Ministers of Health
short-term tenure for long-term goals?
Keywords:
Leadership, Policy making, Health status indicators, Health policy, Decision makingAbstract
CONTEXT AND OBJECTIVE: Healthcare investments should consider short and long-term demands. The objectives here were to compare the average tenures of ministers of health in Brazil and in another 22 countries and to evaluate the relationship between ministers’ tenures and a number of indicators. DESIGN AND SETTING: Descriptive study conducted at Centro Paulista de Economia da Saúde (CPES). METHODS: Twenty-two countries with the highest Human Development Indices (HDIs) and Brazil were included. The number of ministers over the past 20 years was investigated through each country’s Ministry of Health website. Pearson’s correlation coefficient was used to compare the number of ministers in each country with that country’s indicators. The Mann-Whitney test was used to compare ministers’ tenures in Brazil and other countries. RESULTS: The mean tenure (standard deviation, SD) of Brazilian ministers of health was 15 (12) months, a period that is statistically significantly shorter than the mean tenure of 33 (18) months in the other 22 countries (P < 0.05). There was a moderate and statistically significant positive correlation between the number of ministers and mortality rates for several conditions. The number of ministers also presented moderate and statistically significant negative correlations with per capita total healthcare expenditure (r = -0.567) and with per capita government healthcare expenditure (r = -0.530). CONCLUSION: On average, ministers of health have extremely short tenures. There is an urgent need to think and plan healthcare systems from a long-term perspective.
Downloads
References
Ferraz MB. Reconciling 21st century temptations with 20th century resources and problems. BMJ. 2006;332(7545):861.
Ferraz MB. Dilemmas and choices in healthcare: let’s avoid taking the Ferrari off-road! Sao Paulo Med J. 2009;127(1):5-6.
Miranda AS. Intergovernmental health policy decisions in Brazil: cooperation strategies for political mediation. Health Policy Plan. 2007;22(3):186-92.
Alesina A, Rosenthal H. A theory of divided government. Econometrica. 1996;64(6):1311-
Available from: http://ideas.repec.org/a/ecm/emetrp/v64y1996i6p1311-41.html. Accessed in 2010 (Nov 9).
Plsek PE, Greenhalgh T. Complexity science: The challenge of complexity in health care. BMJ. 2001;323(7313):625-8.
Mintzberg H. Covert leadership: notes on managing professionals. Knowledge workers res- pond to inspiration, not supervision. Harv Bus Rev. 1998;76(6):140-7.
Gosling J, Mintzberg H. The five minds of a manager. Harv Bus Rev. 2003;81(11):54-63, 137.
Egger D, Travis P, Dovlo D, Hawken L. Strengthening management in low-income countries. Geneva: World Health Organization; 2005. Available from: http://www.who.int/manage-ment/general/overall/Strengthening%20Management%20in%20Low-Income%20Coun-tries.pdf. Accessed in 2010 (Nov 9).
World Health Organization. Towards better leadership and management in health: report on an international consultation on strengthening leadership and management in low-income countries. Accra, Ghana; 29 January – 1 February 2007. Working Paper No. 10. Available from: http://www.who.int/management/wp10.pdf. Accessed in 2010 (Nov 9).
Eitzen DS,Yetman NR.Managerialchange,longevity,andorganization effectiveness.Administra- tive Science Quarterly. 1972;17(1):110-6. Available from: http://www.eric.ed.gov/ERICWe-bPortal/custom/portlets/recordDetails/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ052618&ERICExtSearch_SearchType_0=no&accno=EJ052618. Accessed in 2010 (Nov 9).
Hambrick DC, Fukutomi GD. The seasons of a CEO´s tenure. Acad Manage Rev. 1991;16(4):719-42.
Finkelstein S, Hambrick DC. Top-management-team tenure and organizational outco- mes: the moderating role of managerial discretion. Administrative Science Quarterly. 1990;35(3):484-503. Available from: http://www.jstor.org/pss/2393314. Accessed in 2010 (Nov 9).
Monitoring human development: enlarging people’s choices. Human development índex. In: Human Development Report 2007/2008. New York: Published for the United Nations Development Programme; 2007. p.229-32.
Brasil. Ministério da Saúde. Sobre o Ministério. Galeria de Ministros. Available from: http://portal.saude.gov.br/portal/saude/Gestor/area.cfm?id_area=1358. Accessed in 2010 (Nov 9).
