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Medical admins lack proper living quarters; deputies not given transport: CMASL President

30 Dec 2021

  • CMASL President highlights challenges to overcome in creating future-ready medical administrators
By Ruwan Laknath Jayakody Difficulties and challenges faced by medical administrators pertain to not having proper official living quarters and the lack of transportation facilities for officers of the deputy medical administrative grade, which need to be overcome in the process of creating medical administrators that are capable of dealing with modern changes to healthcare services. These observations were made by College of Medical Administrators of Sri Lanka (CMASL) President Dr. R.M.S.K. Rathnayake in his presidential address on “A highly competent medical administrator to face the challenges in the 21st Century”, which was published in the Sri Lankan Journal of Medical Administration – Volume 22 in December 2021. Medical administrators have been at the helm of the healthcare delivery system since the inception of the Civil Medical Department in 1856 – presently called the Health Services Department – and the subsequent development of a network of healthcare facilities. The Association of Medical Administrators was formed in 1974, and this paved the way for the establishment of the CMASL in 1992, with the Board of Study in Medical Administration being established in 1994. In this, the second decade of the 21st Century, healthcare services and facilities, and health seeking behaviours, attitudes, and expectations have undergone a dramatic change, thanks to the use of information and communication technology (ICT), evidence-based medicine, cutting-edge technologies, novel management sciences, multidisciplinary problem solving approaches, and a research-based culture, and also the importance of health for sustainable development in the context of the Covid-19 pandemic. Dr. Rathnayake therefore noted the need to develop medical administrators to lead this transformational era in the healthcare service through their empowerment by way of the most updated knowledge, practices, skills, and attitudes. The pathway to develop a highly competent medical administrator, he noted, is based on four pillars – namely, professional development (academic development in order to acquire the relevant knowledge, attitudes, and skills), soft skills development (good communication, oratory, negotiation, team-building, and public relations), financial independence (for stability, self-esteem, and dignity), and social welfare and the safeguard of their dignity (as they perform one of the most stressful duties in the entire health sector with greater challenges and least leisure time). Regarding this, Dr. Rathnayake proposed the introduction of a Postgraduate Diploma in Medical Administration and to encourage medical officers in charge (MOICs) of primary care health institutions to obtain the said qualification. In terms of the pyramid structure of medical administration, it consists of divisional medical officers (DMOs) of primary care hospitals, divisional hospitals, and base hospitals and medical officers of health (MOHs) at the base of the pyramid. Dr. Rathnayake explained: “When this base foundation has academically sound, skilled, knowledgeable diploma holders, we can develop the leaders for secondary and tertiary care hospitals to lead the teams consisting of doctor of medicine (MD) medical administration-qualified consultants with local and foreign training. With three years mandatory post-intern experience, a two years’ Master of Science (MSc) course, another year of post-MSc training, about three years as a pre-MD, and finally two years of post-MD training, it takes a minimum of 11 years to develop a MD-qualified consultant in medical administration after the completion of the internship. But almost all other major specialties develop MD-qualified consultants in almost six to seven years after the completion of the internship. “With this process, we have produced about 40 MD-qualified medical administrators since 2018. The Board of Studies in Medical Administration has restructured the MSc in Medical Administration course for Level 10 of the Sri Lanka Qualifications Framework since 2019. I believe that if we could directly enroll an intake of postgraduate trainees who complete the new MSc, to the MD course in Medical Administration, nearly one-and-a-half years could be saved, as we could take the MSc examination as the MD Part One exam, while for the indirect intake, we could follow the routine pre-MD Part One programme and select those eligible.” He further added that another main concern to address is the need to develop full-time assistant director posts for registrars and senior registrars under their supervisors, as such would improve the skills, knowledge, decision-making ability, and attitudes of postgraduate trainees. “We suggest that it is the correct time to introduce selected sub-specialties and special interest specialties to the field of medical administration. Adding one more year (foreign or local) to the senior registrar period will allow to develop highly specialised consultants in sub-specialty fields such as healthcare policy development and planning, health economics, medical procurement, human