Delegate functions

Published in El Pais, 22 May 2021.

When you think about improving productivity, there are many things to consider. For example, the delegation of functions. It would seem obvious, but many who have acquired a competence position that values their ability to function in the new role, do not have any decision-making power. Many bosses have the last word to decide everything, centralizing decisions even on the details that subordinates have been working on. This last word can be arbitrary, delay action and not be based on the analyzes performed.

An example is the vaccination strategy in Bolivia. This strategy is being managed through the direction of SEDES, an entity that is trained with professionals trained in forecasting the advance of COVID-19, coordinating the number of vaccination posts, how and who to vaccinate. However, when it is noted that people belonging to the risk age group are no longer being vaccinated, the SEDES must ask the Ministry of Health for the possibility of expanding the age group. This request involves letters, and others that delay a prompt response to a visible need by the regional headquarters. Meanwhile, many vaccines are being lost because they only last up to 3 hours after coming out of -18 degrees Celsius refrigeration, a necessary procedure to wait for people to receive their vaccine. These vaccines mostly require temperatures of -30 degrees Celsius, but can last up to six months between -10 and -18 (depending on the brand). This makes adaptation of strategies and rapid and evidence-based decision making urgent.

Another aspect that is observed is that, in the regions, many people have to stand in long lines to receive the vaccine when there are so many health personnel from different public and private health centers that would be able to collaborate in this campaign in order to advance more quickly with vaccination. However, the strategy that has been defined centrally cannot be adapted to the need or availability of collaboration that may arise. And why can’t the epidemiologists in charge or directors of SEDES decide? After all, the people in charge of the campaign also carry out these vaccination campaigns for rabies, rubella, etc. In the meantime, how many vaccines will they be lost? How many more people could be vaccinated? How much longer will the economy be closed?

In COVID-19, you can no longer have to ask permission from higher levels that are delaying productivity and the ability to vaccinate more efficiently. It is important to trust the health personnel and especially the personnel who are directing the regional health because their capacity will know how to make appropriate decisions for the visible needs that are not noticeable centrally.