Ugandan Management- it’s not Drucker

Not like IBM? Call for Drucker?

Quite a bit has been written about management outside of US or Europe.  However, the focus has been on the big trans-national businesses, the IBMs, HSBC’s.  Even the big Non-Governmental Organisations (NGOs) like Oxfam and Save The Children seek business wide standards across the globe.  But down at the level of local NGOs and faith based organisations management looks quite different.

My wife and I worked in a faith based hospital in Pakistan in 1978, Nepal 1986-89, in 2008-2010 in rural Uganda and visited hospitals in India.  Though quite remote, the hospital in Uganda was not a small place. It comprised of a 240 bed hospital, over 300 staff, a primary school, school of nursing, a hydro-power company, a large child sponsorship programme, and sundry other projects.   I was responsible for group finances and was on the management committee.

Two steps from prosperity – one step from disaster: Poverty and Insecurity

It is easy to underestimate the knife-edge people travel along. Working alongside educated colleagues with their qualifications, degrees, and excellent English, it is easy to underestimate that poverty and insecurity cast a shadow over all of the staff at the hospital. Uganda has experienced significant economic growth. But also high inflation. Many feel they are just two steps away from success.  But they also feel they are just one step from disaster.  A sudden illness. Redundancy. A road traffic accident, riot, crop blight, flash flooding can suddenly turn bright hopes to dust.  As a consequence staff are always on the lookout for extra opportunity, for extra money.  This could be additional work that brings with it an additional allowance.  Or it could be from that overseas donor they know well, who will put a little personal money in addition to funding the work they do.  This thinking operates not just at the personal level – it also operates at the institutional level with management being reluctant to turn down offers of money for unwanted projects, for fear of losing what’s on offer completely.  The wishes of the donor hold huge sway for example there was a situation in which the hospital accepted money for incubators which were not needed as the donor would not donate to other items which the hospital did need.

Just-In-Time Planning

Planning? More a case of Just-In-Time.  In an environment where uncertainty is far more certain than in Europe – where serious illness, storm or a visit from the Ministry of Health can strike with no notice whatsoever – then that Five Year Plan begins to look ridiculous. But the reverse is true too. With no serious distinction between home and work, people can be, and often are, mobilised at all hours at the very last minute – to make stupendous efforts to get things done at the very last minute.

The Foreign Factor

From our experience in Pakistan and Nepal, we were aware that money speaks loudly but the issue in Uganda was greater than expected.  See separate article on Giving A Hand – Volunteers.

Management or Mama/Papa?

Underneath the collective consensus, the fear of factions and plotting is endemic. Management styles that are essentially based on family and clan, do not work well with the demands of large and complex bodies like large hospitals. Nor in dispersed but linked bodies like Anglican or Roman Catholic dioceses or agencies[1].  An anxiety of the dangers of disunity moved staff to view the hospital, and indeed, the heads of department as surrogate mama/papa.  They do not see themselves as co-workers to meet client needs, but as members of a family with senior staff as the parents. The idea that the organisation exists firstly for the patient or pupil, and that staff come a distant second is not deemed self evident.

This leads to a staff collective consciousness that abhors disciplinaries and dismissals, hates pay differentials, and seeks to bury conflict.  For example, I had to face a case where senior staff salaries were well below the market rate and there was a serious threat of catastrophic staff loss.  Management had to agree to significant rises of top pay scales. This quickly led to cries of “this is unfair on us”, as my national colleagues expected.  This was most acute from those in the next tier down. The argument that market forces really did bite here in Uganda, was not considered valid. The non-medical staff felt they were being forgotten, again.

There is pressure on the hospital to give staff loans, despite ready facilities from a local bank.  When a staff-run savings scheme went bust through fraud, management was blamed, though none were on the managing committee of this staff scheme.  And even though management was blamed, they were called on to run the scheme as part of the hospital for the benefit of all staff. Management, like Mama/Papa, has to listen to the cries of the staff, and give extra on top.

Is using the phrase “management or mama/papa” being unfair? Or just contentious? It is fair, and was actually used.  For instance, when buying myself a samosa in our busy office, my staff called on me to buy them all one too, not as a treat for doing some difficult work, but as a right. I asked why this was so. I was answered “because you are our father, and a good parent feeds his children”.

The drizzle of foreign money unwittingly fed this paternalistic model. Small foreign church or personality based charities rely on developing key relationships with one or two persons on site. Considering significant amounts of money often was distributed though these de-facto agents, strong and personalised relationships developed. One manager actually called the Chair of one of closely linked supporting charities in UK, “Daddy”.  In British English, saying “you are my father” is a really strong and very personal thing to say.  In Uganda I heard it often, and as in this case, not from a junior.

