The Need for Detailed Roadmaps in Ministerial Directives

In recent news, the Minister of Health instructed that OPD at Bir Hospital, a government-operated public hospital in Nepal, should operate in two shifts. This directive, while well-intentioned, brings to light the broader issue of governmental instructions that lack detailed roadmaps and resource allocation. This article looks into the impact of such directives, drawing comparisons from global and local instances, and highlights the need of detailed planning and resource management to ensure effective implementation.

Understanding the Directive

The directive to extend OPD hours at Bir Hospital aims to improve accessibility to healthcare services for the public. However, merely issuing an order without a clear implementation plan can lead to challenges and inefficiencies. For such directives to be successful, they must be accompanied by detailed roadmaps, adequate resource allocation, and a strategic approach to change management.

Ministers have secretariats and office staff who can assist in creating detailed action plans to ensure effective execution of such directives. Why not do it?

The Importance of Detailed Roadmaps

A directive without a detailed roadmap is like setting a destination without a clear path. Detailed roadmaps provide a step-by-step guide on how to achieve the desired outcome, including timelines, resource requirements, and responsibilities. They ensure that all stakeholders understand their roles and the sequence of actions necessary for successful implementation.

An example (in English): We do not build a house just by looking at a picture of it. Instead, we create a detailed plan that specifies where each room will be, what materials are needed, the construction sequence, and the timelines. This helps everyone involved in the construction understand their roles and the order of tasks.

Similarly, we need to think and incorporate this level of detail in every directive.

Example: New Zealand’s Health Strategy

New Zealand’s Health Strategy – Primary Health Care Strategy (PHCS), initiated around 2001, is a prime example of a well-documented directive. The strategy outlined specific goals, action plans, and performance indicators. It included detailed sections on funding, workforce planning, and infrastructure development, ensuring that the directives are not just aspirational but achievable. The strategy’s success is evident in New Zealand’s high healthcare standards, with patient satisfaction rates reaching over 85% and a life expectancy of 82.21 years (as per 2021 records), one of the highest globally.

The Role of Resource Allocation

Effective implementation of governmental directives requires adequate resources, including human resources, equipment, and infrastructure. In case of extending OPD hours at Bir Hospital, the directive must consider the following:

1. Human Resources: Additional doctors, nurses, and administrative staff are essential to manage the increased patient load. Required vacancies need to be established and fulfilled along with the required budget allocated immediately and for the future as well to keep it going.
2. Equipment and Supplies: Ensuring sufficient medical supplies, diagnostic equipment, and support services is crucial for uninterrupted operations. Just imagine a case when there’s doctor available so are the patients but the treatment is halted due to lack of supplies. Foresight is required to ensure we’re ahead of the requirement curve and we do also have technicians and materials standby to fix anything if they need to be.
3. Infrastructure: Modifying existing facilities or creating new ones to accommodate the extended hours and additional staff are required as well. This does require proper planning and thought put into to ensure a successful implementaion.

Example: India’s National Health Mission

India’s National Rural Health Mission (NRHM) later merged with National Health Mission (NHM), launched in 2005, includes detailed plans for resource allocation. It addresses human resource needs by training and recruiting healthcare workers, improving infrastructure, and ensuring the availability of essential medicines and equipment. Despite challenges, NRHM’s structured approach has led to significant improvements in maternal and child health indicators, including a reduction in infant mortality rate per 1000 live births from 55.7 (in 2005) to 35.3 (by 2015) and a 32% decrease for maternal mortality ratio between 2006 and 2013 before the program merger. The program did reach over 1 crore beneficiaries every year with 87% of those beneficiaries being from rural communities.

