| Border Bytes by Dan |
UNITED
STATES – MEXICO BORDER HEALTH ASSOCIATION
PRESIDENT’S REPORT TO THE
MEMBERS
56th Annual
Meeting
Monterrey, Nuevo León,
Mexico
June 3-5, 1998
PREFACE:
All of the items for action and the successes noted in this report are not intended to be interpreted as the effort of any one person working independently. The members of the Executive Committee and the Association staff should all collectively and individually be given due credit for the initiated and completed actions. Without a doubt, no actions would be possible without the PAHO-funded staff positions assigned to the Association, namely the Executive Director, the Operations Manager and Secretary.
INTRODUCTION:
In July of last year I accepted enthusiastically the responsibilities as your President. Concurrent with that enthusiasm I remained cognizant of and accepted the severe limitations of the position, the extent of problems confronting the future of the Association, the broad and overwhelming mission of the Association, and the complexities of action which is the nature of all binational endeavors.
During my eleven months of interaction with members and non-members alike I experienced the enthusiasm and energy of the many members and others, participating with them at the local level. It was because of this enthusiasm and energy that we must continue to move forward for the benefit of all in ways that are practical, deliberate, and in all instances, results oriented.
Keeping in mind the rule of practicality and the comments and advice of many members I was determined to plan my work and to be guided by a personal vision statement with particular attention toward a number of focus areas. My vision for these very short 11 months was to
Ensure that the Association and its members are in a position to confront the needs of the border community and to act decisively on those needs.
SUMMARY OF FOCUS AREA
PLANS AND ACTIONS:
In view of that vision, I identified and encouraged cooperative effort through the Executive Committee toward the following four focus areas. I will summarize specific achievements and results for each area as follows:
Focus Area:
1) To establish a framework for action among the El Paso Field Office, the membership and other public-private stakeholders.
Actions:
a) Completed an orientation of the Field Office and Association staff operations. Reviewed proposed and planned actions in conjunction with the obligations of the Association and the approved bylaws of the 55th Annual Meeting.
b) Completed a calendar review of meetings for the year and encouraged the continuing consolidation of calendars to maximize the opportunities for communication.
c) Encouraged immediate action on the planning meetings for the 56th Annual Meeting in conjunction with the schedule of the Executive Committee.
d) Requested public and media distribution of the approved resolutions in conjunction with scheduled meetings of the Binational Health Councils.
Evaluation:
One of the suggested first duties of the new Association officers should be to gain an understanding of the operations of the El Paso Field Office. It was difficult throughout my period of service to fully grasp the differing roles and responsibilities of PAHO and Association staff. It is not always clear what level of responsibility each has for supporting the Association and what the limitations of those responsibilities may be. This is not to be interpreted as the fault of any one individual, but of the structure that has been and still is in place. I suggest a more specific and focused orientation on all Field Office operations. This should include a description of the organizational structure and task responsibilities for each person. The officers should also be briefed on the PAHO planning objectives and their relationship to the Association objectives. We must consider what time it would take a prospective contributor to understand the “organization” and feel compelled in the end to support its mission. This scenario then leads us to a key question. Field Office staff are seeking support for which organization’s mission? PAHO’s, or the Association’s? Whose mission and strategies is the staff “selling” at any one time? It has not been clear. Again, this is not the fault of individuals, but of the existing structure. I am of the belief that having one Executive Director for both organizations is simply not the answer. It is an awkward situation for both the person and for the organizations. I submit that the institutional internal fragmentation of loyalty leads to an unintentional external perception of fragmentation. It helps no one.
Focus Area:
2) To establish a framework for strategic planning in all aspects of the Association.
Actions:
a) Conducted the first-ever “Strategic Planning Advance” during February 1998 in Cloudcroft, New Mexico.
b) Established the Advance Action Workgroup from the actions in Cloudcroft. The Workgroup’s first duty was to conduct a review of the bylaws and to propose changes at the annual meeting.
c) Initiated plans for a second Advance with focus on the Binational Health Councils.
