'We have weak civil servants'

Ex-Health Ministry head Gamzu: Make urgent government reforms.

Ronni Gamzu (photo credit: Courtesy)
Ronni Gamzu
(photo credit: Courtesy)
The former director-general of the Health Ministry on Monday accused the government in general – and the ministry in particular – of having “weak and ineffective” senior civil servants. Prof. Ronni Gamzu, who left the ministry in June, is now working in Paris for the World Health Organization during a compulsory cooling-off period before returning to the medical establishment here.
Gamzu, who also has a legal degree, lectured Monday before the Center for Citizen Empowerment during a short home visit, and said the lack of governmental stability “is the main problem in advancing reforms here.”
For example, he noted, delays in implementing the reform of the psychiatric care system – giving responsibility for treatment to the health funds rather than the ministry and treating more patients in the community rather than in hospitals – continue, even though it was proposed by the Shoshana Netanyahu Public Commission on Reforming the Health System about a quarter of a century ago.
Responsibility for psychiatric services was transferred to the health funds in 2003, but then the government changed hands and everything was halted, Gamzu said. The reform was again taken up in 2007, but MKs opposed it because of pressure from the Psychologists’ Association. In 2008, another new government was elected.
Gamzu became director- general in 2010 and “studied the subject. I found that delays in the reform resulted in a waste of NIS 75 million a year.” By now, he added, “more than a billion shekels have been lost by the delays in implementation.” Gamzu left the ministry earlier this year because of disagreements with then-minister Yael German.
Gamzu noted that Israel is one of the most rigid of the OECD countries in its inability to carry out major changes. “There is no effective civil service.
The senior staff here are weak, with no advancement tracks, and the lack of political stability harms the ability of the public system. There is no modern management.
“People who run the state ministries are budget experts and lawyers,” he said, adding that at the Dead Sea Conference in 2000, the theme was “Why Aren’t Reforms Carried Out?” The reforms discussed then have not yet been fully or partially implemented.
Gamzu added that, since the reform in geriatric nursing for the elderly, introduced by the Netanyahu Commission, the share of retired people in the population has skyrocketed. There are too many authorities responsible for them, and they fall between the chairs. German, he said, did not advance this reform.
“To succeed in making reforms, one needs political and professional leadership. It is brought forward not only by the minister but also by the ministry professionals.”
He suggested using partners to push through reform. “One must be creative and determined, and if necessary, use the media as well,” Gamzu added. “Don’t be afraid of hurting your image, because it is only temporary.”
A “firm prime minister is the best key to reforms – such as helping children at risk – that involve several ministries,” the former director-general said.
When a representative of the Association for Freedom of Information who sat in the audience said she wanted to cooperate with the Health Ministry, but the ministry said it was afraid of lawsuits from restaurants. “What scares the ministries from providing the public with information?” she asked.
Gamzu replied that the ministries “function according to obsolete strategies on the provision of information to the public. Israel is in a non-adult position when it comes to transparency.”
Gamzu’s successor at the ministry, Prof. Arnon Afek, was asked to comment but declined to do so.