Decisions, decisions

In my tenure as a municipal health officer, there were two things that demanded much patience and diligent preparation.

One was whenever I would propose a project to the municipal council, in which case I had to write project proposals, talk to stakeholders and check with the budget officer, accountant and treasurer if my office still had enough remaining funds.

But for me, a more important and challenging task is this: deciding how to apportion the allotted budget for the coming year. It should be a well-informed and well-decided process, since a well-planned budget stands to benefit a lot of people.

The task of proposing a budget is one important application of decision science: what would influence an important decision, especially if people rely on it?

Another is deciding how much medicines to request from the health department. To give a backgrounder to this arrangement, in the Philippines, the funding and staffing of health offices at the municipal level have been devolved to individual local  governments. The national department of health (DOH) only provides technical assistance and augments resources by providing medicines and facilitating upgrade of health facilities.

One program the DOH implemented during my tenure was the Complete Treatment Pack program, in which medicines are packaged not by bulk nor individually; they are packaged with the goal of providing the complete course of treatment for patients, especially important for antibiotics.

For instance, a patient requiring amoxicillin, a medicine for bacterial infections, will receive enough medicine to complete the recommended treatment: three capsules every eight hours for seven days.

But this program has a list of drugs to request. For me, the difficulty of relying on previous health statistics to decide on this is the possibility of running out medicines if in case an outbreak occurs. This is why making decisions like this should also consider the context of the target communities: what are their potential exposures? What are their lifestyles? Would I have a good reason to get ready to treat many patients with non-communicable diseases?

Decision making is an essential skill in public health, and it should not just be made out of the desire to exert power: it should be based on what the community really needs.

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