Keynote Address by the Permanent Secretary, Dr. K. Shangula, at the 4th
Enlarged Ministerial Management Meeting, 12th February 2002.
INTRODUCTION
Exactly a year ago, we examined managerial and financial matters. This time round our menu includes same, but more attention will be devoted to patient care. I will briefly review selected issues, which were considered during the last meeting.
1. Pharmaceutical
supplies.
Last year, I spoke passionately
about the inadequate supplies of pharmaceutical items in our health
facilities. This came about in the wake
of persistent complaints from our health facilities and the public. One of the contributing factors was the
cumbersome tender procedure, through which we are obliged to buy our
pharmaceuticals needs. The Ministry
subsequently approached the Tender Board for an exemption, which was duly
granted. The Pharmaceuticals and
Related Supplies Procurement Committee was established and has performed
extremely well. The stock level has
greatly improved. There is still
shortage of certain pharmaceutical items especially those which nobody tendered
for. The Committee also found out that
one of the reasons for shortage of medicines is the tendency among facilities
to order big quantities of medicines than what they can actually consume. This results in overstocking in some
facilities and no stock in others. I implore the heads of institutions to
resist the temptations of hording.
2. The new staff
establishment.
I am unable to conceal my disappointment and frustration at the lack of progress in approval of the revised staff establishment of our Ministry. The staff establishment was submitted to the Public Service Commission in July last year. The Personnel Office has been making regular follow-up with the PSC Secretariat, but up to now there is no progress that I can report to you here today. I was informed that the staff establishment has not yet been presented to the Commissioners. We shall continue to make follow up to the extent that we become a nuisance to them. Once the staff establishment is approved, the posts of the directors in the regions and those dedicated to services delivery at facility level will be filled as a matter of priority.
3. Remunerative work
outside the public service.
Last year, I explained in detail the position with regard to remunerative work outside the public service. The Public Service Act, 1995 clearly states that no civil servant is allowed to engage in remunerative work outside the public service unless permission from the Permanent Secretary concerned has been obtained. Last year, I granted such permission to doctors, which were valid only until the 31st December 2001. Despite clearly written instructions that the permission should be renewed, few doctors have bothered to renew theirs. Those who failed to renew their permission but continue to do paid private work are in contravention of the Public Service Act, 1995 and therefore liable to disciplinary action. Private work is strictly prohibited between 07:30-12:30 during working days. Directors and Medical superintendent concerned are always supplied with copies of the permission, which contain conditions attached to the permission. It is the duty of Directors and Medical superintendents concerned to ensure that these conditions are complied with. If they fail to do this they will be held responsible for their sub-ordinates’ non-compliance.
Managerial issues.
The meeting of today is primarily intended to focus on patient care. However before I consider this aspect, I would like to discuss certain managerial and financial matters, with a view to bring some improvement in our performances.
The Public Service Commission produced the Annual Report for 2000/2001, which was tabled in the National Assembly last year. Members of the National Assembly heavily criticized the performances of the civil servants for poor performance as reported in the PSC Annual Report. There were also several personnel audit carried out in selected directorates of our Ministry. Again, we were criticized for poor performance. These reports were discussed in the Ministerial Management Committee meeting. Personnel office was instructed to bring about improvement. We will hear a report in this regard at some stage during the National Management Committee meeting. I will highlight some negative aspects contained in the Annual Report of the Public Service Commission.
1.
Ex post facto
requests.
The Public Service Commission complained that despite PSC Circular No3 of 1998, Ministries, Offices and Agencies persist in submitting ex post facto requests especially for the extension of contracts, study leave and probation period. I have refused to accept such ex post facto requests in the past. As a result, there has been a marked reduction in such requests. Although last year, there were few ex post facto requests, there was one gross request for which the director and staff members concerned were duly censored. In future do not bother to submit overdue requests to my office, as they will not be considered.
Applications for study leave with full pay must be submitted at least three months before the start of the academic year in order to allow sufficient time for the Ministry and Public Service Commission to consider the applications and grant such permission before the staff member undertakes the studies. If the staff members commence the studies and the Public Service Commission declines to grant study leave with full remuneration, the staff member concerned will be liable to pay back the salary received during the period of absence from the duty station.
