Issa Berthe

Given frequent changes in top tier leadership within ministries, is it really possible for countries to lead the way on health sector reform?’

This question was a recurrent one from the development partners and donors attending the Ministerial Leadership Initiative for Global Health (MLI) sessions on country-led development during the recent 2011 Global Health Council Conference. As panelists from the five focal countries as well as MLI representatives were describing how and why development partners should support ministries in their priorities for health reforms, many hands in the crowd went up.

The questions from the audience reflected a common concern that turnover of ministers weakens ministries of health, making them less able to lead reform effectively. Since the beginning of MLI in 2008, the five MLI countries have experienced 12 turnovers of health ministers; with the exception of Ethiopia which has had the same minister since MLI’s tenure there. 

While consistency of leadership at the top of ministries of health can be very beneficial, Rosann Wisman, MLI director noted that “MLI has found that the ministers are not the only leaders within the ministry. Second and third tier officials within ministries are effective, committed, and represent stable and consistent leadership.  They are often both technical experts and provide the leadership to design and carry out national health policies.”

Dr. Kisito S. Daoh has been working as Sierra Leone’s Chief Medical Officer in the Ministry of Health and Sanitation (MoHS) for years with unfailing determination to decrease rates of child mortality in the country. “I have a strong bond not only to the country but to the objectives of the profession I chose to carry on - that is why any challenge we have in health is not something I can run away from.”

Also at the MoHS in Sierra Leone, Dr. S.A.S. Kargbo, Director of Reproductive and Child Health feels a deep sense of commitment to his country. “Since seventh grade I've been on government money, to this day, through graduate school. So I thought the only thing I can do to pay back that country is go back and serve.”

Dr. Issa Berthe, focal point for the International Health Partnership (IHP) Compact and Public-Private Partnerships in the Ministry of Health of Mali, is driven to create a fully competent and skilled team so that sound data informs policy and programs.  He knows that Mali has indeed made progress on its health outcomes and that it has the statistics to prove it, saying “I had this pride in me to show that Mali was better than what the statistics were saying.”

While frequent changes in ministers of health of several countries may be routine, ministries of health continue to play a critical role as the stewards of health care for their populations.  Second and third tier ministry leaders can work inside government to generate the passion and political will from the time of inception of these health sector reform plans to their implementation.  They are an essential link for these policies and plans come to light.