Why the health sector saga is important

By Dennis Chung
CJ Contributor

Jamaica’s recent health sector saga has brought to the fore the real need for accountability in the country.

The fact is that this is not the first incident to highlight this deficiency, but another one that has been highlighted because of the sensitivity of the health sector and the election atmosphere.

What this incident has shown is that Jamaicans are demanding more and more accountability from our leaders, not only at the political level, but also those entrusted with the management of public assets.

This is a good thing, as accountability is a very important ingredient for development, as without it there is usually an erosion of confidence and credibility in institutions and system.

It is no surprise, therefore, that there is little trust in our public institutions in Jamaica. It is because of the lack of accountability over the decades (as far as I can remember) that there is very little trust in politicians and public institutions like the police. As a result, there is constant suspicion of corruption and a heightened appetite for “scandal” news.

In other words, if there was a perception that people were held to account when things go wrong, then trust would be higher and not everything would be seen as corruption. My own experience, based on my public sector involvement, is that much of what people call corruption results from bureaucratic systems.

It is also because of the lack of systems for accountability that we have created very bureaucratic processes, such as procurement guidelines which take discretion and innovation out of the public sector, and which undermine the potential of many public sector workers. This is because our failure over the years to hold people to account has led us to introduce rules to make up for that accountability, but end up costing us more in the long run.

It is also because of this lack of accountability systems why we end up salivating each time a new so-called “scandal” breaks and calls for blood; because we finally get someone to account for the lack of accountability in all the past mishaps that we were not able to hold someone to account for. So we crucify the individuals in a very personal manner most times, with the objective of destroying them in the name of accountability.

The fact, however, is that when one exists in a culture of accountability, the focus is not on the person, but rather on the issue at hand.

Accountability does not mean “crucifying” the person responsible, but rather holding the person (and the person holding themselves) to account for the execution of the function. So in a working accountable environment, it is seen as learning and a way to improve the person who might have made a mistake.

I remember reading an article when I was around 18, where a young manager in a very successful company in the US made a mistake that cost the company a substantial amount of money.

When he went to the CEO and handed him his resignation, the CEO gave it back to him and said “Why would I fire you when I have paid so much for you learning a lesson, and then hire someone else who may make the same mistake?” In this example, the CEO realised that the young manager had taken accountability and was willing to learn from the mistake.

The problem we have in Jamaica is that no one wants to admit that they made a mistake so the natural reaction is to cover it up and not hold yourself or others accountable. So something as simple as saying to your stakeholders that I am sorry and made a mistake, is one of the problems we have. So, in the end, the problem stays like a sore that deteriorates without medical attention, and eventually threatens the whole.

Health sector saga

This is the problem with the health sector saga. The fact is that when Dr Dawes raised concerns, Minister Ferguson did the right thing and called for an audit. What went wrong, however, is that when the audit came back no one wanted to take accountability for it. So not being transparent and holding the operational people to account (which does not mean firing them as indicated above) resulted in the situation worsening and lives being lost.

Lack of accountability creates a situation where credibility is not only lost in the system — but also the people who manage it.

It is when that credibility is lost (because people have failed to hold themselves to account) that whether or not they can remain in the job comes into question. This would of course be the position the Prime Minister would have faced when she made the decision to remove the minister, and asked someone else to restore the credibility of the system. That was the right thing to do. The question that Minister Dalley must now ask is if the credibility of the system can be maintained if those who failed to hold themselves to account remain involved.

This does not only apply to health. We have also seen it in the police force, where the previous commissioner and INDECOM made accountability more prominent and we then started to see greater trust from the public.

What is certain is that a lack of accountability systems will stymie development, as companies or countries cannot move forward without trust in institutions and governance. And trust is not possible without accountability.

What is also obvious to me is that if people had held themselves to account earlier in this health situation, and said what went wrong and what was to be done to fix the system and restore credibility the loud calls for firings and resignations may not have happened. What is clear is that it is the lack of holding ourselves responsible that cause problems to escalate, and not the event itself.

So my plea to those charged with governance of our public sector is to be as transparent as possible. Share challenges with Jamaicans, as we were able to go through some significant economic transformation and we understand. And please take responsibility for when things go wrong and act. This is what Dr Phillips has done with the economic reform programme, through avenues like EPOC and his own utterances. Is it any coincidence then that the reform programme has been seen as successful?