Final blog, probably

I have my flight ticket home tomorrow and will be back in London 29 February. It was  raining here this morning, major thunder @ 5 a.m but later this afternoon v hot and humid, so rather uncomfortable.

Work

It’s been hard work trying to finalise the Strategic Plan after the consultation. Last night, Sunday, I sent the final draft to my boss, the Principal, and his colleagues.

Self-imposed early deadline because I decided to finish by end February rather than end March. This sort of work can drag on and I think about 4 months to do a strategic plan should be ample. Trouble was the deadline produced new information very late!

One issue was a new-ish Act of the Revolutionary Government of Zanzibar (really), the Public Sector Act 2011. I read the version in English which is full of phrases either written by donors (or Development Partners as they are called) or heavily influenced by them, such as ‘results oriented’, ‘client focused’, ‘participation oriented’, ‘value for money oriented’, ‘decentralisation’, ‘pluralism’ and ‘gender-mainstreaming’.    I wonder how this translates in Swahili.. 

Plus you may be interested in this commitment in the Act:

‘Appointment of CEOs of Agencies to be made by the President on merit after an open and transparent process run by the Central Office’ , qualified by another sub-clause, ‘The President may exempt from merit rule by publication in Official Gazette’. But maybe this is more transparent than some UK processes!

Anyway gist of Act  is that all recruitment, promotion and demotion and transfer decisions about staff in public services have to be approved by the Public Services Commission. As the College is a Government college, this threatens to capsize the Strategic Plan which proposes large scale staff recruitment funded by tuition fees.   Ah well!

fishing boat paje beach

Some other mysterious things here became clearer:

·         A siren goes off at 7 30 a.m. and 3.30 p.m. every week day; turns out this is to mark the start and finish times of work, although very few if any workplaces have this schedule.

low tide mbweni beach

·         The Nursing Department here has seven nurse tutors with Bachelor’s degrees (most of the rest of the staff are educated only to Diploma level). Five of the graduate nurse tutors are on paid study leave for a year or more this year, doing Master’s degrees. This seemed an excessive number at one time and students complain their staff are not as advertised in the prospectus and cannot explain things. The fees for the study leave are paid buy a donor and the money was only available for a limited time, so it was ‘use it or lose it’..

 Recreation

Mostly work but a few good interludes. There was an international music festival here for four days around 9 February. 'Sauti za Busara Zanzibar' (sound of wisdom Zanzibar). I went three evenings, quite interesting local music called Taarab, which is some local instruments plus violins and the music has Arab and Indian influences as well as Western. There is a famous diva from Zanzibar, Bi Kidude, who may be 100 years old and sang, see pic:

Bi Kidude

Also I spent a lot of time at Mbweni Ruins Hotel beach

sunset at Mbweni beach

remains of 19th century chapel @ Mbweni ruins

Yesterday,  my last Sunday, I went with my boss and his family to a beach on the east side of the island, near Paje. He had been promising this since I arrived so I was glad he got round to it! Picture shows my boss – the tallest chap with the white shirt – helping local fishermen to launch a large heavy boat as the tide came in. I think they had made a ‘dry dock’ pit in the sand to do some repairs. It took a good ¾ hour for about 20 men to shift it on logs! Very entertaining.

how many does it take..

It’s been very hot and dust is everywhere in the house as have to have windows open, plus power cuts andr e-emergence of enormous numbers of ant-like creepy crawlies in the house.. Yesterday during a power cut I opened the front door door to try to keep cool. Next thing I know there are crashes and bangs in the bathroom and I chased a hen out of the bathroom, into the bedroom, across the bed and eventually out of the house again via the back. This is the culprit:

lost hen

Then tonight I got home about 7 pm from leaving do at Mary's to find neighbours at the door asking for their hen back. I'd assumed because I'd seen a cock flying over the wall the hen could also get out of the yard, which has a wall about 2 meters high round it, but apparently not! So the family, mum and two girls, went into the back yard and chased the hen again through the bedroom where it hid under the bed and out through the front door!

Have also had leaving do and this afternoon is final one at Mary’s house with work colleagues.

must now finish packing, power has just gone off so really bad decision to do blog instead of that! it's 9.30 pm so power probably won't be back 'til 10.15, even tho' power cut this a.m.too.oh well!

Information sources for the Strategic Plan

Just a footnote on documentary sources for the College's Strategic Plan, illustrated with pix of assorted crabs Rose and I saw on beaches around Zanzibar.

crab.