World Health Organization. WHOSIS: WHO Statistical Information System. Detai- led database search. Available from: http://www.who.int:80/whosis/data/Search.jsp?indicators=[Indicator].Members. Accessed in 2010 (Nov 22).
The World Bank. Country and lending groups. Available from: http://go.worldbank.org/D7S-N0B8YU0. Accessed in 2010 (Nov 9).
International Monetary Fund. Data and Statistics. World Economic and Financial Surveys. World Economic Outlook. Database — WEO Groups and Aggregates Information. Coun- try Composition of WEO Groups. Available from: http://www.imf.org/external/pubs/ft/weo/2008/01/weodata/groups.htm#oem. Accessed in 2010 (Nov 9).
Brazil Country Management Unit. Human Development Sector Management Unit. Pover- ty Reduction and Economic Management Unit. Latin America and the Caribbean Region. Brazil. Governance in Brazil’s unified health system (SUS). Raising the quality of public spending and resource management. Available from: http://bvsms.saude.gov.br/bvs/pu-blicacoes/brazil_gov_sus1.pdf. Accessed in 2010 (Nov 9).
Bola de Prata. Ranking placar. Revista Placar. Available from: http://placar.abril.com.br/bola-de-prata/ranking/. Accessed in 2010 (Nov 9).
Globoesporte.com. Futpédia beta: a memória do futebol brasileiro. Available from: http://futpedia.globo.com. Accessed in 2010 (Nov 9).
Jong-A-Pin R. On the measurement of political instability and its impact on economic gro- wth. Netherlands: University of Groningen, Faculty of Economics; 2006. Available from: http://congress.utu.fi/epcs2006/docs/D8_jong-a-pin.pdf. Accessed in 2010 (Nov 9).
Gordon GE, Rosen N. Critical factors in leadership succession. Organizational Behavior and Human Performance. 1981;27(2):227-54.
Henderson AD, Miller D, Hambrick DC. How quickly do CEOs become obsolete? Indus- try dynamism, CEO tenure, and company performance. Strategic Management Journal.2006;27(5):447-60. Available from: http://onlinelibrary.wiley.com/doi/10.1002/smj.524/abstract. Accessed in 2010 (Nov 9).
Cyert RM, March JG. A behavioral theory of the firm. Englewood Cliffs: Prentice Hall; 1963.
Hambrick DC, Mason PA. Upper echelons: the organization as a reflection of its top mana- gers. Academy of Management Review. 1984;9(2):193-206. Available from: http://www. jstor.org/pss/258434. Accessed in 2010 (Nov 9).
Miller D, Shamsie J. Learning across the life cycle: experimentation and performance among the hollywood studio heads. Strategic Management Journal. 2001;22(8):725-45. Available from: http://www3.interscience.wiley.com/journal/85005054/abstract. Accessed in 2010 (Nov 9).
Lucier C, Spiegel E, Schuyt R. Why CEOs fall: the causes and consequences of turnover at the top. Strategy + Business. 2002;28. Available from: http://www.strategy-business.com/article/20306?gko=bfb5b&tid=27782251&pg=all. Accessed in 2010 (Nov 9).
Lucier C, Wheeler S, Habbel R. The era of the inclusive leader. Strategy + Business. 2007;47. Available from: http://www.strategy-business.com/article/07205?pg=5&preview=1&psid=&ph=. Accessed in 2010 (Nov 9).
Taylor-Robinson DC, Milton B, Lloyd-Williams F, O’Flaherty M, Capewell S. Planning ahead in public health? A qualitative study of the time horizons used in public health decision- making. BMC Public Health. 2008;8:415.
Persson T, Tabellini G. The economic effects of constitutions. What do the data say? Cam- bridge: MIT Press; 2003. Available from: http://www.people.fas.harvard.edu/~iversen/PDFfiles/Persson&Tabellini2003.pdf. Accessed in 2010 (Nov 9).
Pande R. Understanding political corruption in low income countries. Faculty Research Working Paper Series. Available from: http://web.hks.harvard.edu/publications/workingpa-pers/citation.aspx?PubId=4806. Accessed in 2010 (Nov 22).
Summers L, Zeckhauser R. Policymaking for posterity. Faculty Research Working Paper Se- ries. Cambridge: Harvard University; 2008 p. 1-54. Available from: http://web.hks.harvard.edu/publications/workingpapers/citation.aspx?PubId=6537. Accessed in 2010 (Nov 9).
Corrigan J, McNeill D. Building organizational capacity: a cornerstone of health system re- form. Health Aff (Millwood). 2009;28(2):w205-15.
