From Financial Times - Sri Lanka
By W.A Wijewardena, a former Deputy Governor of the Central Bank of Sri Lanka
A mega salary increase to public servants
A mega giveaway offered in the Interim Budget 2015,
presented to Parliament last week, has been the proposal to increase the
salaries of public servants across the board. In terms of this proposal, the
salary increase of Rs. 3000 given in the Budget 2015 presented in November last
year is to be topped up by a further Rs. 7000 in two stages – Rs. 5000 from
February 2015 and the balance Rs. 2000 from June.
Salary increase is given by the public in the expectation
of better services
There is a general belief that this salary increase was
given by the Government, but it was not. On the contrary, it was given by the
public who will ultimately bear the bill as taxpayers. They will have to make
available the needed funds by paying taxes or agreeing to forego some of the
existing public services or handing their savings to the Government as loans or
a combination of some or all. Whatever the method, it amounts to a sacrifice of
their consumption. Why should they choose to make such a sacrifice on behalf of
the country’s public servants? That is because the public servants have to give
back what has been sacrificed by the public by way of improved public services.
These improved public services come from an increase in
productivity and increased productivity comes from inventions and innovations.
Inventions and innovations come from the acquisition of knowledge, skills,
talents and competencies by public servants.
An increase in productivity in the public sector is a
must
The increased salaries will place public servants in a
comfortable, worry-free and satisfying position. But it also inflicts a new
obligation on them. That obligation is to improve their productivity and
provide a better service to the public.
For instance, a teacher who gets the salary increase should
acquire new knowledge, provide higher wisdom to students and help produce a
more talented citizen to the country. It, therefore, comes from teacher’s
learning, training and knowledge acquisition. Hence, the improvement in
productivity is on the other side of the balance sheet that has recorded the increase
in the salaries of the public servants. Recognising this vital requirement, the
Minister of Finance, Ravi Karunanayake, put it in the Interim Budget 2015 as
follows: “I call upon the unions, public servants and all stakeholders of the
public sector to improve the productivity to be on par with the standards in
the Asian region.”
A conscious public policy to improve productivity is
needed
But the improvement in the productivity of public service
does not come automatically in response to a request made by a political
authority. It comes from a conscious public policy program which aims at
improving the productivity of public service at all levels.
A pharmacist at work at Dompe Hospital
It is therefore a matter for the Ministry of Public
Administration to formulate such a public policy supported by the new Ministry
of Policy Planning and funded by the Ministry of Finance. In formulating such a
policy it is necessary to identify the distinction between invention and innovation.
Invention means ‘creating something anew’; innovation means ‘making use of
those inventions in a practical situation to ease the life of the public’.
Hence, inventions are the work of true creators. Innovations
are the work of entrepreneurs who will put them into commercial use.
Accordingly, in the case of public service, those who are engaged in
innovations should act like real entrepreneurs.
Private entrepreneurs have incentives for introducing
innovations
In the case of the private sector, an entrepreneur is a
person who takes risk in using financial, human and physical resources to
produce an output with a view to selling in the market for profit. His survival
and sustainability depend on his ability to continue to make profits.
He faces competition from his competitors and therefore he
has to introduce innovations continuously to remain ahead of them. It requires
on his part the abandonment of old systems and introduction of new systems. He
has no particular love for any system. If the prevailing system does not serve
him, he does not grumble about abandoning it for a better system. Thus, the
movement from old unusable systems to new usable systems should take place as a
continuous process.
Public sector innovation efforts should come from the
political machinery
In the case of the public sector, there is no profit element
and therefore there is no incentive for public servants to introduce
innovations for personal gain. Besides, they have permanency in employment and
do not face the problem of survival as in the case of private sector
entrepreneurs.
However, the politicians who are elected for a given period
are different from public servants. They have a personal interest in
introducing innovations because if the innovations are successful, they can go
before the electorate with a strong claim for re-election. Hence, the initial
initiative for introducing innovations to improve productivity in the public
service should come from the political machinery. Yet, the political machinery
cannot implement them on the ground because it has to be done by public
servants who are dispersed all over the administrative system. As a result, to
motivate the public servants to introduce innovations and through them, improve
productivity, a proper incentive system has to be set up by the political
machinery.
Such incentives can take the form of accelerated promotional
prospects and special salary increases on the basis of the success of the
innovations introduced. After such a system has been put in place, it is
necessary to appoint some selected public servants who have to function as
catalysts or change agents in introducing innovations and ensure that they will
be continued till the final goal of improving productivity in the public sector
is reached.
CIO experiment by PIM not used
A nucleus of such a team of catalysts has already been
trained by the Postgraduate Institute of Management of the University of Sri
Jayewardenepura drawing public officers from all the ministries and
departments.
These officers, numbering 130, and designated Chief
Innovation Officers or CIOs, have completed a Diploma in eGovernment at PIM
funded by the Information and Communication Technology Agency or ICTA.
These CIOs were expected to go back to their work places and
function as catalysts in change management. However, without support from the
political machinery, these CIOs still remain totally unutilised and
consequently have ended up as a frustrated lot over their inability to use the training
they have received specifically for effecting change management. Therefore,
they can be mobilised at anytime as catalysts in change management in the
public service if there is commitment by the political machinery for
introducing innovations and improving productivity in the public service.
Digitisation of Dompe Hospital as a private initiative
But, there is an exception. One such CIO with the support of
the hospital administration has on his own initiated a real change management
exercise in the Government District Hospital at Dompe.
