Health Ministry reform gets green light Business-like culture aimed for By Bebe Buksh Stabroek News August 8, 2000 The Ministry of Health (MOH) is to be restructured following Cabinet approval on July 19 of a plan which is to develop a "business-like" culture in health care delivery and instal Regional Health Authorities (RHAs). The plan is a joint initiative of the Government of Guyana and the Inter-American Development Bank's Health Sector Policy and Institutional Development Programme. Several weeks ago local and Caribbean health officials held a one-day closed door seminar on decentralisation in the health sector in Guyana at the Ocean View International Hotel. Papers were presented by health officials from Guyana, Jamaica and Trinidad and Tobago on their experiences in this regard. According to a paper on "Decentralisation and Health Service Delivery" presented by the Permanent Secretary in the health ministry, Doorga Persaud, implementation of the MOH Strategic Plan will follow "the staged process recommended." This would require that top level managers be put in place first before working under professional guidance to develop a detailed design for the lower levels of the new MOH organisation under their responsibility. "Successful implementation of the new structure requires senior managers in the Ministry to be given the authority for managing their areas of responsibility and being held accountable for their performance," the paper stated. Six basic requirements have been outlined to accomplish the MOH restructuring. In decentralising selected central ministry functions, regional health authorities and other semi-autonomous operating authorities will have considerable freedom and flexibility in terms of administrative processes and decision-making. The paper said that the MOH must be positioned to deal with a new set of dynamics, negotiated decision-making and policy and regulatory control mechanisms that are not typical in the rigid hierarchical environment of the present public service. It identified the present approach to financial and human resource management as impeding effective MOH functioning. In keeping with the 1998 Public Service Commission rules the decentralisation policy committee has agreed that the MOH should work with the Office of the President/Public Service Management (PSM), and as necessary, the Public Service Commission (PSC) to arrange for the delegation of human resources management functions from central authority to the MOH under well-defined policies and standards that include the merit principle. Proposed at the same time is the delegation of human resource management functions to provide the MOH with authority to conduct its own recruitment and appointment process. This would actively involve and hold accountable the ministry's line managers for their human resource management decisions. The policy committee also suggested that while the PSM would retain responsibility for the development and maintenance of the job evaluation tool, job evaluation and classification authority would be delegated to the MOH. Fundamental to the whole exercise too is developing and implementing a performance appraisal system, whereby managers must be able to set objectives and standards of performance for their staff through evaluating, rewarding, disciplining and training measures to lead to suitable performance improvement. Delegation to the MOH of financial administration responsibilities requires agreement with the Ministry of Finance and consultations with the Department of the Accountant General and the Office of the Auditor General. Another element in the MOH reorganisation is the introduction of cost centre management under which managers would be delegated budget authority and be held accountable for performance within the budget amounts agreed. Importantly, according to the policy committee, is that the MOH restructuring should be done within the context of government's overall public sector reform. As for changing the corporate culture of the MOH, the paper asserted that public service organisations could function on a more "business-like basis". It therefore suggested that the MOH needed to build and redevelop the full spectrum of management instruments to implement the corporate culture. Among these are timeliness and transparency of decision making, business like financial systems and transactions and attention to cost effectiveness. The MOH restructuring policy committee stated that the Ministry will be placing these demands on the agencies it regulates, and that it must practise within its own organisation what it demands of others. The committee noted that the final basic requirement for the MOH restructuring is developing human resources through training. Follow the goings-on in Guyana in Guyana Today