From Aloysius Attah, Onitsha
In most public institutions in Nigeria, educational, medical, communications among others, there is a general impression that services rendered are mostly below standard while the workforce perform their duties as everybody’s business.
This situation, analysts say, has made many people write off public institutions and seek private alternatives for services. The resultant effect is low productivity, degradation of facilities and loss of confidence in the public domain.
But for Dr. Joseph Ugboaja, the newly appointed acting Chief Medical Director, Nnamdi Azikiwe University Teaching Hospital, NAUTH, Nnewi, public institutions in Nigeria can function and deliver optimum results when the right leadership is in place.
The obstetrician and gynaecologist turned management expert/ administrator believes that those in the public institution have many leverages above the private sector which when harnessed by a visionary leader and the right team can produce better results to the society.
Prior to his appointment, Dr Ugboaja was the Chairman, Medical Advisory Committee (CMAC) in NAUTH and Director, Clinical Services, Research and Training. He holds a Postgraduate Fellowship in Obstetrics and Gynaecology of the National Postgraduate Medical College, Nigeria (FMCOG), West Africa College of Surgeons (FWACS), and International College of Surgeons (FICS) and is also an Associate of the Institute of Management Consultants of Nigeria (IMCON).
Why is it that public institutions rarely work in Nigeria and how can this trend be reversed?
Anyone sincere would align with this fact and that has been the problem associated with all public enterprises in Nigeria. This situation could be attributed to two things – one is the general perception by people who work in the public sector and feel that this job should be done with some reservations and not with the whole heart and mind. The second factor is the failure of leadership. There is an imperative need for the leader to work on the people so they can change the perception that you can actually work with your heart and mind without reservations. For them to realise that there is actually glory in meritorious service and not haphazard or lackadaisical approach. You also need to have a visionary leader who knows where he is going.
This is the reason the government is seriously propagating public-private partnership in their institutions because if you bring in PPP, it brings out the value and benefits of the private sector into the public space by allowing them to own businesses within the public space. Assuming I am an investor, and you call me to build a laboratory in a teaching hospital, I will gladly do that knowing the prospects. We would have an agreement on how to share the proceeds and others. I would manage the laboratory in a public space without hitches. Any staff not doing well will not work there while every hitch encountered would be quickly dealt with without waiting for the public service bureaucracy and all that. There are many ways to go about it but first of all, get the right leadership, a visionary leader who can mobilize and motivate everybody. You will be so surprised that if you have a leader whom the people so trust and believe in, the attitude will change. The leader has a strategic plan which he drives at and also motivates others to cue into the plan. Once they follow you and look up to the vision, naturally, the system would change and positive results would be achieved. There are strategies to surmount these challenges because one can’t make any headway unless these challenges are addressed. The good thing there people tend to forget is that there is much leverage in the public service to develop the system. It is the government that pays the workers in the public service. In NAUTH here, our wage bill is a hefty sum annually and no private sector person can afford that.
The private sector person on the other hand looks at the cost benefit analysis before engaging workers. If he pays you N1million in a month, he is looking at what you are bringing to the table but here, government is already paying, all you need is strategic human resource management. Sit down, ask yourself what you want as an institution and work towards being a leader, the best in your chosen areas of specialization and conquer the market.
Healthcare delivery is a task for everybody…
All sectors including the media are critical stakeholders in achieving the task. In safeguarding the health of the people, hospitals cannot do it alone. There is also the need for a proper feedback mechanism too. I’ve been in the NAUTH management team since the last seven years so I’m familiar with the terrain and all we need is support from the critical stakeholders to move the health institution forward.
How would you characterise your vision?
It is centred on making NAUTH among the five top hospitals in Nigeria. We want to do that through three critical pathways: massive infrastructural development at the permanent site, procurement of state-of-the-art equipment as well as investment in strategic human resources development. We cannot be among the best in the country with a perpetual temporary site. Infrastructural acquisition and development are keys towards achieving our vision. The second leg of that part is human capital development. If you build the entire infrastructure in the permanent site without training your staff, you’ve not done much. This aspect is in three parts – first is for them to acquire the needed skill and knowledge to be able to treat the patients well. Second, is to train them on attitudinal change because this is about healthcare service industry. The third arm of the training is the leadership and management training. Because we have a vision that needs to be shared among the staff knowing that any vision not shared is a dead vision. People must believe in a vision and work towards achieving them. The leaders of the units must be involved so that they understand the vision and our strategic plans towards achieving this vision. Only by so doing that we can get close to achieving the vision.
What are pillars for achieving the objectives?
Our development pillars towards achieving the objectives include team work, strong partnerships with stakeholders, regular interactions, strong corporate governance structure as well as accountability, transparency and integrity.
The vogue is e-medicine and we must do it through digitalization and not analogue systems again. This requires acquiring state-of-the-art equipment. Fortunately, we have public spirited individuals and corporate organisations within Nnewi and environs that can help us in this direction. Here, we want to give supporting supervision. That is why we said we must issue name tags to every staff so that individuals could be traced and identified easily. Strengthening our disciplinary measures is not to focus on punishing our people. It is to support them to be better through training, motivation and supervision.
Externally we have the stakeholders in town – traditional, political and religious institutions. Engaging them would afford us opportunity to explain what we are doing and get feedbacks from them. It is only when you interact with these people and let them know what you are doing that they can come in and assist in the resources we need to develop the place. Collaboration is top notch for us here because even away from the community, you have to collaborate with stakeholders in Abuja, nationally and internationally. We operate under the Ministry of Health so the ministry would be of immense assistance too.
In terms of funding, how did NAUTH take off?
NAUTH can be regarded as the only public institution in Nigeria that has not gotten a take-off grant since inception. We need to build up advocacy in this direction and collaborative strategies to be able to attract that necessary funding to make us move forward. We need the collaboration of various agencies for the development of that permanent site. We need roads and water in the permanent site, that’s why we need the Federal Roads Maintenance Agency, FERMA and even the Ministry of Water Resources and Power too.
What has the experience been, managing inter-professional cooperation and peace?
One of the challenges in managing public health institutions in Nigeria is the inter-professional rivalry that is there. Any leader in the system who wants to succeed must learn how to manage this relationship. We’ve done very well in NAUTH in this regard because we carry everybody along. Here you have doctors and non-rank and administrators. Once you allow politics to come into what you are doing, it becomes a problem. The solution is showing yourself as someone who is detribalized. Carry everybody along and people would be happy. We are going to maintain industrial peace and harmony.
Moving forward, what should people expect?
In the coming weeks and months, people would be sent out for both local and foreign trainings to get the skills we want. The ultimate aim is to make NAUTH a centre of medical tourism and this can’t be possible if all are stuck in one place. People must move out to acquire the needed skills for us to be able to achieve that. So, attitudinal change training is central and key to our vision. Serious campaigns and sensitizations coupled with attitudinal change workshops would be organized. Our patients must be treated with the honour and dignity they deserve. In addition to the training, we are also going to intensify monitoring. It is either you shape up or you leave the system. Any patient that steps into NAUTH must leave happily or happier than he came.