2.
Mismanagement of the
recruitment process.
The Public Service Commission complained that the recruitment process is often mismanaged with regard to the following:
· Requests for filling of posts with relaxation of requirements, in contradiction of PSC Circular No. 29 of 1998, which discourage such practices
· Inadequate size and inappropriate composition of the interviewing panel
· Incorrect short-listing of candidates
· Balance structuring when applying Affirmative action
· Long delays between the closing date of advertisement and the submission of nominations to the Public Service Commission
· Submission of incomplete schedules of candidates to the Public Service Commission.
Although as a Ministry we have been guilty of some of the mistakes cited above, we have made significant improvement in our recruitment process. Our method and interviewing tools have been highly commended by panel members from other Ministries ,Offices and Agencies who took part in our interviews. In our further efforts to improve our performances, we shall assess competencies and suitability of candidates by way of a combination of written and oral interviews for those posts for which the incumbent is expected to develop and produce documents. We have found out that sweet talkers in the interviews are not necessarily good performers. In selecting candidates, we should be able to assess and satisfy ourselves that we have selected the best candidate.
The appointment in acting capacity, though not featured in the PSC Report, remains a matter of grave concern in our Ministry, because it is not handled according to prescribed procedures. Section 21 of the Public Service Act, 1995 articulates the principle of acting appointment. PSM Circular No 2 of 1996 clarifies the procedure to be followed when appointment in acting capacity is being contemplated. I have received complains from staff members who have been requested verbally to act, but were not subsequently paid. We had an incidence of successful legal challenge on this and I was also called to give a public response after complains aired over the phone-in radio programmes. In all such cases, the directors concerned did not follow the prescribed procedures. I will repeat the basic requirements.
· The appointment in acting capacity is intended to improve service delivery and not the financial position of the staff members.
· The director concerned and his/her team must identify the need for such appointment and identify the suitable staff member.
· The staff member to be appointed in acting capacity must hold a post lower than the one he/she is occupying and the two posts must be in the same occupational class.
· The power to appoint a staff member in acting capacity rests with the Permanent Secretary and is done in writing.
· The staff member appointed in acting capacity is informed in writing on his position while in acting capacity and remuneration thereof.
· The vacant post must have been funded prior to appointment in acting capacity.
· The period of acting appointment must not exceed six (6) calendar months. Successive extensions must not exceed three (3) calendar months. The period of acting must in aggregate not exceed twelve (12) calendar months.
Directors are reminded to consult the
documents related to the appointment in acting capacity and handle all such
acting appointments as prescribed.
3.
Misconduct and
suspension of staff members
The Public Service Commission found out that the time frames prescribed by the Public Service Act, 1995 with regard to misconduct are not adhered to. I know that we have not been as efficient as required. Time and again, the charge has to be withdrawn because the prescribed period had lapsed and the staff member has to be re-charged. This causes delays and undermines discipline in the workforce as an impression is created that nothing is being done to the culprits.
4.
Probation
The Public Service Commission complained that quarterly progress reports on staff members, who are on probation, are not completed timeously. We are guilty of this charge. I will illustrate this with recent examples, although there had been worst examples:
|
Directorate |
Date of promotion |
Submission to the PS |
|
Finance & Resource Management |
01.07.1998 |
30.01.2002 |
|
|
01.07.1999 |
30.01.2002 |
|
Developmental Social Welfare Services |
01.08.1998 |
30.01.2002 |
|
Policy, Planning & HRD |
01.11.1997 |
30.01.2002 |
|
Primary Health Care Services |
01.03.1995 |
30.01.2002 |
All these cases are for
Windhoek. Apart from inefficiencies in
handling probation, there are serious implications to the staff members
concerned. You are all aware that there
are certain benefits, which a staff member on probation is not entitled
to. By withholding these benefits, for
up to six years, you are in fact punishing the staff member concerned unfairly. I ask
this meeting to decide what to do next so that this will be our collective
decision, which everybody has to respect.
