekend, which means that the staff we need won't be available. So there had to be rapid re-scheduling and all the related challenges of communicating that to Districts. That done, at that 5pm, we were still trying to track down the appropriate combination of drivers, vehicles and fuel for the trip. Under other circumstances, the visits could have been delayed, but if they don't happen now, then deadline of sorting out the payroll and recruitment of additional staff before 27th April will not be met.
On the subjct of deadlines, it looks like my (self-imposed) one of finding myself somewhere to live before the weekend will be met: The Simple Goal Guest House is a ten minute walk from work, in a quiet spot with water, electricity, aircon, and a small balcony from my room with an open view. I met the landlord this morning and am due to move in tormorrow. To maximise the chances of this happening, I am now using the estabished management technique of keeping my fingers crossed.
Saturday, 20 March 2010
Trying to get sorted
It's Saturday afternoon and I'm sitting in a bar (drinking ice tea - after re-acquainting myself with Star beer last night). The past week was pretty unrelenting and I have been in the office again this morning, but now intend to chill and re-charge the batteries again for Monday.
The week ended on a bit of a downer when the accommodation I thought I had found fell through last night. So it's back to square one and I'm trying to find other contacts to follow up. The friends from OTB that I'm staying with are being great about me staying until I find somewhere (I have rejected one option on the basis that it is $800 pcm for a pretty poky room in a shared house, with a rubbish mattress!) but if the pressure keeps on at this pace (which I suspect it will) then having my own space to chill will be a high priority.
Before I arrived back, people were emailing that the Ministry is a different place compared to last year, but I am still amazed to see how much it has transformed into a high pressure place of rapid decision-making and urgent action in only 3 months. Everything is focused on 27th April and it seems to me that one of the most important things is to avoid taking short terrm decisions that could create problems in the longer term - for example, in the rush to fast-track staff recruitment we need to make sure that only appropriately qualified staff are appointed and that they are appointed into the areas and roles where the need is greatest. You might think that is basic, but it is not so easy when you are trying to validate payroll records at the same time, and there is lack of information about where existing staff are actually working.
There is a small team (i.e. 2) management consultants here helping with the payroll work and next week they are taking the validation and fast track appointment process out on tour to the regions (a first for a civil service appointment process that has always been cenralised in Freetown). I'm hoping to along myself for at least part of it to get a better understanding of what is going on, though it might only be possible to get away over the weekend.
The week ended on a bit of a downer when the accommodation I thought I had found fell through last night. So it's back to square one and I'm trying to find other contacts to follow up. The friends from OTB that I'm staying with are being great about me staying until I find somewhere (I have rejected one option on the basis that it is $800 pcm for a pretty poky room in a shared house, with a rubbish mattress!) but if the pressure keeps on at this pace (which I suspect it will) then having my own space to chill will be a high priority.
Before I arrived back, people were emailing that the Ministry is a different place compared to last year, but I am still amazed to see how much it has transformed into a high pressure place of rapid decision-making and urgent action in only 3 months. Everything is focused on 27th April and it seems to me that one of the most important things is to avoid taking short terrm decisions that could create problems in the longer term - for example, in the rush to fast-track staff recruitment we need to make sure that only appropriately qualified staff are appointed and that they are appointed into the areas and roles where the need is greatest. You might think that is basic, but it is not so easy when you are trying to validate payroll records at the same time, and there is lack of information about where existing staff are actually working.
There is a small team (i.e. 2) management consultants here helping with the payroll work and next week they are taking the validation and fast track appointment process out on tour to the regions (a first for a civil service appointment process that has always been cenralised in Freetown). I'm hoping to along myself for at least part of it to get a better understanding of what is going on, though it might only be possible to get away over the weekend.
Wednesday, 17 March 2010
...and back again
When I left Sierra Leone last December, I did hope that I would be returning at some point, but never expected it to be this quick. What started as an email exchange with Faye from the Office of Tony Blair in Sierra Leone in January ended in my arrival back here 3 days ago, on contract with the Ministry of Health for 7 weeks.
The reason for the urgency is the Government of Sierra Leone is due to launch free health care for pregnant women, lactating mothers and children under 5 on 27th April. This is part of government efforts to work towards Millennium Development Goals and to end the reputation of the country as having the highest maternal mortality rates in the World.
To say that this is an enormous task is to understate the point: Ministry staff and partner agencies have been working flat out refurbishing facilities, ordering supplies, setting up supply chains and related infrastructure. But... at the heart of the challlenge is staffing. Health service provision here has long been associated with informal charging by health workers (and it was often the only way for them to keep functioning when salary levels were so appalling). The government knows that free health services must mean an end to informal charging and that big increases in salaries are required, but has been struggling to come up with rates that are both affordable and acceptable to staff.
If you know anything about the history of the health service in UK, you will know how much opposition there was from the professions when the free NHS was first launched in 1948 (when they realised the effect it would have on their private income) and you will also know how much bad will was generated by salary reforms over the past 5 years (never did so much new money create so much dissatisfaction). Well, translate that to a very resource poor environment and you might get a glimpse of what is happening here. Yesterday (Day 2 for me) the nurses went on strike in the main teaching hospital and when I left work today it seemed things were getting worse rather than better.
So, it is hard work at the moment, very hard. But I get a sense that underneath it, people know this is an important time, and they don't want to screw up. And busy though they are, they haven't been too busy to welcome me back with open arms. And that is great.
So that is work (and pretty much all I have been thinking about so far). On the domestic front, there is the slight matter of finding myself somewhere to live and related personal matters.I'm staying with friends at the moment (in a very nice house), but need to get it sorted, just as soon as I get time...
The reason for the urgency is the Government of Sierra Leone is due to launch free health care for pregnant women, lactating mothers and children under 5 on 27th April. This is part of government efforts to work towards Millennium Development Goals and to end the reputation of the country as having the highest maternal mortality rates in the World.
To say that this is an enormous task is to understate the point: Ministry staff and partner agencies have been working flat out refurbishing facilities, ordering supplies, setting up supply chains and related infrastructure. But... at the heart of the challlenge is staffing. Health service provision here has long been associated with informal charging by health workers (and it was often the only way for them to keep functioning when salary levels were so appalling). The government knows that free health services must mean an end to informal charging and that big increases in salaries are required, but has been struggling to come up with rates that are both affordable and acceptable to staff.
If you know anything about the history of the health service in UK, you will know how much opposition there was from the professions when the free NHS was first launched in 1948 (when they realised the effect it would have on their private income) and you will also know how much bad will was generated by salary reforms over the past 5 years (never did so much new money create so much dissatisfaction). Well, translate that to a very resource poor environment and you might get a glimpse of what is happening here. Yesterday (Day 2 for me) the nurses went on strike in the main teaching hospital and when I left work today it seemed things were getting worse rather than better.
So, it is hard work at the moment, very hard. But I get a sense that underneath it, people know this is an important time, and they don't want to screw up. And busy though they are, they haven't been too busy to welcome me back with open arms. And that is great.
So that is work (and pretty much all I have been thinking about so far). On the domestic front, there is the slight matter of finding myself somewhere to live and related personal matters.I'm staying with friends at the moment (in a very nice house), but need to get it sorted, just as soon as I get time...
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