The foreigner too often becomes complicit. They slip into the papa/mama role. For the “3^rd World Virgins” and “Holiday Time Missionaries” this is heady stuff.  Giving £400 to a charity in UK never felt like this: the huge and immediate positive feedback, the warmth and wave of gratitude. And £400 in Uganda, Rwanda, Nepal or India goes a lot lot further than it does in UK. The donor gets drawn into the lives of African or Indian normal families, in a way that giving to ex-offenders, the homeless or disabilities in UK is not so possible[2]. In terms of Transactional Analysis, the Adult-Adult relationship readily slips into Parent-Child[3]. We are not far from the worlds of paternalism and in a previous era- paternalistic colonialism, of the mind at least. Indeed, critiques of welfare provision say that just such a paternalism exists in UK too and it grows dependency[4].

When the donor organisation or key players work in Adult>Adult and the done key player(s) seek Child>Parent, then Crossed Transactions take place, meaning and understanding is retarded.

Public Collective – Private Conflict

It has been said that the while a European may state “I think, therefore I am”, his African counterpart might reply “Because we are, I am”.  In the hospital in Uganda, even with staff from quite different regions, there is something of a collective consciousness that tries to suppress all signs of conflict.

There is a very strong desire to avoid public signs of conflict, despite existing tensions and latent conflict.  Difficult decision, like sackings or disciplinaries, are avoided.  Or if they are taken, they are done so in haste, suddenly. As if to get the trauma over and done with.  The stress is on forgiveness, or nsaasire, delays tough decisions being taken.  This is strongest in institutions like ours with religious roots.  There the emphasis was on public repentance, not just of sin in general, but of specific sins. In response, the congregation was to forgive the penitent.

Knowing that new jobs for the ones sacked are not plentiful, does management really want the responsibility of getting a kinsman sacked?  What will his wife and five kids do?  And the one dismissed may not be friends with you, but he’ll be close to people who are. People are just more inter-connected than they are in UK.  The public collective consciousness will require conformity to the group’s decision.  Humanitarian and kinship concerns weakens the challenge on bad performance, and dilutes sanction. For an example, see the case study below:

Case StudyAn able supervisor sought to end the employment of someone still within their probation period.  The supervisor sought advice from the manager responsible for HR. In not wanting to take unpleasant decision and to give a greater chance for a positive outcome, the probation period was extended. Not once but several times.  The supervisor asked foreign technical expert on site, to do an independent and technically specific end-of-probation appraisal.  The appraisal was highly critical of the probationer’s medical competence. The probationer was upset and was foolish enough to send this foreigner a racist text. The supervisor suspended, on pay, the probationer, and asked management to dismiss the probationer. The manager responsible for HR was not happy at the actions the supervisor had taken. But the supervisor responded by clearly stated that retaining the probationer would make the supervisor’s own position untenable.  If Management retained the probationer, the supervisor would resign from being supervisor.  Then the supervisor and probationer presented their cases at a hearing, The probationer stated that he was sorry for what he had texted to the foreigner. After a long discussion, Management did not agree to dismissal of the probationer, but sought to undertake another appraisal, but from someone else, bringing with it another postponement.  Furthermore, Management heavily leaned on the supervisor in the meeting to change his mind and stay on as supervisor.  It was absolutely flabbergasted when he did not relent and resigned from being supervisor. The only action Management was firm and immediate about, was to censure the probationer for the racist text, not for months and months of alleged poor performance putting many patients recovery at risk.

Knowledge Management

It is said that gossip spreads faster than the internet in Uganda, but that is not true.  True, friendship networks are widely linked. But “knowledge is power”, or at least “knowledge is purchase-power” so gossip and information does not travel far. It is savoured only with close friends. It is not treated as a free good. Items of news that you’d have thought would be widely spread do not.

Larger hospitals are really groups containing various distinct components: a hospital, school of nursing, primary school, a guest house, a subsidiary company, or the like.  A hospital is a knowledge intensive activity, both technically and managerially.  Sharing knowledge might seem to be the order of the day, but the reverse is often true.  In UK, knowledge is usually freely shared. This is not only for the benefit of the business, also as a signal to the hearer of how clever the speaker is.  Knowledge has a status function that is demonstrated by expressing it.  In Uganda, it is much less shared.  Knowledge has a status function that is demonstrated by expressing it – only when really necessary and to someone really necessary.  The outsider trying to “gauge the mood” or “assess the consensus” of a situation, will get what people think the outsider wants to hear. You can end up in dangerous ignorance. The minutes of a management meeting may well express the collective expression, but well short of the underlying and unstated sum of knowledge

Delegation

If knowledge is not shared, nor is authority.  Distinctions between leadership, management and supervision are not readily made in discussion. But in practice they are understood – just that those who are called “managers” are really “staff supervisors”.  The “manager” has no freedom to act.  They are to ensure that staff turn up, and that instructions are passed on from above.  The real job of management is goes to the very top. Yet even here, freedom to act is limited.  Hiring, firing, disciplinaries, bonuses, budgeting discretion – these will have to be put to management-in-collective. The Management Team, the true locus of real management and leadership decisions.  Decisions are made by the senior managers together. Interestingly enough this was personally observed in an extremely large, prestigious hospital in India, as well as vividly experienced in Uganda.