During my work here I’ve relied heavily – too heavily I’m sure – on documents in English produced for the Zanzibar Ministry of Health funded by various NGOs and development agencies and often written by outsiders. Danida, the Danish development agency, has been funding ‘capacity building’ at the Ministry for several years. As a consequence of this, there is very good data on public health and an impressive body of research on health needs, To sum up the public health situation, average life expectancy in Zanzibar is 52.  

hermit crab

There is also very good data on the workforce and a Training Plan that is invaluable to my task. There is also an annual review of Government spending on health, which is published in English. Health is a devolved function in Zanzibar, the Government revenue contribution comes from its share of Tanzanian national revenue, which the Government of Zanzibar then decides how to spend.

crab holes

The 2010 health public expenditure review says: 

·         ‘Development Partners’ paid 54.4% of the costs of public sector healthcare, the Government 43%. DP contribution is falling as Global Fund spending is reduced.

·         In Zanzibar in 2010 health was 6.8% of Government spend. This is expected to fall for 2011 as 2010 was an exceptional year due to a large contribution to health from Muli Lateral Debt Relief .

·         To cover recurrent public sector health costs, Government spend would need to be 10.8%. The Government’s strategic plan for health commits to contribute 12% of the its budget. Donor recipient nations have signed up to a target Government spend of 15% of GDP (the Abuja target).

·         WHO recommends minimum per capita spend of over $40 a year, in Zanzibar spend in 2010 was less than $19, the lowest since 2005.

pink coconut crab

·         As much as 12% of the Zanzibar Government’s contribution to health went on medical care for Zanzibaris overseas: a few got an awful lot (there is little specialist medical care in Zanzibar).

blue coconut crab

·         Charges to patients made little overall contribution in 2010 but contributed over 60% to the running costs of the largest hospital, in Stone Town.

·         Charges are due to rise significantly in 2012/13 to sustain health inome.

hermit crabs going to the sea

The Public Expenditure Review paper recommends that it would be helpful if the Government of Zanzibar was more explicit about the priority it attaches to health ….

more wildlife..



That's all for now!

More on working at the College - the mystery of staff salaries

As part of the background information for the draft Strategic Plan that I am here to produce, staff salaries have been a big issue. Illustrated again by snaps from our safari, as you may find the text a bit tedious.

bemused giraffe..

Zanzibar health worker salaries

The College of Health Sciences is a Government college, currently run by the Ministry of Health though an Act of the Zanzibar Parliament passed in 1998. This gives the College a lot of powers, for example, to employ, to own and dispose of land, to borrow. These have not been exercised much, and the College currently lacks management capacity to run very independently of the Ministry.

The Ministry of Health employs College staff, along with all staff at Government health facilities and in central departments – about 4,000 in all. Perhaps not surprisingly, since the Ministry controls the payroll, it takes an age for the College, and possibly other health services, to get permission to hire.  The draft Strategic Plan proposes an expansion in student numbers. This will clearly require more staff and the College is proposing to employ the additional staff itself from tuition fees rather than expect the Ministry to pay. This does not seem very satisfactory and it is more likely that a change in the organisation that pays salaries will be made.

Paying salaries is the largest single contribution that the Government makes to the health system (the Government paid 43% of health costs in 2010, Development Partners over 54% and the remainder came from fees and charges). Some Ministry employees’ posts are funded by donors, possibly as many as 20%. There are also volunteers doing clinical work.

Salaries of Ministry employees have not risen for a long time, possibly years, but inflation is quite high here – 10% in some years recently. So the Ministry has problems retaining staff who can earn much more – 2 or 3 times more – on the mainland. This affects the most specialist posts most – the ‘brain drain’ is for example, medical doctors, more specialist and experienced nurses and pharmacists. The College can’t recruit to some key teaching posts – for example to the pharmaceutical sciences course. 

team members missing?

It’s difficult to compare salaries with those in Europe because purchasing power is so different. A registered nurse after training full time for three years and with experience earns about 220,000 Tanzanian Shillings a month. This is the salary of most tutors at the college. In comparison, my volunteer’s allowance, which is for basic living expenses only – food, utilities, transport by ‘bus, but excluding accommodation costs - is 360,000 Tanzanian Shillings a month. My VSO colleagues who work in education say that teachers earn even less, and people trained to be schoolteachers with reasonable English make more from driving taxis for a living than teaching.

Given these low salaries, it is perhaps not surprising that one of the most efficient parts of the public sector seems to be the administration of the ‘Sitting Allowance’ – an additional payment staff get if they attend in-service training or a special meeting, like the ones I have run to develop the strategy.

Age profile of Ministry of Health employed health workers

The Danish development agency Danida’s has invested in capacity building at the Ministry of Health for some years. This has resulted in a very good information sources on public health and the health workforce.  To sum up the public health situation, average life expectancy in Zanzibar is 52.  Some of the workforce findings are startling, for example the age profile of Ministry staff in health facilities shows that two thirds of staff are over 40 and nearly a third over 50. The College I work for has produced perhaps 200- 300 graduates a year in their early ‘20s for the last 10 years who are intended to work for the Ministry, yet only 200 ministry employees are under 30. The level of salaries is likely to be a contributory factor, with younger people voting with their feet.

sacred ibis..

