50 years of independence in Tanzania and the state of management of health care organisations

Last year, I attended a conference with a theme “The state of management education after 50 years of independence in Tanzania”. This was one of the major events hosted by department of logistics and management of St.Augustine University of Tanzania and focused on the achievements in management education in various sectors in the country since independence. At every networking break I would meet bewildered people who would ask, "Why is a health professional at a management (business) conference?" 

My presentation was on Management education for health care managers in Tanzania since independence: Which lessons can be drawn from it for improvement for the next 50 years?

I explained how management of health care organisations in Tanzania has evolved from colonial period to date and the prospects in the next 50 years. My areas of focus were management training models, availability and utilization of trained resources, the impact on health status of the citizens and the gaps that need to be filled in the next 50 years.

In the first 50 years of independence, we have seen a progress on how health care organisations have been managed. That is from the colonial power-coercive type of management to modern management that conforms to the practice of good governance  However, there has been a gap in the public-private partnership in terms of training health care managers. The Ministry of health institutions (PHCI, CEDHA) and public universities (MuhimbiliUniversity of Health and Allied Sciences and Mzumbe University) had dominated the training of health care managers.This dominance of the public sector in training health care managers might have contributed to limiting innovations in the models of delivering these trainings ( but may be at this time the private sector had no capacity to do so). Today we see some private institutions coming along. However, one would ask whether they will come with innovative  models of teaching or it will be a copy and paste of the old models used by their counterparts. It is inevitable that there is a need of improving or changing the training models, that is, to do away with the traditional models and replace them with modern models that accommodate the rapidly changing health care industry.

On the other hand, there has been no essential progress on the way of utilizing the trained managers, especially in the public sector; local politics have dominated on who to lead health care organisations regardless of the level of education and training in management. For example, the post of a District medical officer has been too much politicized to the extent that it has become useless. In this position  you will find people without any management training appointed as heads of departments (from a clinical officer to a public health or medical specialist).No standards. The Minister of Health and social welfare when asked about this  will say that the  Public service Management (UTUMISHI) is responsible for that.The Public service Management Minister will say that the Minister of Prime minister’s office and Local government (TAMISEMI) is  responsible for that and vice versa.

  Although the private sector has managed to improve its way of utilizing the adequately trained health managers, it has a limited capacity to have a desired impact in the health sector in Tanzania. The private sector ( particularly in curative services) is mainly operating in urban areas and reaching a certain class of people. As it is obvious that in Tanzania nowadays the upper class is struggling in all ways to exploit the poor .You know the phrase, as you saw, so you shall reap. Absolutely nothing new and exciting has emerged for helping poor people in rural areas to improve their health status, leave alone to protect them from catastrophic expenditures when they fall sick, as there is no viable social protection mechanisms that are pro-poor and most of health facilities are corruption zones .  

At a conference like this, mashing people from different worlds together is a major goal of the event. At best, new collaborations are born, and at worst, new perspectives emerge from hearing a different mindset.

In the world I was used to, clinical care, public health and Health care organisations are the terms used without question. However, within a few conversations I realized that most of my audience simply thought that health care organisations are like closed systems where the business community should just leave it to doctors and other health professionals, and they were amazed with the seemingly new teachings that management as a discipline cuts across all sectors and does not require much expertise on that field. 

The second issue I picked up about managing health care organisations was from the outset, it sounds hopeless. What the hell should we as business people be engage in this, while we have health professionals who can do that? I began re-framing the message and said “using business skills to manage our health”. It sounds so much better, right? This sounds like a subject that could inspire a promising young student to study as a health care manager to a career creating innovations in the health care sector. And there were several undergraduate students listening to this presentation.

Finally, and most importantly, I learned that everything about health care management in Tanzania is still focusing on the bio-medical model that treats people as victims of the situation and sidelines the holistic approach of modern management. How can we expect policy makers, public supporters, or researchers in health care management to connect? Personally, this conference revolutionized my mindset and thought of creating awareness to the public that health care is for the people and managing health care organisations needs a concrete management education in additional to the professional training. The month after that conference, I returned to the workplace and began an effort to crowd sources of management of health care organisations with three questions. To engage health care managers trainers and practioners in their own subject and asked what their motivations were accepting their positions, what were the biggest tasks or risks to their carrier, and what could make things better.