The CPSP Governance & Management Mechanisms with an eye to the future

The current structure of governance in the College is a legacy of the time when the fraternity was small and the specialties few in number. It served the College well and is the reason why the College grew in stature, expanded both its repertoire of specialties and its reach in terms of spread across the country and the region. The very reason for the College’s good name was its ‘federal’ nature; this structure is now becoming a cause of dissatisfaction and annoyance for some of its constituents (i.e. specialties and fellows).

While there is good reason to persist with this federal structure as will be clear in the matter to come, it has become essential to alter and separate the systems of governance and management if the College is to meet the challenges of the future. The structure of governance was gradually but comprehensively compromised by the leadership of the past. In all fairness some semblance of separation of management and governance has taken place in the seven years between 2008 and 2015 but perhaps not enough to satisfy the constituents. Suffice it to say that the tussle between structures of governance and management is apparent when one looks at the constant and consistently high turnover in the posts of the College Registrar and Secretary. Such a rapid and similar turnover did not take place in the management structure of the Regional Centers where the Regional Directors (who are and should be management cadre) are part of the governance structure. Governance and Management are two different entities and a manifest difference between individuals appointed on either side must exist.

There are many reasons to maintain the existing structure of governance and introduce changes such that there is minimum opportunity for exploitation by external influences acting through proxy agents (Fellows in the shape of Councilors) wanting to gain a foothold within both the structure of governance and management for purposes of power and pelf.

It is essential that the Council retain its current structure as stated within its charter. Any attempt to change the stipulations within the charter will only afford an opportunity to modify the autonomous nature of the College. This autonomy is an absolutely essential foundation stone on which the progress of the College has been dependent. Any attempt to undermine this administrative and fiscal autonomy will be a factor that will most certainly impede and inhibit the growth and progress of the College in the future.

A classic example of what can happen when ill-advised and malicious change to any original charter is attempted is apparent in the case of the PMDC. Such a change was manifest in the form of the Parliamentary Act XIX that amended the original Charter of the PMDC; this act was surreptitiously submitted and then passed by a motley and scanty crowd of uninterested MNA’s within half an hour just before the break for Friday prayers in 2010. This amendment was and is now the basis of conflict between the CPSP and PMDC because it tilted the balance and encroached upon an area of function that had hitherto not been under the jurisdiction of the PMDC for 50 years. The College had been chartered in May 1962 and the PMDC and PMRC in July 1962 and the original charters separated the functions more or less explicitly. Since the authors and prime movers of the charters of all three institutions were the same they were careful to ensure that any areas of overlapping function and potential conflict were reduced to a minimum. This balance of function was unilaterally disrupted after 50 years without any consultation or negotiation and therefore there is good reason to suspect that there were ulterior motives and mal-intent that were the driving forces for the change and have since been manifest by virtue of acts by PM&DC.

For this very reason no change in the original Charter or rules of the College must be sought, instead the bye-laws can be added to or modified so that areas of function of the Council and management do not create any conflict or concern. A proposal to retain this autonomy yet modify the existing structure of governance is presented.

The college has 70+ specialties that it now caters to. The structure of the faculties that regulate the academic functions of each specialty has to be made distinctly more formal, transparent and participatory, it has not been so for over two decades and is not so at present.

The College Council is made up of 20 Councilors. The ratio of which has been limited to each province following litigation and arbitration by the courts in 1998. To seek a change in this ratio is going to be met with legal resistance or challenges that are going to be retrogressive as far as the College is concerned. It is therefore essential that this portion of the governance structure be left unchanged. Other aspects of the governance structure that are at present embryonic should be modified so that both the established and emerging specialties are empowered. This genuine empowerment would then assist the council in areas that it may not have the expertise in and thus permit timely implementation of advice and recommendations.

The process of the council divesting itself of certain academic responsibilities should have begun many years ago and should have been the priority of past councils. Unfortunately the importance of this gradual accumulation of authority by the council and its President (the Competent Authority) went unnoticed and the council members who while being senior and mature were unable to recognize or perhaps uninterested in exercising the prerogative of advising the President. This inability may probably have been because the presidential personality was unable or unwilling to listen to such advice in the first instance. The accumulation of power continued, such that the President and council have virtually become the managers of the College, relegating both the Secretary and the Registrar to the shadows, neither to be heard or seen. This was not the role envisioned in the charter of both these managing representatives of the College.

The Council has over the years been so embroiled in mundane matters of administration that it has failed to address thoroughly several important functions the chief of which are listed below:
1. The creation of systems that would support the evolution of robust faculties
2. Advise the council as to the creation of specialties
3. Create systems that would permit the innovation of evaluation systems
4. Permit the creation of surveillance or monitoring systems of supervisors, trainees, training sites, examinations, examiners
5. Devise strategies to standardize training in different locations
6. Modernize systems within the College to keep pace with the changing demography of trainees in various specialties
7. To ensure that the balance between specialties is maintained such that services and functions in healthcare centers are maintained as far as possible
8. To utilize training tools and methodologies to reduce the discrepancies between both training sites and individual trainees
9. Develop systems to review training programs and reaccredit institutions
10.Plan and develop for the future both academic infrastructure and centers to support the function
11.Create a culture of financial discipline whereby expenditure is budgeted in advance i.e. allocated rationally and not in an ad hoc manner
12.Create a system of evaluating fellows, guidance and grooming of young faculty in areas of interest to further the academic agenda of the College and specialties to the benefit of the country.

No matter what the basis of allocation of the twenty members of the College Council it will not meet the future aspirations of the College fraternity. In other words there is no equitable way to permit representation in the Council. The current mechanisms of coming on to the Council are extremely politicized i.e. the basis of projection of an individual is a wide variety of negativism (based on personal, parochial, ethnic, religious and other grounds) that is, everything other than the individual’s genuine academic ability or utility to the College are the criteria for selection.