resource management, public health and applied epidemiology, health information, research and biostatistics, disaster management, and hospital designing, and architecture. This will also open up new internationally recognised avenues for highly specialised consultants with the World Health Organisation (WHO), the United Nations (UN), and donor agencies,” Dr. Rathnayake further added. Thus, short-term, part-time diploma courses for currently serving medical administrators and well-structured diploma courses and diplomas in special areas are recommended. Meanwhile, the college’s academic subcommittee’s online weekly professional development programme, he pointed out, involves scientific sessions to share research activities, innovations, and experiences. With regard to the establishment of the Sri Lanka medical administrative service, all medical officers in the Ministry of Health belong to the medical service, which has three service categories – namely, grade medical officers, specialists, and medical administrators (competent technically and, managerially speaking, are in charge of the overall administration of the health services). “A separate medical administrative service is required and it needs to have three grades, namely, the primary medical administration grade, the senior medical administration grade, and the deputy director general grade. It will be needed to amend the service minutes, public administrative circulars, and cabinet approvals. The perfect example for the co-existence of this structure is shown in the education sector with the teacher service, the principal service, and the education administrative service. A new performance appraisal system can be introduced based on performances, along with a new salary and allowances structure.” Concerning soft skills development, Dr. Rathnayake explained that medical administrators need to have good communication skills, oratory skills, negotiation skills, team-building skills, and personal relationship skills, ranging from the way they dress to the way they conduct themselves. In this regard, he pointed out that all structured academic programmes have neglected this aspect. Therefore, the college has initiated a programme named “Medical Leadership” with the co-operation of the Aesculap Academy. On matters pertaining to financial independence and stability, Dr. Rathnayake emphasised that issues pertaining to such have been long-standing problems for medical administrators. He added: “Based on the current law, medical administrators cannot perform private practice, thus causing a severe financial burden compared to the ordinary medical officer. Due to medical administration not being a day job or a duty that is performed on an on-call basis, and since such is round the clock, every day, there is a significant mismatch between the service requirement and the financial revenue. This financial instability has made medical administration a less attractive specialty. Therefore, there is no argument that medical administrators require a better, attractive salary structure and allowance structure which will in turn attract a young, energetic, new set of doctors; reduce the brain drain; and improve the integrity of medical administrators.” In connection with the social welfare aspect of the medical administrators, Dr. Rathnayake noted: “It is well known that medical administration is the most stressful duty in the entire health sector, as it is a full-time duty replete with challenges, requiring commitment, leaving less time for leisure. Due to these concerns, we have witnessed most of our medical administrators developing health problems and some leaving in an untimely manner. Therefore, a special health insurance facility has become a mandatory requirement for the members of the college. A tailor-made health insurance system covering national and international healthcare expenditure for critical illnesses with a proper death cover for untimely deaths is required to be designed and special emphasis is required to be taken to implement that.” Elaborating further on the difficulties and challenges faced by medical administrators, Dr. Rathnayake observed: “Most medical administrators in all categories do not have proper official quarters to live in, with most living in substandard places and some having rented houses out of their own pocket. Most of the ‘offices’ they have in hospitals are not up to the standard as most of them don’t even have the basic facilities required to function as an administrative centre. Therefore, there is an urgent requirement to develop suitable quarters and to develop office spaces.” Another problem, he highlighted, pertained to the lack of transportation facilities to officers in the deputy medical administrative grade. “They are working in faraway places without eligibility to obtain transport facilities. They have no other option but to use their personal transport or public transport for official duties.” As far as the contribution of medical administrators to national development efforts are concerned, Dr. Rathnayake concluded: “They are the leaders and managers of the entire health system from policy development to implementation, leading, guiding, and administering in order to maintain the status quo of the health sector.”


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