Privatizing Korle-Bu is not the Silver Bullet

Tue, 3 Apr 2012 Source: Bannerman, Nii Lantey Okunka

Wake Up Prof Nartey!! - Privatizing Korle-Bu is not the Silver Bullet

I read with mixed feelings the March 25th write up on Korle-Bu hospital published on Ghanaweb. Though without the same keen insights as Prof Nartey, I dare to question his call for privatizing Korle-Bu. Though passively sympathetic, I don’t think he is advocating for the right solution to this particular challenge. I believe the social and economic cost of privatizing Korle-Bu will be very steep and therefore drown any financial gains from privatization. If social Darwinism is not our goal, we must think carefully before we turn Korle-Bu over to the icy hands of private enterprise. If Korle-Bu can be privatized for financial benefit, why is the private sector not racing to build a hospital to meet the numerous health needs of Ghanaians?

In the aforementioned write up, Prof Nartey is reported to have detailed problems centering on equipment, capacity, staffing, discipline, work conditions, funding, water, electricity and a few others. While these problems are real, I am not convinced that privatizing Korle-Bu serves as the magic wand for these problems. Korle-Bu was set up to deliver affordable healthcare to the rich and poor alike. Korle-Bu to start with, is a non-profit organization. So why is Prof Nartey talking about the hospital running a loss? How does he calculate loss? The concept of loss in the context of this conversation is rather interesting. Is the government planning on making money off sick people? Prof Nartey’s seem to have learnt a thing or two from Dr. Frimpong’s business model at the cardiothoracic unit. All of a sudden, Nartey sees the riches that await if he copies Frimpong’s quasi-private sector model. Are we trying to deal with a social challenge or make money? I think we should up the funding, improve work processes, update policies, revamp leadership and enhance capacity. All the above, backed by a mindset change, represent a much better public sector option than privatizing the only hope for our majority poor. Unattended healthcare challenges could cripple the economy and scare investors.

The logic pillaring Prof Nartey’s call for privatization calls for strict scrutiny. The assumption that privatizing will lead to more funds and therefore better performance is a bit of a stretch. Having inordinate funds does not guarantee performance. If it did, the US school system will not have any performance issues. Organizations with adequate funds mal perform just as much as organization without funds. Liverpool football club spent twice as much money than Arsenal in the summer transfer window. Yet, their expenditure does not reflect their position on the league table. There is more to performance that raising and spending revenue. Given the problems that he identified, I can guarantee professor Nartey that more funds by way of privatization is not the silver bullet he is frantically looking for.

It appears to me that Prof Nartey and his crew are poor planners. As a result, they are not able to make a business case for adequate funding from the government. I am talking about hard data driven evidence based business case for adequate funding. Even if we agree that past governments, until 2008, neglected Korle-Bu as asserted by the writer, what is stopping Prof Nartey from identifying other revenue streams? Is Prof Nartey not in a position to facilitate a dialogue with the government to generate revenue without privatizing the hospital? Can the hospital be kept public at the same time as the fees are raised reasonably to offset cost? It is unfortunate that we can’t do means testing in Ghana. The latter will ensure that the rich pay their fair share. Also, the tax base ought to be expanded to support institutions like Korle-Bu. Lastly, has Nartey and his crew looked into grants and charitable donations from Ghanaians around the world? I mean some of this stuff about dryers and washers can be easily met through donations from Ghanaians overseas. The challenges that I see, relates more to proper use and maintenance.

Besides being poor planners, Prof Nartey and his crew are not good stewards of the little that they get. I have no doubt that inefficiencies exist at Korle-Bu. I am certain that the staff over there divert hospital resources for personal and family use. You see, my philosophy is that the person that managed well when they had just a penny, will manage even better when they get a million. If you can’t manage with a penny, there is nothing to say or show that you will do well with millions. I bet more funds will lead to more mismanagement and profligate spending on SUVs and other luxuries even while the patients continue to get poor care.

If money is the main driver of a doctor’s dedication to patients, then we are in big trouble. Doctors in America make far more than their counterparts in the UK and elsewhere. Is Prof Nartey making the claim that American doctors are more dedicated to their patients than UK doctors? Does he have evidence to show that outcomes are better in the US than in England and elsewhere where doctors make far less than American doctors? I don’t dispute that doctors should be paid well in a country where politicians enjoy the largesse of government. However, that is not the same as privatization equals more funds leading to happy doctors and dedicated patient care. There seem to be gargantuan simplification here.

On the issue of discipline due to doctor wrongdoing, I am seriously worried. If Prof. Nartey cannot discipline doctors now, who is to say he can discipline them when they make more money in a private setting? I don’t believe discipline has much to do with private or public sector. I know the general notion is that, it is difficult to discipline in the public sector. I think it is a myth and any leader worth his salt can discipline progressively regardless of what sector. How about coaching and mentoring? The challenge with disciplining employees centers on the leader’s own behaviors. If the leader is preaching virtue and practicing vice, of course it will be impossible to discipline employees. They gang up on you because you don’t set a good example. Even if we assume that some knucklehead doctors don’t want to play fair, we can still deal with them effectively by following laid down procedures and policies for progressive discipline. If Prof Nartey and his crew cannot develop fair and firm policies to run Korle-Bu, they must give way to those who can.

When it is all said and done, Korle-Bu teaching hospital and other government owned hospitals languish in a state of disrepair due to bad political and organizational leadership. Our political leaders have bad priorities. They live outside this bad policies and systems like NHIS that they create amidst pomp and pageantry. Instead of providing adequate funding for hospitals that truly benefits all Ghanaians, they invest in silly activities like Ghana@50, buying planes, huge end of year service packages, medals and SUVs. Healthcare should be a number one priority all the time. The potential of having epidemics or losing productivity is not an incentive for investors or the economy as a whole. This is one of the reasons why Kufour’s epic tours to attract foreign investors was systemically out of whack. We must fix home, even as we leap out to invite others in. Ghana can do better and we do have the resources. Yes we do!

Lastly, the Peter Principle is running rampant in Ghana. We have a lot of people with high titles occupying wrong positions. I am always in amazement as to what job descriptions led to the appointment of most leaders in our state organizations. Having fat and high degrees is and must not be a shoo in to any or all positions. We have to do a better job attracting the right candidates for the right job. Leadership is not meant for every Tom, Dick and Harry. Having high degrees does not make you a leader. That old paradigm that puts the smart academic or loyal employee in charge does not work anymore. In looking for organizational leaders, we must test for potential and monitor for progress or discontinue the experiment. Prof Nartey and his crew must step up or give way. They either lead, follow or surely get out of the way.

Nii Lantey Okunka Bannerman (Also known as the Double Edge Sword). Akyere@aol.com

“I don’t give them hell, I just tell the truth and they think it is hell”—Harry Truman

Columnist: Bannerman, Nii Lantey Okunka