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ASMPH sept
Building Institution to Invest in Leadership in Health
 

Building Institution to Invest in Leadership in Health:
Ateneo de Manila University

School of Medicine and Public Health

 
Some men see things as they are, and ask why?
I dream of things that never were, and ask why not.
 
Robert F. Kennedy, 1968
 
 
I     HEALTH AND THE INDIVIDUAL, COMMUNITY AND DEVELOPMENT

Perspective of the Ateneo School of Medicine and Public Health
Perspective of the Ateneo School of Medicine and
Public Health
            Health defines life and its quality. Yet, fundamental and important as it is, health is not properly attended to, nor appreciated by persons unless it is threatened or lost. For individuals and their families, health ensures the capacity for personal development and economic security in the future. Health is the basis for job productivity, the capacity to learn in school, and the capability to grow intellectually, physically, and emotionally.

            From the point of view of the community, as with well-being of individuals, good population health (or health status at the level of the whole population) is a critical input into poverty reduction, economic growth and long-term economic development. Health therefore must be viewed from a broader and wider perspective where health of the individual is understood in the context of the community just as in the same way, the health of the community must be experienced at the individual level.

            In terms of the development process, the centrality of health in its own right cannot be overemphasized. According to Nobel Laureate Amartya Sen, “health (like education) is among the basic capabilities that gives value to human life.” Sen stresses that certain substantive freedoms (“the liberty of political participation or the opportunity to receive basic education or health care”) are “constituent components of development” (essentially end goals) as well as contributors to economic progress.[1] The human person is central to the development process and health is investment in the human person.

            Having made a case for the centrality and fundamental nature of health at the level of individuals, communities and development, why then, does the primacy of health continue to largely remain elusive and conceptual to the lives of individuals and communities?

  • The Health Paradox

            Ironically, a person’s natural tendency is to take his/her health for granted until this is threatened by illness or is eventually lost. Likewise, a community’s appreciation of health remains at the level of curative care where health is defined only in terms of the delivery of personal care to sick persons by physicians through medicines and hospitals. Naturally, people’s clamor and need for health services centers on the availability of the most up-to-date medicines, the most sophisticated and most modern technologies – diagnostic equipment and treatment modalities. 

Members of the Circle of Experts during a workshop in Tagaytay last March 9-10, 2004
Members of the Circle of Experts during a workshop in Tagaytay last March 9-10, 2004
            It is not any wonder therefore that at the level of policy, legislators and those in the executive branch of government use the same narrow paradigm of health as basis to craft policies and laws that impact on the health sector. The narrow paradigm being referred to here is the very limited view by which health care is addressed – as if good health is solely dependent on the infusion of money to buy medicines, new technology and build hospitals. This leads to misallocation of meager resources driven by irrational behavior at both the individual and societal level. The irony of this situation is that as economists, analysts, financial experts and policy makers acknowledge the primacy of health and its impact on poverty and development, these are not manifested or expressed in policies and resource allocations.     

            A reality that further aggravates this sad state is the fragmented and disconnected manner by which the various players and stakeholders act on health. Suppliers of health care, as exemplified by health professionals, move only in their own narrower worlds without taking into consideration the impact of their decisions and actions on the political, social and cultural sphere. Legislators and policy makers likewise, motivated by a desire to be appreciated as one who is concerned with the plight and needs of their constituents, would do everything within their power to provide the people with what they are clamoring for – medicines, ambulance, hospitals.

  • The Consequences of this Paradox

            Such ironies are not without consequences. Individuals, families, communities and societies are paying for the penalties – disabilities, death and the double burden of disease[2]. From the perspective of development, the greatest consequence is deepening and worsening poverty.

