INTER-PROFESSIONAL COHESION AND HARMONY IN HEALTH.

Dear Colleagues,

Here is a topic worth our attention and discussion.

I have been inspired to post this piece following recent social media conversations on this topic of inter-professional harmony and cohesion in the health sector. As you know, the Health Workforce is made up of different health professions who at best work in inseparable interdependent teams in which each profession has defined roles which reciprocally support and complement each other in delivering health services to individuals and communities. The four dimensions of health workforce performance; namely, availability, competence, responsiveness and productivity are all enhanced when there is team work, harmony and cohesion within and between the health professions in health service planning and delivery.

Yet we are also aware that there is what was described as “Tribalism of the professions i.e. the tendency of the various professions to act in isolation from or even competition with each other” by the Lancet Commission on Health Professional for a New Century. We also know of harmful intra-professional conflicts. Our priority must be to focus our efforts in detribalizing the health professions and promoting intra and trans-professional harmony in order to serve the people and not the professions or individuals. How can this be achieved?

First let us appreciate the context: The World Health Organization has articulated six building blocks of the health system. These are Services Delivery, Information, Health Workforce, Financing, Medical products and Leadership and governance. Two of these namely, Leadership and Governance along with Health Workforce are critical as together they are the drivers that operationalize all other health system building blocks. Between these two, it is the Health Workforce that ranks highest because the Leadership and Governance function is in turn mediated and driven by people who constitute the Health Workforce.
Secondly, the ILO classification of health occupations, recognizes many health professions and with several layers within each profession.

Traditional health professions however include medicine and dentistry, nursing and midwifery, pharmacy and pharmacology, physical therapy, allied health etc. They operate in diverse settings, public, private, hospitals, nursing homes, community, day care centers, operating theaters, critical care etc. These professions work together in mutually supportive teams for the common good of society.

Building effective HWF teams depends on certain factors especially quality of leadership and management exhibited by health workers playing leadership roles at all levels. Clear job descriptions, clear vision and values for institutions or particular setting, recognizing and appreciating each individual, listening, building trust, receiving and giving feedback and transparent reward and sanction procedures are needed.

Another important determinant is organizational structures for coordinating HWF management, performance, learning and financing. In November, 2018, I was a guest speaker at the annual conference of Uganda Society for Advancement of Radiology and Imaging (USOFARI) where I found a united team of radiologists, radiotherapists, sonographers, radiographers discussing how to serve the people of Uganda with the best possible radiology and imaging services. They discussed training, equipment maintenance, patient safety and they raised money to build a home for the group. My talk was titled “Universal Access to Radiology and Imaging Services in Uganda”. I advised them to promote cohesion under three ones namely: (i) One self-regulated Profession of Radiology and Imaging with sub-groups of cadres based on skill need, (ii) One Education and Training Policy and Curriculum for each cadre, complementary and responsive to population need under one Professional College (iii) One National HWF Plan and Information System for the profession based at the Professional College.

I recommended three core roles of their Professional Association namely (i) Social Accountability to the populations, ensuring population access to quality services, (ii) Ensuring quality, responsive and accountable education and training and (iii) Ensuring high standards of ethical practice, fellowship and mutual support to each other; holding each other accountable to the profession and the people.
This model proposes an approach for promoting cohesion and harmony between professionals in services specialties. Tensions are sometimes seen between different cadres within a service area for example between radiologists and radiographers or orthopedic surgeons and orthopedic technicians or pharmacists and pharmacy technicians which can be addressed through this model.

Another source of inter-professional tensions is completion for leadership roles between and within the professions. Who leads who, how and why? Leadership is generally earned. Leadership calls for ability to vision the future and oversee and supervise tasks within the profession and for tasks spanning across professions. Individuals within professions and across professions need to prepare for leadership through relevant education, training and experience. Opportunities for leadership for tasks across professions are continuously evolving and should be opened up. In Uganda for example today the minimum requirement District Health Officers is possession of a Master’s degree in Public Health and not a medical degree as it was in the past and is open to all health professionals.

In conclusion, we must all work for harmony and cohesion among health professionals as it is critical to the achievement of population health goals and Universal Health Coverage (UHC). Health professionals should organize and unite themselves around service categories i.e. specialties as in the Radiology example given above, in order to ensure technical quality and accountability. Professionals should prepare themselves for leadership within and across professions. Countries with leadership from health professionals should mobilize political will and establish trans-professional and multi-sector forums for dialogue on Human Resources for Health (HRH) planning, financing and implementation where opportunities for growth and leadership are open to all.

What do you all think?

Sincerely,

Francis.