Why is the struggle to get onto the Council so aggressive when the ability to contribute is so pathetic? In answer to the question one could speculate that this could possibly be a perceived (but false) sense of power, authority, recognition, achievement or fulfillment of an ambition; but this question can be answered best by those who are literally fighting, betraying fabricating, lying and concealing facts as they move towards their quest of getting on to the Council. The propagation of the objectives and image of the college is difficult to find amongst these reasons to get on to the Council.

In all honesty how can one who has spent their life doing clinical work and is barely aware of the issues (physical, financial and ideational) confronting the College be in a position to steer the ship of the college through the rough seas that are a constant in this country?

There have to be some tangible criteria for eligibility to be on the Council. These criteria have to be based on what is expected of the person when on the council. Clearly, just being a Fellow is not enough, just being old or young is not enough, just holding a rank is not enough and just being popular is certainly not enough. These criteria have to be tangible and listed by the Fellows of the College. Only when individuals make these criteria and fellows who present themselves as potential candidates’ measure up to them should they merit election to the Council.

Perhaps when the community was small, selection based on hearsay and perception was an adequate process (despite the lack of criteria). As the community has grown larger the criteria for selection have to be tangible and rational, not whimsical and vague, since the welfare, reputation and future of such a large community is at stake.

What needs to be looked at anew is the role of the Registrar who is the individual who leads the academic affairs of the College. When the College was small this was a manageable role now that the College has grown the role of the Registrar has to change. The various areas manage themselves and he orchestrates their activities and is the liaison between various departments and the Council and the Competent Authority (i.e. the President, who is at present the contact person and managing all the affairs academic and administrative of the College). While the Registrar and the Secretary of the College are now just administrative heads doing his bidding.

This implies that the management of day-to-day affairs takes up most of the President’s time while the ideas for change, plans for the future and managing finance to permit the implementation of new academic projects have little chance of being seriously attended to. This is the state of affairs at present.

The Secretary who is the administrative head of the institution is no longer able to function to maximum efficiency. The Secretary as administrative head of the College oversees more than fourteen Regional Centers. He has been relegated to managing the Head Office, because the Regional Centers are headed by Councilors who have access to the President and the Secretary can be easily overruled or coerced into performing a task out of turn or irregularly. This is not the only anomaly in the relationship between the Secretary and the Regional Centers headed by the Councilors, the Secretary being a functionary is also a passive member of the Council to whom he reports as an employee. It is not possible for him to demonstrate any independence when his reporting relationship makes him vulnerable to censure in the Council.

So how does the College progress when ensnared in these anomalous relationships that distract it from thinking and planning about its future?

There has to be some innovative thinking, administrative adjustments and creation of new arrangements that allow independent thought and implementation of ideas.

Where does one start?

1. With the Election process, this has to take place at a national level as stated in the Rules. What is not stated is the methodology and the time schedules (a minimum period has been prescribed not a maximum). Clearly this is an area which the College and its Fellows can use to their advantage and satisfaction. The Election can be conducted on-line. Fellows must be allowed the privilege of making their own decisions and executing them too. This can only be done at their convenience and the privacy of their homes or offices. The rare few who wish to cast their votes at the regional centers may do so as the electronic facility can be easily provided there. Such a system would do away with the current hypocrisy of pledging (promising) one thing and doing exactly the opposite. This is not acceptable behavior from an individual who is presenting himself for councillorship and is supposed to be honorable / venerable and a person of integrity.

The issue of tangible criteria that should be present in the nominee for Councillorship has to be developed and can be developed by asking the Fellows what they would like in a candidate and what they wish the Council to achieve. Nominees for councillorship could be measured against these criteria on the College website for all Fellows to see and evaluate three, six or twelve months prior to casting their vote.

The system of electronic voting has been indigenously prepared and can be implemented at a convenient time. (Details are available in another document).

2. The subject Faculties have to be developed. Faculties must not be created and exit at the same time as the Council. A Faculty group must work halfway with one council and halfway with the next council. Any specialty with more than 40 or 60 specialists/supervisors should be entitled to have a subject faculty. Specialties with less than that number of supervisors would be attached to a larger specialty group till they reached a critical mass. Faculty members may be elected from several/four tiers of Fellows in that specialty; for example tier 1: one to three years since fellowship (those with the highest marks in the qualifying examinations), tier 2: four to six years since fellowship, tier 3: seven years and beyond, tier 4: sixty years and older. Thus four representatives from each province could constitute the faculty of a specialty. The responsibility and tasks of each faculty group have to be clearly defined, they are:

• Review of curricular documents
• Evaluation of new training sites
• Inclusion of new supervisors
• Review of training programs
• Surveillance of trainee evaluation and performance
• Surveillance of supervisor evaluation and performance
• Structuring of the evaluation, certification criteria and methodologies for the specialty
3. Setting down the functions of the Council (while no mean task) has to be clearly outlined and can be debated; to begin with the following areas are worth seriously thinking about:
• Review of faculty recommendations and ratification
• Review of financial status
• Prioritization of expenses
• Authorization of expenditures
• Allocation of funds
• Review of faculty reports
• Review of annual departmental, regional center reports
• Employee salaries, appointment and retention
• Review and approval of new associations and projects
• Creation of Council sub-committees or working groups
• Future direction of the College with respect to academic programs, creation of financial reserves, etc.

Rizwan Azami.
24th February 2015.

Note: This article was written in February 2015 while I was on the CPSP Council and on reviewing and reflection the issues in the College continue as written up then. There is no doubt that comments and opinions will be forthcoming and these can be the welcome basis for change in the document and strategy that may come as a consequence.