Challenges of Vague Directives

Vague directives can lead to several challenges:

1. Implementation Gaps: Without clear guidelines, implementation can be inconsistent and inefficient. Different departments may interpret the directive differently, leading to fragmented efforts.
2. Resource Shortages: Lack of planning can result in resource shortages, causing delays and compromising the quality of services. Even if one thing does not fall in place – it’s implementation is delayed or fails so a through planning is a must to get a higher chance of success.
3. Accountability Issues: Without specific responsibilities assigned, it becomes difficult to hold individuals or departments accountable for failures or delays. As without proper planning and role designation – it will open up a floodgate to blame game.

Example: Nepal’s Previous Health Initiatives

Nepal has faced challenges with vague directives in the past. For instance, the directive to improve rural healthcare facilities lacked detailed planning and resource allocation, resulting in suboptimal outcomes. A notable example is the failure to achieve targeted improvements in rural healthcare between 2015 and 2020, where only 40% of the intended health posts were adequately staffed and equipped.

The Need for a Comprehensive Approach

A comprehensive approach to implementing governmental directives involves several key components:

1. Stakeholder Engagement: Engaging all relevant stakeholders, including healthcare professionals, administrative staff, and patients, ensures that the directive is feasible and addresses the needs of all parties involved.
2. Pilot Testing: Implementing a pilot program before a full-scale rollout allows for testing and refining the approach, identifying potential issues, and making necessary adjustments.
3. Monitoring and Evaluation: Regular monitoring and evaluation of the implementation process help track progress, identify challenges, and make data-driven decisions to improve outcomes.
4. Feedback Mechanisms: Establishing feedback mechanisms allows frontline workers and beneficiaries to provide input, ensuring that the directive remains responsive to real-world challenges.

Example: The UK’s National Health Service (NHS)

The UK’s NHS frequently uses pilot programs and stakeholder engagement to implement new initiatives. For example, the introduction of extended general practitioner (GP) hours, initiated in 2014, was preceded by pilot programs to test feasibility, gather feedback, and refine the approach. This comprehensive strategy ensured that the initiative was well-received and effectively implemented across the country, leading to a 15% increase in patient satisfaction and a reduction in emergency department visits by 10%.

Recommendations for Nepal

To ensure the successful implementation of directives like the extension of OPD hours at Bir Hospital, the following recommendations are crucial:

1. Develop Detailed Roadmaps: Create comprehensive plans that outline specific steps, timelines, and responsibilities for all stakeholders. Ministers must optimally use their secretariat along with ministry level staff to formulate strategy and detailed plan in coordination with the stakeholder involved to ensure effective participation of all parties to invoke a sense of ownership. This gives higher chance of success.
2. Ensure Adequate Resource Allocation: Assess and allocate the necessary human resources, equipment, and infrastructure to support the directive. Make sure backup are in place along detailed plan of action if anything goes wrong to quickly resolve it.
3. Engage Stakeholders: Involve healthcare professionals, administrative staff, and patients in the planning and implementation process to ensure the directive is practical and addresses all needs.
4. Implement Pilot Programs: Test the directive in a controlled environment to identify potential issues and make necessary adjustments before a full-scale rollout.
5. Establish Monitoring and Evaluation Systems: Regularly monitor progress and evaluate outcomes to ensure the directive is on track and achieving its intended goals.
6. Create Feedback Mechanisms: Establish channels for frontline workers and beneficiaries to provide input, ensuring the directive remains responsive to real-world challenges.

Issuing directives with clear objectives is only the first step in driving change within governmental and public sectors. For these directives to be effective, they must be accompanied by detailed roadmaps, adequate resource allocation, and a strategic approach to change management. By learning from global best practices and addressing the specific challenges faced in Nepal, the government can ensure that initiatives like the extension of OPD hours at Bir Hospital lead to meaningful improvements in healthcare services.

The focus must be on reskilling and providing detailed guidance to ensure successful implementation. By investing in learning and development, preparing workers for new roles, and ensuring clarity in instructions and resource allocation, the government can maximize the productivity and effectiveness of its directives. Failure to address these aspects may result in missed opportunities and could alienate the human workforce that remains central to the country’s competitive advantage.