Editorial: Shame to share in health

It is usually apparent, in short order, the quality of leadership someone will bring to an institution. The ones who tend to get things done are the ones who start with a clear vision of what they want to achieve and have thought of a path for getting it done, even as they make adjustments for internal dynamics.

So, we will soon know the stuff of which Horace Dalley is forged and how he will fare at the health ministry, a Cabinet portfolio he has assumed at a time of largely self-inflicted crisis by his predecessor, Fenton Ferguson. Dr Ferguson was not one for transparency and frank discourse and presumed every criticism as a personal attack, for which we suppose there is a definition in psychology journals.

Among the symptoms of Fenton Ferguson's phobia is being defensive, hubristic and officiously opaque when confronted with problems in one's portfolio, as well as to draw around you a coterie of public officials who act as Praetorian Guards. It, therefore, becomes difficult to hold anyone accountable for poor performance in their jobs, as was played out during last year's chikungunya epidemic and the ongoing dead babies scandal.

SITUATION POORLY HANDLED

Ironically, it was not specifically the deaths of the 19 preterm babies from the bacteria klebsiella and serratia at the neonatal facilities of two top hospitals that brought down Dr Ferguson. They may not have been reported to him in a timely manner.

Rather, it was his handling of the findings of an audit of hospitals that the minister himself had commissioned, which ought to have forewarned him of the increased vulnerability of Jamaica's public health facilities to nosocomial infections and against which he might have moved aggressively.

The health minister chose not to publish these reports and sought to play down the extent of their findings, on a claim that he did not wish to embarrass the institutions.

As it has turned out, while policy failures and the Government's fiscal constraints contributed to the crises at the institutions, the greater fault lay in the inadequacies of operational managers and the failure to hold them to account for inadequacies.

For instance, that contract cleaners do not provide employees with appropriate mops and buckets is hardly policy worth detaining

senior technocrats or Cabinet ministers. That nurses or technicians do not wash their hands or wear gloves before taking blood is a breakdown in operational procedures that is the fault of line managers, as is the storage of food and drugs in the same refrigerator. Nor is the non-labelling of chemical solutions a

policy issue.

However, ministers are accountable for the combined impact of breaches on institutions if they have failed to install competent managers, or have failed to hold them to account. That, in the end, was the bane of Fenton Ferguson and ought to be the starting point of Minister Dalley.

The new health minister, and those in charge of other portfolios, must be ready to move incompetent staff and resist the temptation to appoint replacements on the basis of political support. Given Jamaica's fiscal constraints, the managers of health services must be able to accomplish the same with less and be held accountable for their performance. The minister must also articulate new approaches to health-care delivery and be frank with Jamaicans about what is affordable.