Evaluation:
It was clear during the planning phase for the Advance that it was not going to be easy. For this reason it was important to have the support of the Executive Committee. I believe that this new step in strategic planning will go far toward encouraging more specific follow-up initiatives. The proposal for an Advance of the Councils is a good idea that was proposed at Cloudcroft and we should all work to support that proactive step. This forum served for many as the first opportunity to engage in broad discussions on the mission and objectives of the Association. I believe it was helpful. I believe it was an investment well spent. The Advance should be repeated at least every five years in this form. I also recommend that the Field Office staff conduct a mini-Advance as an internal organizational management approach for the discussion of the essential issues.
Focus Area:
3) To engage more directly in the assessment and evaluation of the Association’s organizational structure.
Actions:
a) Supported the drafting of a “Concept Paper” on the self-sufficiency of the Association. The paper was distributed widely and its
points were discussed in the forums in Cloudcroft. The paper was an ambitious undertaking, was well structured and
was an indication of the new openness that can be possible in the transparent
discussion of the issues.
b) Completed the distribution and analysis of a membership
survey on the issues impacting primarily on
the organization of the annual meeting and the general future of the
Association.
Evaluation:
I believe that the concurrent actions in the completion of the Concept
Paper and the membership survey were timely and necessary. It is critical that this type survey be
completed at least every three years.
It is also important that an evaluation mechanism for the annual meeting
be established that will support the constant improvement to the benefit of the
members. Additionally, the Concept
Paper should be updated and distributed by September 1998. It should serve as a living document for the
discussion of issues and actions on the future of the Association.
Focus Area:
4) To focus on the improvement of all operational mechanisms, such as the means for communication with the membership and new efforts to improve the marketing and public information activities of the Association.
Actions:
a) Encouraged the improvement of the membership databases that will allow for greater clarity in the membership records of the Association.
b) Ensured the distribution of the membership lists to partnership offices on both sides of the border that would encourage more direct communication with members, in particular those members not from the border.
c) Supported the implementation of the Association Home Page.
d) Submitted articles to the ‘News’ publication for the January and April editions.
e) Supported the implementation of the Border Health Editorial Board.
Evaluation:
This area of focus is one that is closest to the membership. The value and credibility of the Association is won or lost in the quality of communication with its members, the quality and utility of its publications and in the quality of its posture and presentation to the public in general. The Association must establish a specific media and marketing plan. A press release that brings attention to the Association’s resolutions should be distributed no less than 15 days after the conference. I believe that there has been significant progress in this area overall, in particular the long-term potential of the Border Health publication. We should acknowledge that this has been possible through the contribution of the Editorial Board Co-Chairs and the volunteer members of the Board.
ASSOCIATION MEETINGS
ATTENDED:
Palomas/Columbus Council - August 1997
Executive Committee - October 1997; February 1998
Conference Planning Committee - October 1997; February 1998
California/Baja California Council - November 1997
Brownsville Council - December 1997
PAHO Headquarters Orientation - December 1997
Strategic Planning Advance - February 1998
California Legislative Border Hearing - February 1998 (By Eva Moya)
Palomas/Columbus Council - March 1998
Monterrey Planning Visit - March 1998
El Paso/Juarez/Las Cruces Council - May 1998
Evaluation:
The calendar of meetings for the binational health councils should be established by August 1 of each year. This should allow for greater planning opportunities among the Association officers to share in the meetings of the binational health councils. The above list does not include all the meetings and functions attended by the Vice-Presidents, Dr. Elba Cornejo Arminio and Eva M. Moya, LMSW. They attended functions on their own initiative and also through coordination with the Association staff. I can guarantee you that these were the hardest working Vice-Presidents ever. I commend and thank them for their contributions. I recommend that the incoming President visit the PAHO Washington office as early as possible. This was a very fruitful visit and will benefit all that partake of this opportunity. I sincerely apologize to Dr. Miguel Escobedo and Blanca Serrano of the Texas Department of Health Regional Office in El Paso. I was never able to fulfill my promise to make the visit to Ojinaga/Presidio area to participate in their well-attended binational health council meetings. Although not yet an official chapter of the Association, these two small communities probably have the most active council on the border. The TDH staff travels nearly ten hours to attend and coordinate this binational health council. I have the highest regard for their commitment, leadership and perseverance. We should do all we can to support them.
