I can boldly say that 80% of labour agitations have and will continue to center on two main sectors: health and education. The reason is simple: these are professional services run by trained service providers that unfortunately our laws, policies and regulations, insist on treating as bureaucracies. Thus, teachers and doctors are treated as ‘civil servants‘ rather than service professionals. In the educational sector for instance, teachers are placed in a regimental system in which length of service and the picking up of worthless diplomas from Winneba matter more than the real output: how many successful students you can train. In the health system, there is very little attempt to identify and reward doctors who get the best clinical results, in terms of patient satisfaction, remission, etc.
When groups like IMANI dismiss the ‘single spine’ program, we are motivated by the simple fact that this tottering wreck of a public sector reform program does not address any of the REAL challenges, including the ones identified above.
The only way to enhance public sector productivity, reduce labour unrest, and enhance the working conditions of public workers at the same time is to significantly devolve the ‘consumer-facin g service oriented sectors’, like education, health and citizen services.
Read the proposal carefully, the argument is not that all the hospitals, for instance, should be privatised. Most people see the market as a coalition of profit-maximisi ng interests, but this is a reading of the market that is flawed because it is a reaction to those who promote what are essentially ‘corporatist’ interests under the guise of the ‘free market‘.
The ‘market’, properly described, is a set of PRINCIPLES. Three of these key principles are ‘autonomy’, ‘local responsibility’ and ‘competition’.
Devolution of even public institutions can lead to competition and more effective local decision-making autonomy. In the case of the health sector, for instance, rural clinics will simply receive more funding from the NHIS and be organised as mutualised Trusts. That is because the NHIS will be freed from trying to spread the same amount of substandard services across to everyone regardless of whether they can afford to contribute more or not. Some rural hospitals may venture into recuperation therapy that the urban hospitals simply do not have the competitive edge to offer. Why do you think Sogakope spas have become so popular in Ghana? There are always competitive and comparative advantages if you look carefully. So the view that it is somehow immoral to introduce ‘internal competition’ into a devolved healthcare system in which hospitals, Trusts and Provident Funds run the show by making strategic and tactical decisions on who to hire and fire, and how much to pay local professionals, as well as how to devise better means-testing so that those who can afford to contribute more do so through co-payment for services, is actually wrong-headed.
The problem is that we have been indoctrinated in this country into believing that government is made up of selfless superhumans somehow capable of addressing all flaws within even the most dysfunctional systems, if only they want to. This belief complements another one: that a ‘committee of geniuses’ can always fix all our problems. The truth is that government is made up of ordinary folks, and most knowledge is actually dispersed among the general population, so almost always a devolved system for problem solving is superior to a tendency to defer to the “Ogas at the Top”.