            Long held tradition in the Philippines assigns the blame to poverty, especially material poverty, as the reason for the unhappy state of ill-health of persons and communities. The relationship in the reverse, that is, that ill-health does cause poverty, is less a top of the mind consideration. Certainly there is much reality in the above observations. But throwing more money into the health sector – assuming that it can be found and such can be done in the face of many other competing demands – may not solidly solve the problems and may in fact complicate them

  • The Challenge of this Paradox

The Medical City – ASMPH co-venturer and primary training hospital
The Medical City – ASMPH co-venturer and primary training hospital
            It may be pointed out that if this problematic state, as described above, is the reason why the health situation in the Philippines (and even globally) is what it is today, how does one then explain the significant improvements in health outcomes such as life expectancy and child mortality in majority of countries around the world. 

            Indeed there have been gains in the health sector, globally and locally, resulting from the rapid process of industrialization and improvements in the standard of living. New medical and health care technologies are continually discovered and used to make the practice of medicine more precise and effective. However, looking closely at all of the progress that technology has brought about, one realizes that in developing countries, like the Philippines, the benefits of technological developments have not had as intense an impact on the health situation. Sadly, though, globalization and its benefits in terms of easy access to information has also led to the creation of irrational needs in the health sector that require heavy financial investments and yet may not be appropriate for the realities and limitations of a poor country. As a result of this, the gap between the haves and the have-nots, among people in the country and between countries is widening.

            Traditionally, such a dilemma is explained by rationalizing that there is simply not enough money infused into the health sector. Such reasoning is unacceptable, first because to accept it would be to exclude people who are not in the money economy from accessing health care, surely a fundamental human right. More importantly, while the money excuse may be true, it is certainly not the whole truth. Making progress on addressing inequities in health has never been achieved by more technology, but rather by a clearer and more balanced understanding of needs and wants, rights and responsibilities, expectations and realities. Bringing Philippine society to this desired state requires systemic thinking especially among those who are in positions of authority and leadership in health, particularly those in the public sector responsible for policy formulation and program design and implementation. Furthermore, it also requires that all stakeholders – suppliers of health care (those that provide services, goods, equipment and technology), policy makers, financial experts, and beneficiaries (all living human beings) engage themselves in the health sector, bringing with them their respective strengths and realities. In so doing, good health outcomes brought about by a more equitable access to services stems from in an integrated and connected manner of addressing this challenge and paradox in health.

The Medical City core values: Excellent and Compassionate service, Primacy of the Human Resource, Client Partnerships and Integrity
 The Medical City core values: Excellent and Compassionate service, Primacy of the Human Resource, Client Partnerships and Integrity
           Unfortunately, the health sector in the Philippines lacks the appropriate leadership that is able and willing to frontally address this challenge. In the Philippine setting, the great majority of persons thrust into leadership positions, are physicians, formed and trained in medical schools to care for sick individuals, generally not sufficiently interested in the health of groups and communities, untutored in the art and science of management and on the whole disdainful of politics. As in many countries in the world, medical education tends to focus on developing the requisite clinical expertise to deal with illness at an individual level. With the onset of modern and state-of-the art technology, the practice of medicine has, in fact made the physician’s world narrower and more constricted in terms of his/her profession.

II      THE VENTURE

            Prevailing realities and circumstances require therefore a change in paradigm and in ways of thinking, feeling and acting on health. These entail developing the appropriate leadership that will, first of all, recognize the challenge and raise the flag to key decision makers in both the public and private sector in order that these problems and issues are addressed in a systemic, systematic and organized fashion.

 Members of the Curriculum Coordinating committee during a curriculum integration workshop in Antipolo.
 Members of the Curriculum Coordinating committee during a curriculum integration workshop in Antipolo.
            This is what this venture seeks to put forth – the development of a cadre of leaders in the health sector. Such a leader possesses a broad and expanded view and understanding of the health sector and appreciates how health drives development. This should also lead the individual to ensure that he/she reaches a stature wherein his/her leadership is recognized and respected not only by fellow health practitioners but by leaders in other domains of governance and development (e.g. economics, finance, politics and law).

