Closing the management competence gap
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BioMed Central
Open Access
Commentary
Closing the management competence gap GL Filerman* Address: Health Systems Administration, Georgetown University, Washington, DC, USA Email: GL Filerman* - [email protected] * Corresponding author
Published: 08 October 2003 Human Resources for Health 2003, 1:7
Received: 18 August 2003 Accepted: 08 October 2003
This article is available from: http://www.human-resources-health.com/content/1/1/7 © 2003 Filerman; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.
Abstract The success of any organized health program depends upon effective management, but health systems worldwide face a lack of competent management at all levels. Management development for health systems, particularly at the first line of supervision, must be given much higher priority by senior leaders and for investment. Human resource development leaders must be the advocates for making the investment in managerial competence.
"We are treating only a very small faction of the people who are infected ... These countries have very limited infrastructure, so we have been advocating that the Global Fund and other funding sources try to build up a least a rudimentary health care infrastructure, so that patients can be treated ... Even if the drugs were there, free, they wouldn't reach those patients." Dr Jean-Pierre Garnier, Chief Executive Officer, GlaxoSmithKline [1]
The challenge Most discussions about the potential impact of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the pharmaceutical Accelerating Access Initiative, the United States HIV/AIDS initiative and expanding World Bank funding to the health sector end with either "it will outrun absorptive capacity" or "they do not have the infrastructure to use the funds". The observations come from wellinformed and well-intentioned people. They are correct. The systems were inadequate before these new resources appeared, so why do we assume that they are adequate now? Not only have they not improved, but also in many countries they are actually weaker than they were a decade ago. The most fundamental barrier to these new resources reaching the people who need them is the lack of compe-
tent management at all levels. Infrastructure is not an organigram; it is not handbooks and procedures, job descriptions, computers, budgets and supply chains. Infrastructure is people. An effective infrastructure is the right people in the right places. Health systems lack people who have and use the managerial competencies that match their responsibilities. In most health systems in developing countries there is an acute shortage of the right people. There is also an acute lack of understanding of the direct link between the lack of "hard" management skills at all levels and the poor outcomes of the health systems. This lack of competent managers at all levels fosters "vertical" health
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