By Nalin Abeysekera –

Prof. Nalin Abeysekera

All Sri Lankans Need to be aware of “Good Governance”. I asked about the meaning of our main discussion on the discourse of “Good Governance” by many stakeholders in the health sector(Around 50 in number).70% Said “Good Governance” should be something related to the Government and nothing to do with institutes or individuals. People do not properly understand the real meaning of good governance. This is the same for many sectors in Sri Lanka. One of the reasons might be that the one of previous governments came to power with this jargon of Good Governance but did not articulate this in their “practice”. Anyway, it is our duty to make people aware of Good Governance.

What is Good Governance?

We need to understand the concept of Good Governance with an operational definition.

“Good Governance is legitimate, accountable, and effective ways of obtaining and using public power and resources in the pursuit of widely accepted social Goals (Johnston ,2002)”

This definition mainly looks at Legitimacy and Accountability. More importantly, we should be really careful with the effective usage of utilization of public power and resources. In this entire process, it needs to be aligned with social goals. This is relevant for a country, An institute, and for an individual as well. United Nations Economic and Social Commission for Asia and the Pacific has depicted interesting and worthwhile characteristics of Good Governance.It discusses consensus-oriented, accountable, transparent, participatory, equitable and inclusive, effective and efficient, responsive and follows the rule of law. Refer following diagram; 

I think all the variables above are relevant and need to be properly communicated to all the stakeholders and Sri Lanka needs to have a mechanism to propagate through our education system and industry forums.

Good governance in the context of the Health Sector

By considering the main attributes of Good Governance World Health Organization (WHO) defined Good Governance as;

“formulation and implementation of appropriate policies and procedures that ensure effective, efficient and ethical management of all aspects of health systems, in a manner that is transparent, accountable, follow the rule of law and minimizes corruption”

(Source: World Health Organization (2009). Measuring transparency in the public pharmaceutical sector: assessment instrument. World Health Organization.Geneva:.10–7.)

In this definition I would like to give prominence for Ethics, minimizing corruption, and transparency which is one of the most important in the Sri Lankan context. Nowadays with IMF conditions and the ground of public forums, all these concepts are being discussed heavily and authorities need to take some measurements on this. Especially in the health sector procurement can be considered as one concern that needs of proper framework for minimizing corruption and transparency with ethical behavior.

Good Governance is the main prerequisite for a resilient health sector. As Per Josep Figueras, director of the European Observatory on Health Systems and Policies “Resilience with regards to health systems is not so much about surviving external shocks. For public health systems, the issue is not just about how to survive or adapt, but also how to come back stronger than before. Resilience goes beyond the concept of sustainability and performance”. Interestingly, Scott Green, a professor at the School of Public Health at the University of Michigan has observed some aspects which is crucial to resilience within a system. Scott categorically highlighted decision-making which should be transparent and affected parties needed to be engaged in the process. He is of the view that Integrity should be ensured through clear jobs and hiring tenure, while policy analysis always needed to be a central concern.

Good Governance, Patriotism and Medical Professionals

On 11 December in the year 2014 “The Times of India” published an article on how we can align good governance with patriotism in the medical profession. See the following excerpts.

“Senior bureaucrats will soon visit schools across the country regularly to interact with students and generate their interest in nation-building, ethics, and good governance.

The combined initiative of the department of school education and literacy and department of personnel and training is inspired by Prime Minister Narendra Modi’s Teachers’ Day address to the students on September 5 this year. Modi had suggested that doctors, engineers and civil servants who wish to volunteer to teach select a school in their neighbourhood and visit it to share their learnings/experience.

Under the program, aimed at strengthening the moral fabric of the nation by instituting a sense of pride in nation building and sensitising the senior officers about the mindset and aspirations of the students, the officers can participate by volunteering to visit schools and share their perspectives on topics such as ethics, nation building, environment protection, development, good governance issues, etc.”

I think there should be more involvement of Medical professionals to make the general public aware on many matters. In our context, in general ,people have recognized them as “opinion leaders”. And Sri Lankan Healthcare  sector is one of the most respected in the world as Sri Lanka scores higher than the regional average in the health having a high life expectancy and a lower maternal and infant death rate than its neighbors (Source WHO)”’

Framework for practicing Good Governance for the Healthcare sector in Sri Lanka

By Considering the experts’ reports, literature and some interviews conducted I am proposing the following framework for Sri Lankan Health to have a better good governance mechanism (here I am proposing not the attributes, a framework for practicing good governance for Health)

Factors such as Transparency, Ethics, Accountability together with Efficiency, and Effectiveness can be considered as important attributes for Good Governance in the Sri Lankan context. Anyway, there should be a proper Media relationship with the ingredients of “Prompt response, transparency and accuracy“ can be proposed as much negative publicity on the sector can be seen. The Strategic Management Plan of the health sector needs to have some direction toward Good Governance (As an Example in the Strategic Management Plan of the Open University of Sri Lanka under the Goal of “ensure social and environmental responsiveness” we can see an objective of “Practice Good governance in all activities in the institution”). Public Health Education is important to be aligned with  Good Governance as part of the holistic scope of discussion. The relationship between medical administrators, consultants, nurses and all stakeholders is important and needs to engage in decision-making.

Conclusion

Good Governance cannot be implemented in isolation. Sri Lanka needs to have a change.That “change” comes from individuals. You cannot change the system unless transform yourself. As the late Most Venerable Madihe Pannaseeha Mahathera mentioned “One cannot develop a country in its true sense without the moral development of a man”. There is a need to change as individuals.Sri Lankan Health Sector is one of the prominent sectors and for a resilient health system, we should have better good governance .

*This article is based on the speech made on the invitation made by the College of Medical Administrators, Sri Lanka for a Pre-congress session of the 30th Annual Scientific Sessions of the College of Medical Administrators, Sri Lanka held on 6th of October at the Galleface Hotel, Colombo. The writer is a Professor in Management Studies at the Open University of Sri Lanka. You can reach him on nabey@ou.ac.lk)