Therefore decisions are passed upwards, up a set of steps: to the supervisor, to the senior manager, then to the Management Team.  There is a serious anxiety associated with the taking on of responsibility, as it is too often also linked with getting the blame, even for small things.  For example, see the case study:

Case StudyBusiness took me from time to time to other parts of the country for several days, or on UK deputation, for several weeks. Passing on the office and safe keys was a problem, repeated on each departure.  Subordinate staff, and also senior colleagues, who were trusted and respected refused to take office keys and safe keys respectively.  Despite my public protestations that I trusted them they were reluctant. A senior colleague was reluctant to tell me why (a conflict avoidance issue).  Later I heard it was about distrust arising from other senior colleagues, following from an unresolved past issue arising five years ago, which individuals avoided resolving. A supervisor also refused to take office keys, despite manager assurances of trust that the keys would be in safe hands, and that supervisor was the only sensible person to do the job. The manager had to depart, and the problem was only resolved when the Management Team in collective, insisted that the keys be taken. The root fear was an anxiety of responsibility should something go wrong (as they do in the normal progress of events).

Delegation upwards leads to congested agendas and extremely long meetings. Management meetings can take 5 to 7 hours, even into the next day.  And though there are minutes taken, with action points, they are not circulated in advance, nor policed with vigour.  For what is really important is not action tracking, the consensus and general agreement. Both approaches seek compliance, the former by a detailed-who-does-what, the latter by a general-who-knows-who[5].

Management Information – It Is In Your Head

Even in larger rural hospitals, there are computers, network, servers, satellite and internet to the outside world.  Staff IT skills are not strong, but they are fairly widespread and improving.  Yet, proper management information system are slow in arrival.  There is a computerised accounting system, and a payroll based on Access.  In Uganda, I produced HR statistics from downloads from the payroll system and financial reports from the accounting system, which have not been done before.  Full computer records for patient records or patient statistics were only just arriving.

Hitherto, much management is been done on a highly personalised basis. By senior staff acting as matriarchs or patriarchs. Cash flow management was done by simple recall from bank statements.  Indeed, people’s powers of recall are amazing.  Much that an MIS could provide, they already have a good feel for, which explains how such complex organisations could run in such a personalised manner. But as organisations grows in size, what was manageable for 90 staff is no longer sensible when you have 300, or 3000.

Finally

Traditional practices, or what was set up by the organisations founders, have worked surprisingly well over the years. But for the larger modern organisation, and in the face of donor expectations, the status quo cannot be tinkered with.  Yet, force feeding managers with new management guidelines or procedures would be a lazy recommendation.  Best practice is offered frequently by well meaning visitors and is politely accepted. Yet it remains undisturbed on a shelf, after the deliverer has departed.  There has to be a desire to use the best of the personalised approach combined with a rigorous implementation of existing procedures[6].  This does not mean Westernisation, but does mean moving from a village enterprise mind-set to practices already to be found in the big businesses existing in Uganda or in the best Indian NGOs.

 

(c)  Bill Lovett

May 2011, modified May 2015

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[1] An grim example of this in the public domain is Revd Kalimba Jered’s book “Church and Society in Rwanda” 2010, which describes church factionalism after the genocide in Rwanda. The horrors of 1994 did not draw churchmen towards the bigger issues in life.

[2] The Finance Act 2010 (UK) is likely to intensify this relationship. It has new rules for the donor to require the donee to give more detailed information to what purposes the money was actually use, and when, even leading to independent verification. Local management autonomy could be impaired further.

[3] Eric Berne “Games People Play” London 1966, and many others since.

[4] EG “Cameron must take this chance to end the giant evil of welfare dependency” Spectator 1/8/2010.

[5] Popular books like “The Bottom Billion” Paul Collier, London 2007, talk too readily about the Bad Governance trap. The move from a world built on relationships to one built on procedures is done when the populace moves from the village to the city, and the power of personal connections is residual.

[6] The tension between formal controls and the bonding aspect of social relations in managing NGOs are not Third World specific at all. EG Social Bonding and Formal Controls in an Australian housing NGO in “Social Capital: the role of management control systems in NGOs, Chenhall, Hall & Smith CIMA Research Executive Summary V6 No.6, 2010.

Bill Lovett 30th December 2011