Profile of a Vice-Minister: Leading under Constraints
The case narrator is doing research on the health sector in Portobello—an alias for a Central American country—and follows Vice Health Minister Jose Manuel Quesada as he implements several major policy reforms. In the capital Santander, Quesada is overseeing a transfer of authority of all hospitals from the Ministry of Health to the National Social Security System (IPSS). This transfer will involve a new focus on a rural health programs and preventative health measures. The case covers approximately 20 months in which Quesada must manage the policy reforms and engage major opposition in his own ministry as well as external resistance. In the cities, local leaders allied with unions and doctors oppose having their special benefits threatened by the reforms. Quesada begins the reforms in local areas that are not so entrenched and will benefit from the new reforms. Nonetheless major strikes soon break out against the reform. In the ministry the newly opened rural health posts suffer from a lack of coordination among health programs and are generally resistant to change. Quesada’s major internal rival the Technical Vice Minister supports this resistance. Facing both field and central office opposition, Quesada decides to take a vertical supervisory structure and ‘horizontalize’ it essentially creating a bypass to create his own information flow and leverage accountability. This circumvents the Technical Vice Minister and her resistant allies. At the same time the Vice Minister must coordinate a national nutrition plan for the country, negotiate a major nutrition loan for the ministry and convene a major conference on nutrition to gain information and build support for his government’s initiatives. As the multiple policies pile up the Vice Minister finds it very difficult to handle all the issues and personnel and hold the calm demeanor that marks his leadership style. At the nutrition conference he stumbles in his performance. After consulting with his Minister must faces a set of decisions about reprioritizing his approach to leading, facing opposition and investing in the strategies.