            When such a person is put in a position of authority, responsible for policies and programs of national, societal and sectoral import e.g. Minister of Health, in competition with other interests and forces for limited resources and crowded priorities, his/her formation and orientation should sufficiently equip him/her with the necessary attitudes, skills and knowledge to enable him/her to be heard and recognized. This leader should be sufficiently insightful and smart to quickly respond to the imperative of acquiring the requisite knowledge and skills as well as developing a level of comfort to move and effectively function in a world very different from that in which he/she is traditionally exposed to. He/she should quickly recognize that in this world into which he/she has been thrust, the ordering of priorities and the allocation of resources, even for health concerns, is in the hands of those who hold the levers of power and wealth, of government and society, and not necessarily the health professionals. 

“Surely there must be something more to life than treating patients, writing prescriptions, ordering diagnostic tests and doing surgery?

        In order for this person to become recognized and respected in his/her own medical world, he/she should equally be trained to become a good and respected clinician, thus requiring also the rigor and discipline that most medical schools teach. But over and beyond this, our envisioned leader in the health sector should be able to integrate all of these diverse interests and perspectives and ground these on a broader, connected view of health.

            This is the desired product that this venture seeks to produce. This concept and way of proceeding is a fruit of accumulated experiences and insights of kindred spirits, largely from the medical profession who, by some happy coincidence, were brought together by the Ateneo de Manila University Graduate School of Business (AGSB) to explore additional ways by which the offerings of its Health Unit could become more responsive to the present needs of the market, in terms of education and training for health professionals. This group of professionals belonging to various areas of clinical specialization realized that beyond their narrow worlds of hospitals, patients and clinics was a broader world out there waiting to be discovered and understood in relation to its impact on the health sector. Moreover, the different members of the group found themselves asking the question: “Surely there must be something more to life than treating patients, writing prescriptions, ordering diagnostic tests and doing surgery?”

            The School seeks to produce a new breed of health leaders, – physicians/practitioners respected and recognized as experts in their own clinical areas of specialization in medicine, whose capture and understanding of the health sector allows them to operate not only within their own area of expertise but to connect to other players outside the domain of health. This new breed of leaders in health is what we describe as the Doctor of the Future performing the following roles:

            Outstanding Clinician who possesses a mastery of clinical skills and compassion to care             for the health needs of the individual;

            Dynamic Manager who has the expertise to bring systems and resources together to      enable the clinician to practice his/her craft;

            Social Catalyst who possesses the leadership competencies to systematically solve the     systemic problems of ill-health and poverty and make quality health care available and      working for all. 

 The New Medical City
 The New Medical City
            Education and learning of this new breed of leaders is likened to a formation process whose curriculum is based on this new paradigm of defining and understanding health. This innovative way of educating health practitioners hopes to initiate the process of unlearning an old paradigm and taking on this new one by enriching and integrating the traditional courses in medicine with other disciplines such as epidemiology[3], economics, sociology, management and political science and the other social determinants of health. In so doing, this venture guarantees that the product it seeks to form is a physician-practitioner who, as an exemplary clinician is able to generate the necessary respect and acceptance within the medical profession that will then enable him/her to work within the health sector to deepen and elevate it. At the same time he/she is also sufficiently equipped to connect to leaders in other sectors and is able to pull them into this broader view of health. All in all, this new leader is clinician, public health specialist and physician-leader rolled into one, actively becoming a significant major player in the development process. We are confident that all future Secretaries of Health will come from our graduates.



[1] Sen, A (1999), Development as Freedom, especially Introduction and Chapter 1

[2] The double burden of disease is experienced by many developing countries, like the Philippines, where both infectious, preventable diseases (commonly defined as diseases found in poorly developed countries) and chronic degenerative diseases (commonly defined as diseases of the rich and highly developed countries) comprise the top ten leading causes of illness and death.

[3] Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems (Last, Dictionary of Epidemiology, 1998).





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