In this exercise, the hospital, which had been operating on
the basis of manual records for decades, has been transformed into a fully
digitised hospital (available at: https://www.youtube.com/watch?v=-YqujXDfHHQ
).
Dubbed eHospital, the project has been supported by many:
ICTA with funding for computers, undergraduates of the University of Moratuwa
who have volunteered to train the staff and the hospital administration which
has carried the project on its shoulders until it has reached its success.
Financially, the project has cost ICTA less than Rs. 5 million. But when the
cost of the voluntary work is also added, the cost of the entire eHospital
Project at Dompe has been less than Rs. 10 million. But the benefits to the
patients, hospital, community and finally the Health Ministry have been
enormous.
The success story of the eHospital Project at Dompe
Hospital
This writer, who has been a facilitator of the CIO training
program at PIM, had followed the progress of the eHospital Project closely. In
order to assess whether the project has been sustainable and identify what
action is being contemplated by the Project Management to improve its services
further, he visited the Dompe District Hospital last week. What he found was
evidence of a success story which could be replicated throughout the public
service in order to improve its productivity at a relatively low cost provided
that it has the blessings of the political machinery and there is a dedicated
change agent to carry it forward.
The first could come as response to the call by the Minister
of Finance and steered by the Ministry of Policy Planning. The second can be
filled by the 130 odd trained CIOs presently scattered all over the public
service without being utilised.
Digitisation of operations from beginning to end
When a patient visits the hospital for the first time, his
particulars are captured into the server and he is issued with a barcode
identity generated by the system containing his particulars which he has to
produce every time he visits the hospital.
If for some reason the barcode is lost or misplaced, his
particulars could still be accessed by using other options: Name, NIC No.,
place of residence or date of birth. Another officer scans the barcode identity
and issues the patient with a computer generated number for the day’s service.
It also specifies the room of the physician whom the patient should consult for
receiving the treatment.
The physician scans the barcode and accesses the file
pertaining to the patient stored in the server. It gives the full particulars
of the patient. After examining the patient, the physician enters in the relevant
fields of the file the diagnosis made, lab tests if necessary, prescription of
medicines, injections or immunisations prescribed or if it is a physical
injury, the treatments to be given in the dressing room.
To minimise the data entry, which takes time, a readymade
menu listing all options pops up on the screen automatically. All these are
instantly transmitted to the respective units of the hospital through an
intranet. The officers at the respective units are also able to access the
patient’s file by scanning the barcode and provide the necessary treatment for
him. If it is a lab test, the results of the test are added to the patient’s
file and the physician could access it when the patient visits the hospital
subsequently. The pharmacist, having accessed the file of the patient from the
server, issues the medicines prescribed by the physician with the necessary
instructions. When he enters the drugs issued, the system automatically takes
them out of the stocks enabling the hospital to make a drug requisition order
promptly.
For in-patients, the discharge sheet and diagnostic cards
are also generated through the system and added to the patient’s file. When the
patient revisits the hospital, his complete medical history is thus available
to the physician to make a holistic assessment of the patient’s status and
decide on the curative treatment.
The process has completely done away with the paperwork. A
system has now been introduced to get appointments by using mobile phones
thereby cutting down the waiting time of the patients significantly. This is
indeed a revolutionary innovation introduced to a local hospital in the
country. What it has achieved with its limited resources ranks on par with the
excellently digitised practices being used by modernised private healthcare
institutions in emerging countries like Thailand as presented by this writer in
a previous article (available at:
http://www.ft.lk/2013/09/16/private-healthcare-providers-in-sri-lanka-should-benchmark-with-better-service-providers-abroad/
). By any standard, Dompe eHospital ranks higher than any of the private sector
healthcare institution in Sri Lanka.
Dompe eHospital project can be replicated
All the staff, including sanitary workers and ambulance
drivers, has been trained in the use of the computers. It is amazing that old
officers who had had the fear of even touching a computer have become
proficient in even accessing information from the internet today. It has in
fact improved their self-value, dignity and confidence.
Patients too have now become familiar with the use of IT in
delivering an efficient service to them at the hospital. Its side benefit is
that the local community has now become IT savvy, especially in the use of the
social media and email communications. The Dompe eHospital project is a success
and could easily be replicated in all the hospitals in the country. The costs
involved could be accommodated under the Government’s enhanced budget for
health services at 3% of GDP.
Learning lessons from eHospital Project
There are a number of lessons that can be learnt from the
solitary eHospital project at Dompe Hospital. First, officers in the public
service are trainable provided they are given right types of incentives.
Second, one catalyst can effectively implement an innovation
project. Third, costs of introducing innovations are not that high. Fourth,
every rupee spent on innovations brings back more than one rupee’s worth to the
public. Fifth, there is no need for reinventing the wheel and the existing
knowledge can be tapped for introducing innovations and improving productivity.
Spend money on capacity building of public servants
However, the campaign for improving productivity requires
funding for training and capacity building of public servants. This can be accommodated
under the current plan of the Government to increase the education budget to 6%
of GDP. At the current GDP level, this amounts to about Rs. 600 billion.
Education involves improvement of human knowledge, talents, skills, capacities
and competencies. It should be done through formal education, research and
training. Hence, the training of public servants could be accommodated under
the current education budget of the Government.
Public servants have now been given a thumping salary
increase. It can be vindicated if and only if there is a commensurate
improvement in the productivity in the public sector.
(W.A Wijewardena, a former Deputy Governor of the Central
Bank of Sri Lanka, can be reached at waw1949@gmail.com )
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