Recommendations to the Public Services Commission from all directorates and Regional Directorates are sent to my office for approval. I rely on your honest judgment. However, of late I have been receiving recommendations, which reflect poor judgment on the part of the directorate concerned. This calls to question the loyalty to the public service and the competency of the directors concerned.
Financial matters
The Office of the Auditor General carried out audit of our Ministry’s financial statements for the year ended on the 31st March 2000 as required by the State Finance Act, 1991. The audit included a review of the accounting systems and procedures operated by our Ministry to the extent considered necessary for the effective performance of the audit and carried out a test examination of financial records relating to salaries, payment to suppliers, subsistence and travel and receipts. I will share with you some of the findings:
1.
General
Descriptions for manual journals are not complete or in some instances, do not exist at all. It is also unacceptable that, when additional information was requested by the audit team no response from our Ministry was forthcoming. The team also found that the filing system in our Ministry is not up to standard. As journals are the playground for fraud and corruption, failure to pass journals according to general accepted accounting practices, maximize the risk thereof. The director of Finance and Resource Management is instructed to rectify this situation forthwith.
2.
Reconciliation
The audit team found that the staff members have performed well and asked me to convey this message to them and to encourage them to continue in the future as well. Congratulations!
The director of Finance and Resource Management is requested to convey
this message to the staff members concerned.
3.
Subsistence &
Travel
The audit team found discrepancies between the General ledger and the Subsistence & Travel System. The team recommended regular reconciliation between the General ledger and the Subsistence & Travel System.
4.
Unauthorized
payments
The following unauthorized payments were noted:
The audit report noted that such unauthorized payment are in contravention with Treasury Instruction and has potential for fraud and corruption.
5.
Social pension
With regard to social pension the team found out that there are variations in payments to pensioners depending on the location where the payment was done.
Other negative findings include missing vouchers and overpayments. The Division: Finance must ensure that there is strict compliance with financial regulations.
Mr. Chairperson
Our budget performance has not been satisfactory during the first part of the current financial. As you know during the last National Management Committee meeting, I announced suspension of filling of vacant posts due to the fact that we were going to overspend on personnel expenditure vote. I am pleased to note that these measures have brought some relief and we are likely to remain within the budget judging from the current trend of expenditure. We will discuss these and other matters during the National Financial Management Committee. I thank you for your understanding and cooperation.
Although we have succeeded to manage our finances well, this came about at the expense of filling our posts. One is always caught up in the vicious cycle of trying to balance the books but at the same time sacrifice on service delivery. I would advise that we fill our critical posts at the beginning of the financial year while our financial situation is still healthy. When that is done and there is a need to cut down, then we will look in other areas like suspension of overtime and moratorium on acting appointment
Patient care
6.
Medical care
Earlier, I have alluded to the fact that doctors are expected to devote their full time to their patients. Nurses and medical assistants are expected to refer only those cases that are beyond their capabilities to the doctors. There has been always a tendency for nurses and medical assistants to refer all cases to the doctors. This is in part as a result of pressure from the patients. Sometimes the nurses and medical assistants do not wish to work to their full potential. As a result, the doctors are overwhelmed by patients and in the process, the quality of medical care is compromised. I call on Medical Superintendent and Nursing Managers to instill that sense of confidence in nurses and Medical Assistants so that they can discharge their duties without fail.
7.
Nursing care.
HIV/AIDS has presented
unprecedented challenges to nursing care due to its long debilitating
period. The majority of the nurses are
living up to the challenge. However,
there has been a tendency of late for some nurses to concentrate more on
financial gain at the expense of quality nursing care. I have been informed that in big hospitals,
especially the Windhoek hospitals, some nurses are pressurizing the supervisors
to work on Sundays and Public Holidays.
Because these nurses do not get enough rest, they are booked off during
week days. As a result, you find more
nurses on duty during Sundays and Public holidays when they are least needed,
and few nurses on duty during the week when they are most needed. I ask
the Medical Superintendents to review the duty rooster of nurses in order to
ensure that all departments are well covered during the week.
