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Barriers to Strategic Decision Making
DDBA 8560 - Seminar in Healthcare Managerial Decision Making
Walden University
Barriers to Strategic Decision Making
Although managerial skill and a sound logistical network are crucial factors in ensuring that
optimal decisions are made in drug supply, there are other factors which influence management
decisions, and which are beyond the control of managers. These factors are usually the result of
healthcare policy. .
Sometimes policies, while well intentioned, may have adverse impacts. For instance, the current
strategy of the Ministry of Health is a “push” model of drug supply, in which Ministry officials
determine the quantity of drugs to be supplied to health facilities on an annual basis, regardless
of the rules of supply and demand. The result is bare shelves in the pharmacies of some health
facilities, while urgently needed drugs expire in the stores of other facilities.
/Policy can also be discordant with practice when there is more than one policy maker, such as
the Ministry of Health and international organizations. Kangwana et al (2009) discovered that the
Ministry of Health has negligible input in HIV/AIDS policy, as the international partners play a
dominant role, leaving the Ministry to merely implement its policies. This is the case in ARV
provision, where a medical officer in charge of an institution could not give the population of
patients on ARVs to the extent that the Ministry of Health had to seek permission to retrieve this
information from the development partners database. Such scenarios lead to confusion among
managers, thus affecting service provision and drug supply even further. The reason for these
policy headaches is that the Ministry of Health’s strategic development plan is formulated to
attract donor funding, rather than to meet the needs of the community. Thus the final result is
poorly coordinated and duplicated interventions.
Even without the influence of international organizations, the work of medical managers is still
exposed to policy conflicts because health policy is implemented by three different ministries
namely the Ministry of Medical Services, Ministry of Public Health and Sanitation and Ministry
of Special Programmes.
/The policy tangle gets even more complicated when the establishment of new health facilities
and plans for their subsequent management are brought under the Constituency Development
Fund (CDF). These facilities are constructed with political considerations in mind, without any
thought as to how staff, drugs and medical supplies will be provided (Kangwana et al 2009). This
opens the possibility that politicians may influence the supply of drugs to facilities in which they
have a political interest, thus depriving larger facilities, with greater need for drugs, of their
rightful share. .
/Finally managers have to cope with a legal framework that is in a state of confusion. Kenya’s
health sector laws consist of over twenty statutes which are overdue for reform. Furthermore, the
lack of coordination between the three ministries that share the health docket, as well as the poor
coordination even within the Ministry of Health itself, mean that inefficiency, duplicity of efforts
and wastage of resources are rife. Thus the need for effective management decision making,
while crucial at the hospital level, is also sorely needed at the ministry level.
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