Emily Spry: Managing or management?

Pikin HospitalHospital management. In my various hospital jobs in the UK, I have had very little direct contact with the practitioners of this dark art. Missives to my compulsory trust email address were the main evidence that “the Managers” existed. Tales of targets and other woe from disgruntled A&E staff seeded doubts about their intentions.
But I can see now how foolish I was to take them for granted. If only I had taken the time to observe and learn.
Not that the Managers here have an easy time of it. Firstly, it isn’t easy to manage nothing, which they have had to do for many years. Until recently, the hospital had just muddled on, desperately short of many of the resources that allow a building to be a hospital.
For the first time this week, I saw a budget of what the government aims to spend on the hospital. The drug budget alone was over a billion Leones (250,000 USD) for 2010. By my estimates, this is not far off what it would actually cost to provide essential drugs, at least to inpatients.
Unfortunately, the hospital management and the pharmacist are adamant that the hospital has not received any drugs since 2006. People tell me that the process for releasing funds or materials that are allocated is long and laborious; it requires bribes to the relevant administrators along the way. The funds do not appear and then are re-absorbed at the end of the year.
Of course, I have no idea what the truth of all this is. All I know is that when I start to think about whether that billion Leones exists and where it might be, my head spins and I have to sit down.
Over the past few months, the government has been trying to complete a strategic plan for the whole health sector, requiring detailed input from each major healthcare facility and unit.
At the Children’s Hospital, people seem to have entirely lost faith in such processes. After the hospital had missed numerous deadlines to fill in an Excel sheet outlining its plans for the year, we were asked for help.  The result is a hypothetical wish-list written in a few hours, with vague costings and little bearing on what the hospital will actually do this year. The file was sent off, never to be thought of again. Until a similar request comes through next year.
The hospital aren’t too worried. They understand these as formalities and don’t expect to see any results from such requests.
The hospital would say it is the government that fails to ensure that necessary supplies and money reach the hospital. The government would say that the Hospital is failing to claim and utilise what it is entitled to.  I wonder where the truth lies, between the two.

Emily Spry is a doctor from London who has taken a year out of her General Practice Specialty Training Programme to live and work in Sierra Leone, West Africa. She is working for the Welbodi Partnership, a charity which supports the main government Children’s Hospital in a country where more than one quarter of children die before their fifth birthday.