The Minister of Health, Tuitama Dr. Leao Tuitama, says the merger between the National Health Services (N.H.S.) and Ministry of Health (M.O.H.), will lead to better primary health care services.
It will also sharpen the focus and finances on services as opposed to the current situation where the “total expenditure for health is about 80 percent personnel and 20 percent on services.”
During an interview with the Samoa Observer, the Minister said the restructure should strengthen the ability for health professionals to provide improved health care services.
The Minister acknowledged the move to separate the two entities 10 years ago was justified, according to the advice from experts at the time, who thought that a separation could improve the services.
However, during the past decade, the reviews that have been conducted showed clearly the separation was not achieving the goals they had envisioned.
One of the main concerns was that there was no cohesion or collaboration between the M.O.H. and N.H. S.
“An example was that the N.H.S. was carrying out activities that were contradictory to the advice of the M.O.H.,” Tuitama said.
“This was not in accordance with the mandates and also that consultation needed to be carried out before such actions are taken. It affects the health of the whole nation.” The other major concern was the growing layers of management roles within the structure of the N.H.S. which caused a top heavy corporate like body that took the focus away from the quality delivery of health services.
“They created positions that have already existed in the M.O.H. and the N.H.S. was more or less acting as an independent entity having their own H.R., quality assurance these are functions that already existed with the M.O.H.
“Because of those duplication of services, there was an increase in management staff and it was noticeable that N.H.S. had become top heavy, more managers than the actual services itself.
“This is also reflected in their expenditures in finance in that there was a higher percentage spent on personnel and low percentage on the service
“So in spite of the increasing management, the services suffered because the actual people doing those services were of the minority so to speak. Priority was not given to service but was given to the management.”
According to the Minister of Health, what the analysis from the reviews revealed was that there a very noticeable absence of community health correlating with a rise in Non- Communicable Diseases (N.C.D.s)
“Primary health care has suffered a lot; public health has suffered a great deal. There was almost none in existence.
“The government’s concern at the moment, like all other countries, is focused on the increasing N.C.D.s and according to expert advice (such as W.H.O. and all other health institutions), the only way to combat the N.C.D.s like hypertension, heart disease, cancer, diabetes is not treating the complications of the diseases but preventing the occurrence of these diseases.
“We want to go back to improve the community facilities.”
In his view, the merge is the only way to prevent the increase of complications due to N.C.D.s which has risen exponentially in the past five years.
A clear indication of this is the hospital being filled to capacity in trying to respond and treat N.C.D.s.
“When we finished the hospital, this was right after my term at the hospital when I was head of the medical service there. Our patients were spread out in fales, separate open house and we thought we needed something to house everybody and we completed this hospital, it was huge compared to the spaces that we had.
“It had a 300 hospital beds and we thought we may never need to fill it up. Now five years after, we have no space. It’s full, why? Because the increase of people with N.C.D.s is filling up the place, now we can’t even accommodate all of them.”
The Minister insists that a return to focus on district health is the best way forward.
“Instead of waiting for people to come, we need to go to where they come from and stop them there and treat them there and prevent them from coming here.
“That’s our plan. To upgrade district hospitals, put doctors there and treat patients there and as you know with diabetes there are a lot of amputations at the moment.
We need a lot of wheelchairs. We’ve got amputees; orthotics is working almost full time.”
Do we have enough doctors and nurses to meet the demand?
“Yes, this week we approved the new doctors and there are 18 of them. We are having a medical school now so we are getting them from the medical school. This is a part of the whole picture. Other efforts are linked together to achieve the bigger picture, it’s not just one effort, there are multiple set of activities that are aiming for same thing.”
The Minister also confirmed that the restructure needed to accomplish their goals will result in redundancies, but also new job creations.
“The merger will not change how we deliver service or give treatments. Nothing will change.
“We are only looking at management. This is the merging of the management and like I said, it was really top heavy as separate entities and putting them together would make them more top heavy. Our latest review shows that the total expenditure for health is about 80 percent personnel and about 20 percent on services.
“I said are these real figures? It only popped up this week in our meeting. If that is true then yes, it is a necessity that some people will have to go. There will be some redundancies and maybe there will be new positions required for new management for people that we know who can carry this forward.”
One thing that will remain the same will be the budget as the Minister also said they have been instructed that there be no extra costs incurred by the restructure
“We’ve also been assured or rather warned by the M.O.F. that in the merge, there will be no added expense – the budget will remain the same in the merge.
“So that is the focus that we are working towards. To make sure the merge does not bring about added burden to our finances. But if we cannot reduce it, then remain the same, definitely not more than what we have now.”
With the merge, the Ministry of health will be able to be more hands on with monitoring and improving the health system to provide safe and efficient service and better use of funds.
“We have a transition board. I am the chairman of the transition board. So we are not only dealing with the merger, we also deal with a lot of management issues concerning staff performance, service delivery, equipment.
“Recently we reprimanded a service for taking their time acquiring necessary results in the backlog of operations and of course of those backlogs, the serious cases had to be treated so we sent a couple of them to New Zealand to be treated .
“The costs of those operations almost surpassed the cost of the equipment’s that would have benefited 300 operations. So you see, this is happening and these management issues so hopefully with the new merge, we are trying with a new structure.”
Learning from past mistakes’, the Minister has an ideal system in mind and is confident that with arrangements in place to improve monitoring and evaluating of their new structure to prevent reorganizing such big entities again.
“We have mechanisms in place to monitor and evaluate but we are aiming for a structure that is easy to manage. My insistence for this structure is to reflect the clear line of authority right “From the top to the bottom. I find that at the moment with the existing structure sometimes the line of authority never reaches the bottom. It’s either diffused, diluted and maybe trickles down in time. It can be a long time before it gets to the bottom.
“I want everyone to know what is going on and everyone knows what they are expected to do and not just the bottom managers and not the worker and vice versa, we need also a clear line of reporting right from the grassroots to the top so that even people working in the lowest jobs will have the opportunity to take their issues right up to the top and it is fair. That is an ideal system.
“I would like to see people, especially working in health, have a sense of ownership of the heath of the country, the lives of the people right down to the domestic staff, the cleaners, grounds men to have pride in your work – you are part of the system . We cannot operate without you; they are a necessary component of the team as a whole. Be proud to be there, that’s the kind of spirit we want to instill.”