Public servants salary hike, productivity

improvement and lessons from Dompe eHospital

Project

A mega salary increase to public servants- February 2,

2015
A mega giveaway offered in the Interim Budget 2015, presented to
Parliament last week, has been the proposal to increase the salaries of
public servants across the board. In terms of this proposal, the salary
increase of Rs. 3000 given in the Budget 2015 presented in November last
year is to be topped up by a further Rs. 7000 in two stages Rs. 5000 from
February 2015 and the balance Rs. 2000 from June.
A physician diagnosing a patient at Dompe Hospital
This top-up proposal is estimated to cost an additional Rs. 88 billion. A
salary increase of this magnitude has been justified on the grounds that it

would produce a team of satisfied public servants who have been agitated
by a marked erosion of real purchasing power due to increases in the cost
of living not matched by a compensating salary increase in the past.
There is an element of truth in this argument. For instance, a typical basket
of goods consumed by a family and contained in the Colombo Consumers
Price Index had cost Rs. 27,972 in 2007. The same basket has nearly
doubled to slightly more than Rs. 50,000 by the end 2014 when the public
servants salaries on average had increased by less than 50% during this
period according to the Central Banks nominal wage rate indices. Hence, a
need has arisen, it has been argued, for a mega salary increase.

mChannelling at Dompe Hospital

Salary increase is given by the public in the expectation of

better services
There is a general belief that this salary increase was given
by the Government, but it was not. On the contrary, it was
given by the public who will ultimately bear the bill as
taxpayers. They will have to make available the needed funds
by paying taxes or agreeing to forego some of the existing
public services or handing their savings to the Government as
loans or a combination of some or all. Whatever the method,
it amounts to a sacrifice of their consumption. Why should
they choose to make such a sacrifice on behalf of the
countrys public servants? That is because the public servants
have to give back what has been sacrificed by the public by
way of improved public services.
These improved public services come from an increase in productivity and
increased productivity comes from inventions and innovations. Inventions
and innovations come from the acquisition of knowledge, skills, talents and
competencies by public servants.

Initial advice

productivity in the public sector is a must

The increased salaries will place public servants in a comfortable, worryfree and satisfying position. But it also inflicts a new obligation on them.
That obligation is to improve their productivity and provide a better service
to the public.
For instance, a teacher who gets the salary increase should acquire new
knowledge, provide higher wisdom to students and help produce a more
talented citizen to the country. It, therefore, comes from teachers learning,
training and knowledge acquisition. Hence, the improvement in productivity
is on the other side of the balance sheet that has recorded the increase in
the salaries of the public servants. Recognising this vital requirement, the
Minister of Finance, Ravi Karunanayake, put it in the Interim Budget 2015 as
follows: I call upon the unions, public servants and all stakeholders of the
public sector to improve the productivity to be on par with the standards in
the Asian region. (available at: http://www.ft.lk/2015/01/30/100-dayrevolution-mini-budget-in-full/ ).
An increase in

Age is no barrier to using IT

A conscious public policy to improve productivity is needed

But the improvement in the productivity of public service does not come
automatically in response to a request made by a political authority. It
comes from a conscious public policy program which aims at improving the
productivity of public service at all levels.

pharmacist at work at Dompe Hospital

It is therefore a matter for the Ministry of Public Administration to formulate
such a public policy supported by the new Ministry of Policy Planning and
funded by the Ministry of Finance. In formulating such a policy it is
necessary to identify the distinction between invention and innovation.
Invention means creating something anew; innovation means making use
of those inventions in a practical situation to ease the life of the public.
Hence, inventions are the work of true creators. Innovations are the work of
entrepreneurs who will put them into commercial use. Accordingly, in the
case of public service, those who are engaged in innovations should act like
real entrepreneurs.
A

Private entrepreneurs have incentives for introducing innovations

In the case of the private sector, an entrepreneur is a person who takes risk
in using financial, human and physical resources to produce an output with
a view to selling in the market for profit. His survival and sustainability
depend on his ability to continue to
make profits.
He faces competition from his
competitors and therefore he has to
introduce innovations continuously to
remain ahead of them. It requires on his
part the abandonment of old systems
and introduction of new systems. He
has no particular love for any system. If
the prevailing system does not serve
him, he does not grumble about
abandoning it for a better system. Thus,
the movement from old unusable
systems to new usable systems should
take place as a continuous process.

