![\"Pikin](\"http:\/\/www.bmj.com\/columns\/icons\/pikin_hospital.jpg\")
Hospital management. In my various hospital jobs in the UK, I have had very little direct contact with the practitioners of this dark art.\u00a0Missives to my compulsory trust email address were the main evidence that \u201cthe Managers\u201d existed. Tales of targets and other woe from disgruntled A&E staff seeded doubts about their intentions.\n\u00a0
\nBut I can see now how foolish I was to take them for granted.\u00a0If only I had taken the time to observe and learn.
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\nNot that the Managers here have an easy time of it.\u00a0Firstly, it isn\u2019t easy to manage nothing, which they have had to do for many years.\u00a0Until recently, the hospital had just muddled on, desperately short of many of the resources that allow a building to be a hospital.
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\nFor the first time this week, I saw a budget of what the government aims to spend on the hospital.\u00a0The drug budget alone was over a billion Leones (250,000 USD) for 2010.\u00a0By my estimates, this is not far off what it would actually cost to provide essential drugs, at least to inpatients.
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\nUnfortunately, the hospital management and the pharmacist are adamant that the hospital has not received any drugs since 2006.\u00a0People 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.\u00a0The funds do not appear and then are re-absorbed at the end of the year.
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\nOf course, I have no idea what the truth of all this is.\u00a0All I know is that when I start to think about\u00a0whether that billion Leones exists and where it might be, my head spins and I have to sit down.
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\nOver 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.
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\nAt the Children\u2019s Hospital, people seem to have entirely lost faith in such processes.\u00a0After the hospital had missed numerous deadlines to fill in an Excel sheet outlining its plans for the year, we were asked for help.\u00a0 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.\u00a0The file was sent off, never to be thought of again.\u00a0Until a similar request comes through next year.
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\nThe hospital aren\u2019t too worried.\u00a0They understand these as formalities and don\u2019t expect to see any results from such requests.
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\nThe hospital would say it is the government that fails to ensure that necessary supplies and money reach the hospital.\u00a0The government would say that the Hospital is failing to claim and utilise what it is entitled to.\u00a0 I wonder where the truth lies, between the two.<\/p>\n