The College’s policy on salaries

I believe the Government has been considering raising public sector salaries for some time and I thought that the ‘Top Up Allowance’ that the College recently began to pay to its 50 staff from its tuition fees income was just bringing forward by a few months a general pay increase that the Ministry would pay in future. College tuition fees were raised for 2011/12 and now contribute a significant amount to the College. They are collected by the College rather than the Ministry and students now cannot proceed without paying, whereas in previous years there was no enforcement of payment.

The ‘Top up Allowance’ is on average 100%!  I asked whether there were any conditions attached to the additional payment to staff, like a performance review system. Apparently not, but at the staff meeting in December to discuss the College’s strategy several members of staff said there should be performance appraisal. It is in the draft Strategy – I know this may not mean much but the head of human resources at the college says performance appraisal is in his work plan, so it is not just me who is driving this!

I thought the College was relying on the Ministry to pick up the cost of the Top Up Allowance in 2012, which seemed a bit of a risk to take. I misunderstood what was going on. Recently I was given a document explaining the salary increase being negotiated with the Government, fortunately mostly in English. What is under discussion is the transfer of College staff to academic pay scales and it is these that are to be adopted from March 2012. For teaching staff at the College these are on average five times as much as currently!

post prandial lions





Amongst other things, this must worry the hospital and other health facilitiers, whose staff are likely to want to work at the College rather than delivering services.

lions' lunch - ex-zebra..

Interestingly, there is a major dispute at the moment in Dar es Salaam between the medical doctors and the Government of Tanzania. The doctors have been on strike for several days because the MPs have voted themselves much more generous allowances on top of the very generous salaries that they already have but have not done anything about the salaries of health workers which have been in dispute on the mainland for a long time.

vultures waiting for lunch..

Reorganisation?

The budget for the new salaries may be transferred from the Ministry of Health to another Government Department – apparently there are other tertiary colleges in Zanzibar whose staff are paid by the Ministry of Finance.  It is also possible that the salaries, and employment of staff, will be transfer to the College. If this happens, the new salary scales will more than absorb the income from the fee rise and a new financial settlement with the Government will be necessary.

The resolution of who pays the salaries is likely to be made when the outcome of an investigation in to whether the College should become part of the State University of Zanzibar. The President of Zanzibar, an elected executive position, set up a Committee to look into bringing together the Zanzibar Medical School and this College into a Faculty of Medicine and Health Sciences of the University. This seems likely to happen although apparently opinion is divided. The Vice Chancellor of the University is the Chairman of the College Council..  

lizard..

I appreciate that the Strategic Plan may prove not to have much utility in a merger/takeover situation, but the College will be better off in discussions with a Plan than without it.

This change to the College’s status will be the first major one since it was set up as a Nursing School in the late ‘30s – maybe that is because I arrived, as it continues the pattern of my working life for the past 20 years and five different public sector employers: within months of starting a new job every organisation I joined would be involved in a merger or break-up into a different organisation!

That's all for now! 

Working at Zanzibar College of Health Sciences

Mbweni, Zanzibar

Working at Zanzibar College of Health Sciences – meetings, meetings..

You may be interested in the work I am doing so I’m posting a series on what it is like working here.

To enliven the narrative, I’ve posted some photos of the safari Rose and I went on in January, which was lovely. The juxtaposition seems suitably surreal as I would be pleasantly surprised if I had got to grips with 80% of what goes on here. Much remains mystifying!

Scared rabbit..

Meetings with the boss

Most days I start by 8 a.m. to catch the boss – the Principal of the College - for a chat as this seems to work best - he has never asked to see me! Sometimes he is too busy for more than pleasantries but occasionally we have longer sessions, for example earlier this week nearly two hours to go through the presentation for a meeting we are planning on the Consultation draft of the Strategic Plan. I did not anticipate this so it seemed fortunate that I dropped by!

The hazard of this method of accessing the boss is that everyone else does too, so we are likely to be interrupted several times, by people coming in, the mobile etc. The people ranges from external visitors to the ‘fundi’, the handyman, who often seems to take his orders from the boss!

Team of weaver birds..

All staff are very helpful, but tend to respond to questions rather than volunteering much, so I’m trying to ask the right ones! There is a pleasant working atmosphere and a very informal approach compared with what I am used to. This is a small place though – only 50 College staff (and only 1.2m people on the islands – so certainly anyone in the health business knows everyone).

Internal business meetings

As the teaching at the College is in English (at least in theory), I assumed that was how the College operated, but not so, unfortunately. The business at the College at meetings is conducted in Swahili, as are the letters, memos reports etc.(business is in transition from paper to electronic, perhaps where UK offices were 15 years ago).

