Fri, Jan

On Service

Here And There
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If good health care requires strategic planning, from committed players, and it has devalued the way it has in this country, then it is either there has been no strategic planning, or the players have been uncommitted or both.

There is this bread selling business in my neighbourhood. I don’t know how they do it. Really. But if I need soft, pliant, delicious, bread at 10pm, I go there. And I get it. Without fail. No questions asked. And me and my indisciplined self… yes, I have tried it after 10. I did not get it. They had closed. And I knew I had pushed it far enough. There is really a limit to soft bread provision. All service, no matter how excellent, depends on well planned duration limits.

I envy the bread seller sometimes. They have a good business going. They have an oven that never stops baking, they have a well oiled distribution network, and a faithful clientele, including even the indisciplined ones like me, who close too late, and leave too early to get bread at reasonable times. I know a lot of faithful bread lovers like me. We know this lady’s brand. We come searching from far and near for that special texture. And when we have travelled, and have to deal with the airy flour honeycombs that some people call bread in some countries… we have dreams, of a better land, a better taste and look forward to coming back. So this bead seller in my area has a well oiled bread making process. She has created value. She has monetized it, and the money keeps trickling in, even at odd times. She has been in the area for decades, and it looks like she is going to make more money in coming decades.

I wish something like that could happen for health care in this country. I wish we had a service as dependable as this lady’s. A service with value, that has not dissipated over the years. And it has never been rocket science. The bread seller has done it. Surely a whole host of intellectuals in a Ministry and a Service, should be able to do better. After all, there is an essential product, a value chain, and a huge customer base that is completely dependent on the product. Everyone needs good health. And if only we could provide this product in a strategic, sustainable way, the future would be bright, for this country. And every impact made in keeping the value transmitted along the chain, has far reaching consequences for a country which has half its population under 18 years.

If good health care requires strategic planning, from committed players, and it has devalued the way it has in this country, then it is either there has been no strategic planning, or the players have been uncommitted or both. In the countries where health care flourishes, there is a technocrat base, robust enough to deflect the machinations of the political class. There are weathered health governance battle generals, who know how to negotiate the tentacles of power brokering politicians away from the precious tenets of sustainable health care. They make sure that the financing, training, and research propagation decisions are untouched. And it does not matter how powerful the government is. There are fixed red lines, and no one crosses them.

The financing pot is out of bounds, so National Health Insurance coffers cannot get emptied. The training programs are out of bounds, so no government can interfere with the mechanics of running medical and allied medical institutions. Quality assurance is sacrosanct, so the government cannot open medical centers without plans for how to staff them. The pomp and pageantry of politicians commissioning beautifully equipped rooms, and the overwhelming silence that fills the same empty offices waiting months to become operational… is a garish indication of how far healthcare institutions have fallen from the narrow, true path of efficient care provision.

I have spent more than half of my life training for what I do now. I have spent money on training. My parents, my family, my church, my friends have spent money on my training. My country has spent money on my training. There are active interests in the optimization of the value intrinsic in my training. Until there is commitment to developing the mechanisms that enhance the value along the health promotion, our failings will continue to dissipate the investment made by so many different parties in my training. If health provision does not prioritize efficient service, there will be no sustainable product.

And the health provision gap will continue to widen.

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