Public sector innovation efforts should come from the political machinery
In the case of the public sector, there is no profit element and therefore
there is no incentive for public servants to introduce innovations for
personal gain. Besides, they have permanency in employment and do not
face the problem of survival as in the case of private sector entrepreneurs.
However, the politicians who are elected for a given period are different
from public servants. They have a personal interest in introducing
innovations because if the innovations are successful, they can go before
the electorate with a strong claim for re-election. Hence, the initial initiative
for introducing innovations to improve productivity in the public service
should come from the political machinery. Yet, the political machinery
cannot implement them on the ground because it has to be done by public
servants who are dispersed all over the administrative system. As a result,
to motivate the public servants to introduce innovations and through them,
improve productivity, a proper incentive system has to be set up by the

political machinery.
Such incentives can take the form of
accelerated promotional prospects
and special salary increases on the
basis of the success of the
innovations introduced. After such a
system has been

put in place, it is necessary to

appoint some selected public
servants who have to function as
catalysts or change agents in
introducing innovations and ensure
that they will be continued till the
final goal of improving productivity
in the public sector is reached.

CIO experiment by PIM not used

A nucleus of such a team of
catalysts has already been trained
by the Postgraduate Institute of
Management of the University of Sri
Jayewardenepura drawing public
officers from all the ministries and
departments.
These officers, numbering 130, and
designated Chief Innovation Officers
or CIOs, have completed a Diploma
in eGovernment at PIM funded by
the Information and Communication
Technology Agency or ICTA.
These CIOs were expected to go

back to their work places and function as catalysts in change management.

However, without support from the political machinery, these CIOs still
remain totally unutilised and consequently have ended up as a frustrated
lot over their inability to use the training they have received specifically for
effecting change management. Therefore, they can be mobilised at anytime
as catalysts in change management in the public service if there is
commitment by the political machinery for introducing innovations and
improving productivity in the public service.

Digitisation of Dompe Hospital as a private initiative

But, there is an exception. One such CIO with the support of the hospital
administration has on his own initiated a real change management exercise
in the Government District Hospital at Dompe.
In this exercise, the hospital, which had been operating on the basis of
manual records for decades, has been transformed into a fully digitised
hospital (available at: https://www.youtube.com/watch?v=-YqujXDfHHQ ).
Dubbed eHospital, the project has been supported by many: ICTA with
funding for computers, undergraduates of the University of Moratuwa who
have volunteered to train the staff and the hospital administration which
has carried the project on its shoulders until it has reached its success.
Financially, the project has cost ICTA less than Rs. 5 million. But when the
cost of the voluntary work is also added, the cost of the entire eHospital
Project at Dompe has been less than Rs. 10 million. But the benefits to the
patients, hospital, community and finally the Health Ministry have been
enormous.
The success story of the eHospital Project at Dompe Hospital
This writer, who has been a facilitator of the CIO training program at PIM,
had followed the progress of the eHospital Project closely. In order to assess
whether the project has been sustainable and identify what action is being
contemplated by the Project Management to improve its services further,
he visited the Dompe District Hospital last week. What he found was
evidence of a success story which could be replicated throughout the public
service in order to improve its productivity at a relatively low cost provided
that it has the blessings of the political machinery and there is a dedicated

change agent to carry it forward.

