The key to being a successful public health manager is to ensure that people feel their needs are being met. Problems may be varied, and will range from simple to complex. But unless something is actually done to address them, people will always feel neglected by government.

This is one lesson Dr Eduardo Janairo, regional director of the Department of Health-MIMAROPA office, wants to share with anyone who is in public health service.

A second lesson he shared with MIMS, in an exclusive interview, is that local problems need to be managed on a local level. “It’s very important to localize management of problems and not base them on national programs, which are drawn up by consultants.”

He pointed out that for a region that includes many indigenous people’s groups, nationally instituted systems are often a hindrance to delivery of service.

With a clean conscience

MIMAROPA is composed of island-provinces - Oriental and Occidental Mindoro, Marinduque, Romblon and Palawan. Dr Janairo admitted their hands are tied because of auditing systems, which he believes needs to be changed.

“If you are a manager, especially in rural areas with indigenous people, you should not think of any system as long as you do things right.”

Director Eduardo Janairo: Health issues at the local level need problem-based management, not program-based.
Director Eduardo Janairo: Health issues at the local level need problem-based management, not program-based.

By right, he means using funds judiciously without being guilty of doing anything underhanded. It’s not necessarily going against laws, the director explained, but more about having the courage to circumvent certain issuances to address pressing concerns. “That’s being a manager.”

So far, his bold approach has gotten the job done, all of which have benefited the region, which he said is leading in government’s list of “hardest to serve” regions.

Dr Janairo added there is still much to be done because MIMAROPA is also the ‘second to the lowest funded health program served’ primarily because its population is a mere 3 million and because of its geography.

Creative solutions

To cite an example, since mobility is a big problem in the region especially in terms of attending to medical emergencies, he found a way to have sea and air ambulances. Since the region has not been a priority, this issue was not addressed. But once the regional office took the initiative, national government responded by providing local ambulances.

Every programme undertaken by the regional health office goes through due diligence, and are often creative, which is much appreciated by the people. They have also realized that since many of the natives live in remote, mountainous areas, it is vital that health services be brought to them.

Having to cross bodies of water to get to rural health units is very high risk, he said, so it is a must to “make sure local citizens are empowered and they get the service they need.”

Attention begets cooperation

All their sacrifices, though, are rewarded. Communities visited by health workers are very open to cooperation. If new ideas are introduced to help improve their lives, the people, especially IPs, are open to learning, whether it is in terms of nutrition, agriculture or preventing diseases.

“We always have to be culturally sensitive in order to get them to adopt best health practices. You cannot separate their culture when asking them to do something new.”

His being proactive and bold, but with very positive outcomes, resulted in being given more leeway in managing healthcare service delivery, specifically in the use of funds. “Now, they allow us to use savings from programs for other purposes, as long as they meet overall health objectives. Every quarter, we are able to reprogram funds so there are no wasted resources.”

“Being a regional director, I now have the authority to have some leeway, declaring something as urgent to expedite things, although I have to be challenged by disallowance but I have to prove that. That is part of the risk in management in government.”

Director Janairo is also strongly advocating for the abolition of the bidding process, because the republic act that mandates the practice is “institutionalizing the wrong process and corruption.”

The fact is, if you nurtured a good manager, he pointed out, you won’t need a tedious bidding process, because that manager can prove that you can get things done without resorting to corruption. MIMS

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