Many, if not all, health
facilities are experiencing shortage of nursing staff. Last week, I visited both Rundu and Oshakati
Intermediate hospitals. I had
discussions with the managers of the two institutions. The main reason of this apparent shortage is
the absence of nurses because they are attending upgrading or other training
courses. Human resource development is
a priority for our Ministry as much as patient care. This situation therefore calls for a fine balancing of the two
competing demands. The managers are therefore called upon to exercise sound discretion
without compromising any of the above demands.
The second main reason cited was the abuse of compassionate leave and sick leave. In most cases compassionate leave is used for instances which are not legible for compassionate leave. Sick leave is often used in instances which clearly call for vacation leave. When a nurse fails to obtain permission from the supervisor to be absent from duty, he or she will present afterward a sick leave usually from a private doctor.
In the past when the number of nurses who were on “light” duty was getting out of hand, we instituted measures to have those nurses boarded medically. This measure had a positive spin-off. The number of the cases has greatly decreased. Since we appeared to have relaxed on this issue, the number of cases, I am told is going up again. I call on you that those staff members who display this tendency, must be medically examined whether they are still fit to be employed in the public service.
Accommodation
Shortage of official accommodation has prevented the Ministry to recruit and retain health professionals in the facilities where their service is most needed. The abuse of available accommodation is another worrying factor. In most instances the available accommodation is used up by Namibians who have opportunities to acquire their own, or subsidized accommodation outside the hospital premises. The Housing Committees must ensure that priority in allocating accommodation is given to expatriates. I also instruct that the policy on accommodation be completed.
Re-organization of departments
Last year, the Ministry lost two of its most senior top managers. Mr. Onesmus Akwenye, the former Deputy Permanent Secretary retired. Dr. Nestor Shivute, the former Undersecretary for the Department of Health and Social Welfare Policy resigned to join the World Health Organisation. Since this department represents the core function of this Ministry, it cannot be left vacant. The Steering Committees has approved the horizontal transfer of Dr. Norbert Forster from the Department of Policy Development and Resource Management to the Department of Health & Social Welfare. The process of filling the vacated post has already been initiated. I ask you to give him the usual support and cooperation as you did with the previous incumbent.
New programmes
Before I conclude I would like to inform you about the new initiative of the Ministry of Health & Social Services in the control of HIV/AIDS in Namibia. I will confine myself to two although there are many others.
1.
National programme
for the prevention of mother to child HIV transmission
The Ministry has taken a principle decision to introduce a national programme for the prevention of mother to child HIV transmission. The programme will initially be implemented in two sites: Oshakati and Windhoek. The programme involves the administration of one dose of Nevirapine to HIV positive mother at the onset of labour and one dose of Nevirapine to the baby within seventy two hours after delivery. Besides, the parents and the baby will be put on antiretroviral treatment if they meet the indications for initiation of such treatment. The preparatory work for this programme is progressing well. The Protocol for implementation of the programme has been finalized and printed. Negotiations with the pharmaceutical companies for the supply of antiretroviral medicines have almost been completed. Nevirapine has been ordered and we are waiting delivery thereof. This medicine will be provided free of charge. The supply contract for the delivery of zidovudine/lamivudine at a discounted price has been signed and the order will be placed soon once the financing thereof has been sorted out. Arrangements for the supply of protease inhibitors at negotiated price will be completed soon and delivery will be done once the financing of the purchase has been completed. Training of the counselors has been completed and health education is on-going. Eventually the programme will be rolled-over to other sites.
2.
Agreement with
Pfizer Laboratories (Pty) Ltd
The signing of supply agreement with Pfizer and the launch of the Diflucan Partnership Programme, whereby fluconazole for the treatment of cryptococcal meningitis and oesophangeal candidiasis, will be signed on the 21st February 2002. Fluconazole will be used in all public hospitals only and will be handled as a restricted medicine. Copies of the agreement will be made available to you once signed, and you are under obligation to comply with the provisions of the agreement.
Chairperson
Ladies and Gentlemen
The Year 2001 was full of challenges and expectation. It is pleasing to note that you have accepted those challenges and emerged victorious. I salute you all for the good work you have done. I am confident that you have the same determination to carry on in the new year 2002 as well. Let me conclude by wishing you all the strength in the New Year 2002.
I thank you.