Jim Haveman reflects on his tenure at the Ministry of Health. In an email response to a series of questions about what went well and what could have been done better, he writes:
A few examples of successes:
I walked into a situation with two empty 11 story towers, 120,000 employees of Ministry of Health, 240 hospitals, 1200 clinics, employees not paid for 3 months, a $16 million budget. I got the administrative staff back into the building within 45 days.
-got the enterprise moving ahead and responding, with some momentum.
-worked with and through the Iraq staff...and had to move quickly since top leadership of the Ministry of Health were out of the ministry before I got there by CPA (Coalition Provisional Authority that governed Iraq after the invasion) via de-Ba'athification programs.
-responded to outbreaks quickly and effectively.
-switched the mind set of health care from hospital and prescription focus to prevention and primary health care.
-co chaired with Dr Jaffari (ex-prime minister) the 2003 Hajj...over 44,000 Iraqis went.
-successfully orchestrated with the Minister his agenda with the complexity of the various ministries and senior advisors and CPA leadership.
-completed immunizations successfully.
-worked with Iraqis to complete first budget.
-left with Ministry of Health budget of excess of $1 billion in Iraq funds.
-worked with Iraqis to write a basic mental health code and worked successful and still do with mental health/substance abuse national advisor and Iraq based Ministry of Health team.
-formulate a basic health advisor team of civilian and military personnel (from Holland, Italy, South Africa, USA, Romania, United Kingdom) health affairs of Pentagon did great job in providing rear support to our team - a real plus for our team's talent.
-was the first Ministry to be handed over by CPA to the Iraqis.
-having my own security team as funded by Ministry of Health. I was able to travel and spend many nights in Iraqi homes or out in Baghdad with Iraqi leaders and Ministry of Health staff.
-was at the ministry every day and toured and visited throughout the country providing encouragement and problem solving.
-took Kimadia (the government pharmaceutical importer) from a stand alone department within Ministry of Health to being part of Ministry of Health under direction of the Minister of Health.
-assisted in getting security at hospitals and ministries functioning.....and under the management of the Minister of Health. I got basic supplies addressed.
-supported various professional groups to form...nurses, specialties.
-worked to support and expand resources of medical schools .... training materials and books and technology.
-brought in computers to assist.
-had a fine working and personal relationship with Minister of Health.
-advocated for mental health and substance abuse funds allocated for the first time
-utilized CPA funds for extensive remodeling of administration campus and basic repairs at many hospitals.
-did full assessment of all Ministry of Health holdings (engineering and architectural)....and participated in donor conferences with Minister.
-held first planning conference in August 2003 with Ministry of Health, European Commission, case, World Bank, WHO, UNICEF, Red Crescent, Red Cross, combined j-7 task force, Abt, USAID and regional Iraqi representation. We started the agreed 10 planning areas which took place over the subsequent several months.
-closed 50 nursing schools run by the Ministry of Health that graduated nurses ..9th grade plus some training...this increased the image and education levels of the nursing profession.
-teaching of management techniques to Iraqi Ministry of Health leadership.
-brought in team members to work with Iraqis in areas of disease surveillance, tracking and assessment, EMS (??), primary health care goals ...decrease infant mortality and several others.
-worked with NGOs to fund projects that fit Ministers objectives
-submitted supplemental request to US Congress as approved by the Minister of Health
A few examples of challenges:
-the lead of reconstruction should have been Iraqi contractors with funding from NGOs and governmental sources via contractual management program that was Iraqi run.
-operations was always a challenge in conversation with governorates. Next time I would more aggressively work with military to share some of their communication assets.
-should have advocated early on for Ministry of Health training academy for refreshing Iraq skills in planning and financial management....and setting benchmarks and measurable objectives.
-move quicker to establish more Ministry of Health managed community education and training programs...however many of it was being done by Abt and USAID and others.
-should have advocated harder for U.S. military having throughout Iraq to have common objective for health funding ...each command had different funding strategy...often not coordinated with Minister.
The Red Cross and Red Crescent were always partners. The Red Cross left the country after bombing in late summer early fall 2003. We always planned and traveled with the Red Crescent. In fact Dr Hakki who worked with our team went over to be the director. One of the colonels with our team traveled to Turkey with Dr Hakki and others to work on donations to Iraq.
As you know our team worked hard to work with and through the Iraqi leadership in government and at the ministry. We were all leaving but they were staying. As you know that political process had to have its own character and identity and I respected that. I believed as have all the Ministers at the Ministry of Health that they are they lead for health delivery and strategy for Iraq. They will work with the donor community and advisors and consultants to set the pace and all NGOs and others will follow the basic objectives/goals of the Ministry of Health. This isn't easy work but they will be successful in time.
After we left the insurgent activity increased and they targeted increasingly the health system. Saddam used the health system to his benefit and decreased funding to blame the sanctions. In 1964 Iraqi doctors I worked with were doing kidney transplants in Iraq. Its where folks in the Middle East went for health care and it was completely reversed during the ex dictators reign of terror. The health system of Iraq will come back, investment will take place one things settle down. Its just a matter of time - 10 years from now plus they will again become the system they desire to be.