A highly competent Medical Administrator to face the challenges in the 21st century.

Dr.  R.M.S.K Rathnayake

Healthcare is one of today’s most dynamic and growing fields, with a wide range of opportunities and challenges. Medical Administrators have been at the helm of the Health Care Delivery System in Sri Lanka since the inception of the Department of Health Services in 1856. Due to the untiring efforts of the Medical Administrators for well over a century, Sri Lanka has achieved an enviable health status. The present health indices provide ample testimony to this fact. Furthermore, our health care delivery system serves as a model to other developing countries.

The establishment of the Civil Medical Department of Sri Lanka in 1856, led to the development of a network of health care facilities. Establishment of Provincial councils following the 13th amendment to the constitution in 1987 was a major reform as it led to the devolution of the provisions of healthcare to the Provincial Council.

A significant event in Medical Administration was the formation of the Association of Medical Administrators in 1974 mainly to look after the interests of government medical administrators. This Association paved the way for the establishment of the College of Medical Administrators of Sri Lanka (CMASL) in 1992 by a group of 43 Medical Administrators who were members of the Association. The first Council of the College was headed by Dr. George Fernando as President, and Dr. Shanthi Dalpatadu who served as the first secretary. The Board of Study in Medical Administration was established in 1994.


Health in 21st century

In the second decade of the 21st century, the healthcare services, healthcare facilities, health seeking behaviors, attitudes and expectations of the people have undergone a dramatic change. Use of Information and Communication Technology, evidence-based medicine, cutting age technologies, novel management sciences, multi-disciplinary approaches for problem solving, Research based culture have changed the face of Healthcare in the world where the change is inevitable.

On top of everything, last year we experienced the ‘’COVID 19 pandemic’’ a novel experience to the world which transformed the world to a ‘new normal world’.  Impact of the COVID yet again reminded the whole world regarding the challenges in Health and importance of Health for sustainable development.

Like Lord Buddha said ‘’ Change is the only unchanged thing in the world’’.

We need to develop the medical administrators to lead this transformational era of healthcare service. As Warren Bennis (who is widely regarded as a pioneer of the contemporary field of Leadership studies) said ‘’ Leadership is the capacity to translate vision into reality’’.  Therefore, as leaders of the Healthcare Service of our country we have the utmost responsibility to make the National Health vision a reality. Thus, we need to empower our Medical Administrators with most updated knowledge, practice, skills and attitude to fulfil this task.


Developing a highly competent Medical Administrator to face the challenges in 21st century

Developing a highly competent Medical Administrator to face the challenges in 21st century is not an easy task. But as the torch bearers in the field of Medical Administration, it is our responsibility to work at our fullest capacity to fulfil the task.

The pathway to develop a highly competent Medical Administrator is based on four pillars, namely, Professional Development, Soft Skills Development, Financial Independence and Social Welfare & Safeguard of Dignity.

Professional Development can be considered as the backbone to develop a competent Medical Administrator. In that, their academic development is of utmost importance in acquiring the knowledge, attitudes and skills relevant to Medical Administration. Another very vital dimension in a career in Medical Administration, is the development of their soft skills. A successful Medical Administrator must possess good skills in communication, oration negotiation, team building and public relations. These necessary skills are instrumental in developing a true leader with a great charisma. Financial stability and financial independence are also important aspects of a career in Medical Administration which will help uplift the self-esteem and dignity of the Medical Administrator. These areas have to be addressed properly as they perform one of the most stressful duties in the entire health sector with greater challenges and least leisure time.

I propose to introduce a ‘’Post graduate Diploma’’ in Medical Administration and encourage MOICs in primary care health institutions to obtain it empowering them with skills, knowledge and attitude and developing them professionally to run primary care institutions productively. The pyramid of Medical administrative structure of Sri Lanka, consists of DMOs of Primary care Hospitals, Divisional Hospitals, Base Hospitals and MOHs as the base of pyramid. They are the foundation of our system. When we get the base of our Medical Administration pyramid strengthened with the academically sound, skilled, knowledgeable diploma holders, our Pyramid will be stronger and sustainable than the ‘Great Pyramid of Giza’.

