Doctors Without Managers

A couple of years ago, residents of Rwanda’s Bugesera region thought of their hospital as a death trap, and not because it was understaffed or underfunded. Its director was simply incompetent, and everybody knew it. Just months after a new director came to the rescue, patients began streaming in. 

Columbia University public health professor Josh Ruxin shares this anecdote in Democracy (Summer 2008) to illustrate a little-discussed problem: A shortage of good management, not of energy or passion or equipment, is often what stifles progress in public health. 

“For too long, doctors have run the public health establishment,” Ruxin writes. Docs-turned-directors often lack the business sense and management skills needed to run successful programs and clinics. “We need less do-goodism, and more do-it-rightism.”

As global public health programs expand, infused with donor funds from high-profile campaigns against AIDS, malaria, and other diseases, they’ll need to start taking strategic cues from the private sector. That, Ruskin argues, means venturing outside the field’s traditional Good Samaritan comfort zone to seek “the sort of perspective economists, sociologists, management consultants, and even poli­ticians can bring.”

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