THINKING ALOUD: Operationalisation of Mlonganzila Hospital a major challenge

Thursday December 7 2017

Professor Zulfiqarali Premji

Professor Zulfiqarali Premji 

By Prof Zulfiqarali Premji

President John Magufuli formally opened the Muhas (Muhimbili University of Health and Allied Sciences) Academic Medical Centre (Mloganzila Campus) on November 25.

I closely followed the President’s speech and one thing that surprised me the most in the address was what amounted to an impromptu attempt to suggest how to operationalise the newly built facility, popularly known as Mlongazila Hospital.

Partly built using a soft loan from South Korea, this multibillion-shilling hospital is a state-of-the-art establishment which, if properly managed, will elevate Tanzania’s health sector into providing quality healthcare. There is no doubt that such a facility was sorely needed in Tanzania and, indeed – as explained in Dr Magufuli’s speech – credit for the feat should deservedly go to Retired President Jakaya Kikwete.

I was surprised by the President’s remarks because, for such a huge project, there should have been detailed forward-planning on how the hospital would be managed on a daily basis, as well as its financial viability.

In many parts of the developed world, contemporary hospital care is confronted by workforce challenges; changing consumer expectations and demands; fiscal constraints; increasing demand for access to healthcare; a mandate to improve patient-centred care, and issues concerning levels of healthcare quality and safety.

Effective governance is crucial to maximising effective management of care in a given hospital setting.

I recall that, when the project was initiated, there was undue secrecy and lack of transparency that marginalised even senior Muhas faculty members.

Maybe this was done because there could have been the possibility of creaming off the top a percentage of the project’s budget by some officials of dubious probity. But I would like to believe that this did not happen.

If there had been dialogue and consultation, the operational aspect would not be the issue it is today.

Again, if the hospital was built near Muhimbili National Hospital (MNH) after, for instance, relocating Azania secondary and Jangwani girls schools, that would have been ideal, but this option is no longer relevant.

Three months after the “soft opening” of the establishment, there has not been a single inpatient in there, and I tend to believe that outpatient services are similar to those at an ordinary health centre. Mlongazila Hospital should do much bigger things.

Currently, Mlongazila is under Muhas and the Education ministry – and is headed by a deputy vice-chancellor. To manage Mlongazila with part-time leadership – and perhaps with very little or no experience of how to manage hospitals – is to invite failure.

Secondly, the objective will not be achieved with part-time faculty because the current set-up divides faculty time between MNH and Mlongazila.

Thirdly: as a patient, why should I go to Mlongazila when I can be treated at Muhimbili nearby?

So, is Mlongazila going to compete with Muhimbili – and what is the added value in seeking treatment at Mlongazila?

What Mlongazila needs is an autonomous committee that will have its own CEO and management team. Muhas does not have the expertise or experience to manage a big hospital. The hospital should be under the Health ministry, with a memorandum of understanding (MoU) with Muhas thrown in. Anything short of this would undermine Mlongazila Hospital’s full potential.

Managing big institutions is definitely a challenge, and we should learn from past mistakes. Management and administrative structures are indeed very important. Otherwise, a lot of chaos may result.

At the current Muhimbili National Hospital campus, there are independent institutions like MOI and the JKHI cardiology institution. These two are not under the MNH director general, which is a management anomaly.

In any case, it is very important to start on a clean slate regarding the Mlongazila campus – and have its management organigram (organisation chart) clearly defined.

I believe that – as directed by President Magufuli – the stakeholders concerned will be meeting to explore the best management system needed for a successful outcome. But, my advice is that it’s necessary to control personal and institutional egos.

Hospitals are complex socio-political entities, and the ability for engagement and leadership among clinicians can be hampered by power dynamics, disciplinary boundaries, and competing discourses within the organisation.