We as medical Administrators are entrusted to develop the leaders for secondary and tertiary care hospitals to lead the teams consisting of MD Medical Administration qualified consultants with local and foreign training. No doubt, that our academically sound MD qualified medical administrators will lead those institutions with dignity and vision. With 3 years mandatory post intern experience, 2 years MSc course, another 1 year post MSc training, about 3 years pre MD and finally 2 years post MD training, it takes minimum of 11 years to develop a MD qualified Consultant in Medical Administration after completion of internship. But almost all other major specialties develop MD qualified consultants in almost 6-7 years after completion of internship.  With this process we have produced about 40 MD qualified Medical Administrators since 2018.

With the significant improvement of MD training, we need to look into the possibility of improving our mission further. The Board of studies in Medical Administration has restructured the MSc in Medical Administration course for the Level 10 of the Sri Lanka Qualifications Framework since 2019. Considering the fact that it is the stepping stone to the MD in Medical Administration, I believe if we could directly enroll the PG trainees who complete the new MSc, to the MD course in Medical Administration nearly 1.5 years of valuable time could be saved. With this direct intake, we could take the MSC examination as the MD part 1 exam and for the indirect intake we could follow the routine pre MD part 1 program and select the eligible. This will also withstand the equity of the failed.

Other main concern is that, we need to address to develop full time assistant director posts for our Registrars and Senior Registrars to function with dignity and authority under their supervisors to become a part of the workflow with responsibility and to train with first hand experiences. This will definitely improve the skills, knowledge, decision taking ability and attitudes of our Post Graduate trainees and make them ready to function as leaders when situation demands.

The 21st century has made greater emphasis on quality of care. The world has been moving to develop highly specialized doctors, opening the doors to develop sub specialties and special interests. This has improved the quality of care, health status of the nation as well as the quality of the main specialty.  We as the caretakers of the specialty of Medical Administration suggest that it is the correct time to introduce the selected sub specialties and special interested specialties to the field of Medical Administration. Adding one more year  (foreign or local ) to the Senior Registrar period, will allow adequate time frame to develop highly specialized consultants in subspecialty 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 as well as Hospital Designing and Architecture.  This will not only improve the quality of our service to Sri Lanka but will also open new adventures in internationally recognized avenues such as WHO, UN, Donor Agencies etc. as highly specialized consultants.

Short-term part-time diploma courses for currently serving Medical Administrators will provide significant short-term as well as long term benefits to our profession. Well-structured diploma courses endorsed by the Sri Lankan College of Medical Administrators developed to fulfill the needs of our health sector will be an asset to all our members. Diplomas in special areas as noted above will significantly improve our skills, knowledge, attitudes thus developing our professionalism. With highly competent, professional medical administrators, we will be able to win the challenges in the 21st century with flying colors.

Our scientific sessions are the platform to share our research activities, novel innovations and to share our successful experiences. Thus, with the ever-energetic academic subcommittee we have introduced an online weekly professional development program. Annual scientific sessions will also be held in an international level standard, this year and I am looking forward to see all of your contribution, to make it a success.


Establishment of Sri Lanka Medical Administrative Service

 All medical officers in the Ministry of health belong to the Sri Lanka Medical Service and has three service categories, grade medical officers, specialist and medical administrators.

Medical Administrators competent technically and managerially are in charge of the overall administration of the Health Services in Sri Lanka. Therefore, their service requirements, services as they offer as well the problems they encounter are different to other medical offers in the Sri Lanka Medical Service. For the professional development   of the Medical Administrators a separate service under the name of ‘’ Sri Lanka Medical Administrative Service ‘’ is required. 

Medical Administrative Service in Sri Lanka needs to have 3 grades.

1.         Primary Medical Administration Grade.

2.         Senior Medical Administration Grade.

3.         Deputy Director General Grade.

It is a long process and will need to amend the service minutes, public administrative circulars and need cabinet approvals. But this will settle lots of current administrative and professional problems regarding the Medical Administrators. (The perfect example for co-existence of this structure is shown in Education sector with 3 services, Sri Lanka Teacher Service, Sri Lanka Principal Service and Sri Lanka Education Administrative Service)

With new ‘’ Medical Administrative Service’’, new performance appraisal system can be introduced based on performances, new salary structure , new allowances structure can be introduced.