The first could come as response to the call by the Minister of Finance and
steered by the Ministry of Policy Planning. The second can be filled by the
130 odd trained CIOs presently scattered all over the public service without
being utilised.
Digitisation of operations from beginning to end
When a patient visits the hospital for the first time, his particulars are
captured into the server and he is issued with a barcode identity generated
by the system containing his particulars which he has to produce every
time he visits the hospital.
If for some reason the barcode is lost or misplaced, his particulars could still
be accessed by using other options: Name, NIC No., place of residence or
date of birth. Another officer scans the barcode identity and issues the
patient with a computer generated number for the days service. It also
specifies the room of the physician whom the patient should consult for
receiving the treatment.
The physician scans the barcode and accesses the file pertaining to the
patient stored in the server. It gives the full particulars of the patient. After
examining the patient, the physician enters in the relevant fields of the file
the diagnosis made, lab tests if necessary, prescription of medicines,
injections or immunisations prescribed or if it is a physical injury, the
treatments to be given in the dressing room.
To minimise the data entry, which takes time, a readymade menu listing all
options pops up on the screen automatically. All these are instantly
transmitted to the respective units of the hospital through an intranet. The
officers at the respective units are also able to access the patients file by
scanning the barcode and provide the necessary treatment for him. If it is a
lab test, the results of the test are added to the patients file and the
physician could access it when the patient visits the hospital subsequently.
The pharmacist, having accessed the file of the patient from the server,
issues the medicines prescribed by the physician with the necessary
instructions. When he enters the drugs issued, the system automatically
takes them out of the stocks enabling the hospital to make a drug
requisition order promptly.
For in-patients, the discharge sheet and diagnostic cards are also generated

through the system and added to the patients file. When the patient
revisits the hospital, his complete medical history is thus available to the
physician to make a holistic assessment of the patients status and decide
on the curative treatment.
The process has completely done away with the paperwork. A system has
now been introduced to get appointments by using mobile phones thereby
cutting down the waiting time of the patients significantly. This is indeed a
revolutionary innovation introduced to a local hospital in the country. What
it has achieved with its limited resources ranks on par with the excellently
digitised practices being used by modernised private healthcare institutions
in emerging countries like Thailand as presented by this writer in a previous
article (available at: http://www.ft.lk/2013/09/16/private-healthcareproviders-in-sri-lanka-should-benchmark-with-better-service-providersabroad/ ). By any standard, Dompe eHospital ranks higher than any of the
private sector healthcare institution in Sri Lanka.
Dompe eHospital project can be replicated
All the staff, including sanitary workers and ambulance drivers, has been
trained in the use of the computers. It is amazing that old officers who had
had the fear of even touching a computer have become proficient in even
accessing information from the internet today. It has in fact improved their
self-value, dignity and confidence.
Patients too have now become familiar with the use of IT in delivering an
efficient service to them at the hospital. Its side benefit is that the local
community has now become IT savvy, especially in the use of the social
media and email communications. The Dompe eHospital project is a
success and could easily be replicated in all the hospitals in the country.
The costs involved could be accommodated under the Governments
enhanced budget for health services at 3% of GDP.
Learning lessons from eHospital Project
There are a number of lessons that can be learnt from the solitary eHospital
project at Dompe Hospital. First, officers in the public service are trainable
provided they are given right types of incentives.
Second, one catalyst can effectively implement an innovation project. Third,
costs of introducing innovations are not that high. Fourth, every rupee

spent on innovations brings back more than one rupees worth to the
public. Fifth, there is no need for reinventing the wheel and the existing
knowledge can be tapped for introducing innovations and improving
productivity.
Spend money on capacity building of public servants
However, the campaign for improving productivity requires funding for
training and capacity building of public servants. This can be
accommodated under the current plan of the Government to increase the
education budget to 6% of GDP. At the current GDP level, this amounts to
about Rs. 600 billion. Education involves improvement of human
knowledge, talents, skills, capacities and competencies. It should be done
through formal education, research and training. Hence, the training of
public servants could be accommodated under the current education
budget of the Government.
Public servants have now been given a thumping salary increase. It can be
vindicated if and only if there is a commensurate improvement in the
productivity in the public sector.
(W.A Wijewardena, a former Deputy Governor of the Central Bank of Sri
Lanka, can be reached at waw1949@gmail.com )