Health sector leadership
Many health ministers, senior health officials, health insurance representatives, pharmaceutical representatives, and private service providers have received some portion of their education from in-country health professional institutions, but they often disregard the leadership of those institutions in the formal health decision-making and policy dialogue process. There needs to be a strong interface between the institutions charged with producing the nation’s health human capital—who not only produce most of the participants in the public and private health labor markets but also carry out critical national research—and leaders responsible for policy formulation and decisions about financing and service provision. In short, health planning, generally, and health workforce planning and provision, in particular, should formally and regularly include health professional leaders who are directly responsible for health workforce production and health worker skills.
A number of countries around the world, both rich and poor, provide positive examples of leadership by key health professionals. (See Appendix for more details on the individuals mentioned below and other relevant health professional school leaders.)
- Canada: Dr. John Evans, following his period as dean of the University of Toronto Medical School, both academically and politically strongly influenced Canadian health sector reform efforts—especially with regard to biotechnology policies.
- China: Professor Chen Zhou, as China’s minister of health, drew on his academic experience at Shanghai University and the Chinese Academy of Sciences to significantly and successfully influence China’s health policies and programs. Notably, Minister Zhou worked to expand health care and public health services to the lowest income quintile and to remote rural patients, strengthen the quality of Chinese medical schools, and ensure the influence of analytical and research evidence in health policy decision-making.
- France: Dr. Philippe Douste-Blazy, as a professor of medicine and cardiology at Toulouse Science University, “managed upwards” and influenced French noncommunicable disease policies in a major way. He then served twice as minister of health as well as minister of culture and minister of foreign affairs, remaining a linchpin in linking academia and politics in the fields of French health insurance reform, global health initiatives, and health and medical research financing.
- Ghana: Dr. Fred Sai used his position as professor of preventive and social medicine at the University of Ghana Medical School to successfully influence government policy in the fields of family planning, nutrition, and maternal health. Dr. Sai subsequently became the country’s chief physician for nutrition and director of medical services. A later position at the Harvard University School of Public Health enabled Dr. Sai to crucially influence global human resources for health, family planning, and maternal health innovations at the United Nations, the World Bank, International Planned Parenthood Federation, and other institutions. As an advisor to several presidents of Ghana, Dr. Sai instigated health insurance, family planning, and pharmaceutical policy reforms in ways that served as examples to many other countries.
- India: Professor Nirmal Ganguly, as director-general of the India Medical Research Council, used his Cabinet-ranked position to include important disease priorities in India’s national and state health reform efforts.
- Indonesia: Minister Haryono Suyono built upon his previous academic and technical leadership to importantly advance reproductive and maternal health and family planning.
- Netherlands: Dr. Louise Gunning successfully drew on her experience as dean of the Amsterdam Medical School, president of the Netherlands Health and Medical Research Council, and president of the University of Amsterdam to influence the Dutch government’s health policy changes and heighten the analytical role of Dutch academia for the country’s health insurance reform efforts.
- Nigeria: Professor Tayo Lambo, as minister of health, used his former academic standing as the leading health economics academic of the country to instill important economic and finance dimensions into Nigeria’s health reforms.
- South Africa: Minister Dlamini-Zuma used her pediatric leadership at the University of Kwazulu-Natal to integrate scientific and evidence-based approaches into South Africa’s health reform decision-making process.
- Uganda: Professor Nelson Sewankambo, as dean of Makerere University Medical School and then its vice-chancellor, teamed up with Dr. Francis Omaswa, the Ugandan government’s director-general of health, to importantly reposition the country’s health financing policies and its health workforce approach.
- United States: Dr. David Satcher served as faculty member at the UCLA School of Public Health and chairman of the Department of Community Medicine and Family Practice at Morehead School of Medicine. As US surgeon general, director of the Centers for Disease Control and Prevention, and assistant secretary of the Department of Health and Human Services, Dr. Satcher was instrumental in focusing attention on health disparities for minorities, the poor, and other disadvantaged groups. He also drew attention to the need to promote sexual health and responsible sexual behavior as well as address tobacco use.
These examples illustrate that when there is a willingness to draw on academic expertise, the interaction between the leaders of a country’s health professional schools and the government decision-makers involved in health reform can be both positive and productive. Unfortunately, in most countries such interactions remain woefully uncommon due to the absence of institutional structures and arrangements, including political and legal systems. This needs to be rectified so that the types of mutually beneficial interactions discussed in the examples become the norm and a matter of course.