Soft skills Development

Soft skills development is the icing on the cake for a competent and professional medical administrator. Successful Medical Administrators need to have good communication skills, oratory skills, negotiation skills, team building skills and Personal Relationship skills. From the way of dress to the way of conducting the self is observed as soft skills which are instrumental to develop a true professional and a great charismatic leader. It improves the competency of the Medical Administrator.

All our structured academic programs have neglected the ‘’Soft skills development’’ of medical administrators. To overcome this, we as the Sri Lankan College of Medical Administrators have initiated a program named ‘Medical Leadership’ with the cooperation of ‘AESCULAP Academy ‘’ unfortunately, the COVID pandemic has affected the continuation of the program. But with time the program will be widened and continued for the betterment of all Medical Administrators.


Financial Independence

Financial stability and financial independence have been the long-lasting problem for the Medical Administrators in Sri Lanka. Based on the current law, medical administrators cannot perform private practice causing a severe financial burden compared to the ordinary medical officer. Medical Administration is not a day job or an on-call basis duty. Medical Administrator is required to be on service round the clock every day. Consequently, there is a significant mismatch among the service requirement and the financial revenue. This financial instability has made Medical Administration a less attractive specialty.

There is no argument that medical Administrators required a better attractive salary structure and allowance structure to lower the financial instability. Financial stability will attract the young energetic new set of doctors in future who will further develop the field of Medical Administration. This will also reduce the brain drain and improve the integrity of medical administrators.  This requirement needs to be well thought of, with the implementation of ‘’Sri Lanka Medical Administrative Service “.


Social Welfare

It is a well-known factor that, Medical Administration is the most stressful duty in the entire health sector. It is a fulltime duty with full of challenges, complete commitment with least leisure time.  With all these adversities, we have witnessed most of our medical administrators develop health problems and some unfortunately leaving us untimely. Therefore, a special Health Insurance facility has become a mandatory requirement for the members of Sri Lankan College of Medical Administrators. 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 required to be taken to implement that.


Securing the dignity of the Medical Administrators

Medical Administrator being the leader of the institute, need to have an exemplary life with dignity and respect. It is our duty to advance the infrastructure to uplift the dignity of the Medical Administrator.

With my own experience since 1995 as the DMO of Chilaw Hospital, RDHS Chilaw, PDHS of North Western Province, Director of National Hospital Kandy, DDG of Ministry of Health and Secretary of the Sate Ministry, I have witnessed the great difficulties and challenges faced by my budding medical administrators.

Most of the medical administrators in all categories do not have proper official quarters to live in.  Most are living in substandard places and some have rented houses through their own pockets. Most of the ‘’Offices’’ they have in hospitals are not up to the standard. Most don’t even have basic facilities required to function as an administrative center. Therefore, there is an urgent requirement to develop suitable quarters and to develop office spaces, to the medical administrators to function with dignity and respect.

Another problem is the lack of transportation facilities to the officers in deputy medical administrative grade. As the newly appointed medical administrators 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. Providing transport facilities to the officers in deputy medical administrative grade is very much essential, for them to function with dignity, respect and with good job satisfaction.


Our contribution to the National Development

Good Health is the backbone of the development of the country. As we have very clearly witnessed that during the recent COVID Pandemic, every government spends a significant portion of the National Budget to the Health sector to enhance the prosperity of the Nation as it depends on the Health of the Nation.

We, the Medical Administrators are the leaders, administrators as well as the managers of the entire Health system in Sri Lanka. From policy development to implementation, leading, guiding and by administration we maintain the status core of the Health sector. With our competent medical administrators we can achieve a healthier nation but without it development of the country is a dream. Thus, we are the main driving force of the development of this Nation. 

Containing the COVID pandemic with timely decisions and leading the whole health sector to achieve one goal has shown everybody the importance of developing competent medical administrators to maintain the sustainable development of the country.

Development of a highly competent Medical Administrator to face the challenges in 21st century is the key to achieve the Sustainable Development Goals and to achieve the overall development as a country. Our success is the success of the country.

Let us rally under the flag of Sri Lankan College of Medical Administrators to develop the highly competent Medical Administrator. Let us overcome the challenges in 21st century. Let us make a healthier nation. Let us create a Developed, glorified Nation for the future generation.