I have been extremely lazy about the language – I do not seem to have the mental space to do anything except the work in English and mundane tasks like washing clothes by hand, shopping for food and cooking a bit.

Getting on with day to day..

So I’ve only been to one internal business meeting, in early December on a Saturday morning which about next year’s budget, in preparation for an application for funds from the Ministry for the next financial year, July 2012 to June 2013, the ‘subvention’. At least I thought it was about next year, but when the note was produced all the figures related to this year. Mystifying, but possibly as the College is a department of the Ministry of Health the management infrastructure, such as it is, is there rather than at the College. Certainly only recently has a Registrar function been established and an accountant appointed because tuition fees have been raised and the income needs collecting and accounting for.

The Saturday morning meeting was held  It was held in Swahili but I managed to follow some of what was going on as I had my computer and could use ‘Google translate’ – you put a word, or phrase or sentence in one box in Swahili and it shows the English translation in an adjacent box. Possibly adequate for budgets as the subject matter is straightforward, e.g. vehicle maintenance, electricity, water, but not much else!.

According to my calculations, the recent student fee rise means that the College has lots of money, a point I made to the Principal a few weeks ago. Having done more work on the figures, I still think that is generally true but it is also true that non-pay running costs have been under-funded at best and in many examples, e.g. teaching materials and laboratory equipment, text books, repairs and maintenance of buildings, not funded at all. My main contributions to the budget/subvention discussion was to suggest there should be a significant budget for repairs and maintenance and that the desire for a conference/examinations hall should be listed as a capital not revenue requirement!

The last I heard about the progress of this application for a ‘subvention’ was that the Ministry of Finance has asked the College for the last five year’s cash flow figures. This seems very odd to me, not least because the main variable is student numbers in the future and therefore forecast fees, but what do I know?

Stakeholder meetings

Then there meetings of stakeholders in the Zanzibar health world (health is a devolved function) - the Ministry, Development Partners (e.g. UN Agencies, Africa Development Bank, Danida which is the Government of Denmark development agency and a very significant investor in health in Zanzibar) and institutions like the College and the main public hospital, Mnazi Mmoja, which is about 6 km from the College.

Dangerous outside world..

I went to a two day meeting in Pemba, the other populated island that makes up Zanzibar, in October. This was the Ministry’s annual report to its partners, held in English. The ‘Development Partners’ contribute over half the costs of the public health service in Zanzibar.  I also went to a stakeholder meeting on the HIV/AIDS programme strategic plan.

Dependency culture..

Both were characterised by great assiduity to working through the material in detail. In Pemba there were a series of power point presentations, one after the other. The meeting started about an hour late (standard practice as far as one can tell) and was then interrupted by a flying visit from the President of Zanzibar (and large entourage including armed guards).  The first day was scheduled to finish @ 4.30 but went on until well after 7 pm, and people stayed!

The AIDS/HIV meeting was also two days, it started an hour later than scheduled but again people were willing to stay on at the end of the day way past 6 pm to get through the agenda. This meeting was facilitated, and after some presentations there were small groups. An hour was taken up sorting out who would go in which group and then the groups were asked to work through sentence by sentence whole sections of the draft strategy.  Each group was given a laptop with the text so they could agree ‘tracked changes’ - I lost the will to live well before lunch!

Lunch ..

At both these meetings there were constant late arrivals, mobile ‘phone conversations, etc. etc. 

Meetings for the College Strategic Plan

Anyway I thought I’d try something different for the meetings I would run for the draft Strategy, but that proved difficult. I’d written a proposal about the process we would follow to arrive at the Strategic Plan. I assumed we were following this, but in the event we didn’t! One staff meeting on the 1^st draft of the Plan I thought was going to be four or five people so we would just go through main issues.  In the end there were 26 people!

Large group..of hippos..

An earlier meeting at the pre-draft stage was planned for the teaching staff, and I knew there would be about 30 people. This did have more a lot more preparation but was characterised by:

- a room that was plainly too small and did not have enough chairs

- late arrival of two out of three of the people who were to present at the beginning

- constant to-ing and fro-ing as latecomers arrived, found there was no chair and went to get one and bring it in

- mobile ‘phone conversations

- decision not to break for refreshments but mass exodus at prayer time (c. 1230), with different people arriving for the 1^st time after that

Plus to add to my befuddlement, much of the discussion was in Swahili!

Nevertheless we got through and I even wrote up a note of the event, from the small groups, which again assiduously worked through the suggested questions and reported back as requested only three main points. What I am used to tends to be the reverse: very orderly meetings but participants much less likely to do what the facilitator suggests.

So it is a different experience from work at home, and you may see why I am not convinced I have got to grips with the way things are done, let alone the content. But it does seem to me a Strategic Plan should take a few months, not years, to produce, so I continue to muddle through with the aim of a final Draft by end February.

.