Dr. Celinah Sefako, Public Health Specialist, Lesotho

“What is needed is empowerment of the level of directors and district health managers, to be the professionals many of them wish to be: not scared to critically speak out on technical grounds.”

There seems no doubt in Dr. Celinah Sefako’s (47) mind: “Governance is about leadership. And leaders should be workers before they lead. Leaders should go to the field and be approachable by those working there. They should see things, really be there.”

Early this year, Dr. Sefako made her way back to the Lesotho Ministry of Health (MoH) as Public Health Specialist. A dentist by training, but “A public health specialist by passion” as she describes herself. “I was not happy doing merely clinical work. I loved the public health side of things, hence I got my Masters in Public Health in 2006 in South Africa, specialising in health policy and management.” 

With a smile on her face, she talks about her ‘jack-of-all-trades’ existence over two decades of wide-ranging experience in the health sector. She moved up the ranks from district level to working in a referral hospital (then Queen Elizabeth II Hospital). 

“In 2007, I entered the MoH headquarters in Maseru, where I became Director Oral Health Services for about 8 years. I also acted in the offices of Director Clinical Services for two years, overseeing the performance of district hospitals and leading supervisions of the clinical technical team of the MOH Headquarters for monitoring and evaluation of services. 

“For a very short spell, I acted in the office of Director General of Health Services. I discovered that being a director in an office is good but not enough for me. If I don’t get to be there where things are really happening, I feel out of my element.”

All in all, there are indeed few hands-on civil servant tasks Dr. Celinah has not performed. 

“I participated in hospital, DHMT and Health Centre Performance Based Financing evaluations, have trained district teams and communities, organizing and implementing district services, have executed operational research.  

“As a manager at central level, I took part in development of numerous policies, strategies, budgets, staff development schemes, relation management and stakeholder coordination schemes. I am a member of the National Emergency Preparedness and Response Team which deals with preparedness of health emergencies and other disasters and supervise national surveys.” 

A lot of work, indeed, “But what I’m still most proud of is the initiation of a Dental Therapy Program at the National Health Training College of Lesotho, the first in country. It took oral health team and myself many years for the programme to start but it eventually started in 2016 and is now firmly established and training pupils.”

It was her energy, which took her out of the Ministry in 2015, when she was engaged by the Lesotho Millennium Development Agency (the Lesotho follow-up of the US-funded Millennium Challenge Corporation) as their Public Health Specialist. Here, she was tasked to assist reform efforts, empowering the private sector. 

“It was hugely stimulating to work for this parastatal. The work was organized, the leadership firm which provided professional autonomy to meet clear targets and deliverables. I felt great.”  

Returning to the MoH in January 2017 gave Dr. Sefako a lot of food for thought: 

“In our political arena lately, there have been too many changes, government changing after two years. This has impact on the leadership and on the continuity of policy. We are faced with individuals performing functions of Director Level, but without proper position officially attached, leaving people in uncertainty. 

“At district level, people that lead the district health teams should also be capacitated to be stronger and consistent leaders and not doctors fresh from school, assuming roles in districts that should be given to slightly more experienced people.

“The leadership should appreciate what is actually happening on the ground to enable sound and appropriate decision-making.  There, they would see, what in the private sector I also experienced, as practices that should be transferred to our advantage to the public sector: 
a) to give local health workers and district management people proper training on governance; 
b) to have proper assessments and competition on merit for jobs; and
c) to strengthen workers expertise in finance, monitoring, human resource capacity, performance assessment.” 

“In the end, for governance, the top-level jobs in ministries are very important but are political appointments so they come and go. What is needed is empowerment of the level of directors and district health managers, to be the professionals many of them wish to be: not scared to critically speak out on technical grounds.”