RECOMMENDED ITEMS FOR
FUTURE ACTION:
1) Complete a new revision of the Concept Paper for discussion at the Advance of the Binational Health Councils.
2) Review the USMBHA agreement with PAHO. Based on the proposed bylaws changes only minor language changes may be required to the agreement.
3) Review the USMBHA agreement with COSSMHO as was suggested but not completed during this year. This relationship could be very advantageous to the Association in the opportunity to open new venues for technical capacity and institutional memberships.
4) Work on a new revision of the Grant Policy for discussion by the Executive Committee. This is critical to ensure that the Association establishes the essential internal controls that protects its obligations and commitments only to those agreed upon by the Executive Committee.
5) Develop a definitive plan to promote the Institutional Membership program now in place. This effort could be very beneficial to the Association for the long-term.
OTHER SIGNIFICANT
ISSUES:
Four issue areas affecting the Association are so important that they require specific mention and discussion. These are the issues of governance, self-sufficiency, the relationship between PAHO and the Association, and the future of the PAHO Field Office.
I will discuss the issues of governance and self-sufficiency together because one is dependent on the other. Stephen Covey, the popular author of The 7 Habits of Highly Effective People, promotes the principal that “involvement is the key to implementing change and increasing commitment.” People will not commit to an organization that even unintentionally hampers their involvement. Involvement is the ability to affect change. It does not mean an opportunity to attend a meeting. The Association cannot even consider the possibility of self-sufficiency if its governance structure is such that the decision-making mechanisms are dependent on an external organization and a leadership group that meets three times a year, maybe. An organization that has a membership base of less than 500, but has over 120 elected positions. An organization that can’t decide where to focus its strategy, whether it should be with Conference Groups, Technical Sections, or Binational Health Councils. Improving the governance of the Association will bring about an improved capacity to be involved, thereby improve our chances for self-sufficiency. We have an opportunity at this meeting to make some adjustments, such as in the changes to the bylaws. Taking advantage of this opportunity can help to bring about increased opportunities for true change.
The relationship between the PAHO El Paso Field Office and the Association is one that has been discussed since the beginning of time. It is, as we so commonly say, time to smell the coffee. The best scenario as in all cases is to have a win-win outcome. The difficulty in the current situation is the complexity of role responsibilities that one notes of the staff, and the perception of conflict to the membership and the public in the mission, vision and strategies between that of the Association and PAHO. It is very difficult to discern the decision-making structures of the two organizations outside of the Association meeting functions. When does the Association Operations Manager answer only to the PAHO Executive Director and when can he respond to the Association President or Executive Committee? When is an initiative owned by PAHO and when is it owned by the Association? When can PAHO direct Association staff to work PAHO projects and programs without the concurrence of the Association leadership? It is absolutely essential to clarify this process. The current agreement between PAHO and the Association should be reviewed with the intent to clarify and improve on the issues of authority and responsibility, funding, supervision and direction, etc.
To follow that discussion, we have the issue on the role of the PAHO Field Office. I am concerned that the vision, mission and strategies of the Field Office have not been in concert with those of the Association or the border communities. There is concern throughout the border that the Field Office continues its planning posture without the awareness for the new capacities at the border. One of the more common concerns is that there currently is no mechanism for the continuing review and analysis of the actions and decisions made at the Field Office. There is no mechanism that involves anyone at the border or the leadership of the Association, in a form that is, transparent, objective, and focused. Why is the border at the mercy of unilateral decisions that affect our personnel, time and resources? Where are the checks and balances? Where is the oversight? I do have some recommendations. First, that a structure be established by the Federal governments that includes state and local representatives that establishes an assurance of review, approval and analysis of the Field Office actions and decisions affecting the border. Second, that a thorough review and evaluation be conducted of the existing programs and projects of the Field Office. And third, that the Field Office be precluded from accepting grants or contracts that compete with or are implemented without the concurrence of local or state health departments or other community-based organizations affected by the initiative. And, finally, that the Federal governments, notwithstanding the above recommended review, complete an immediate analysis of the strategies, goals and objectives of the Field Office in light of the proposed implementation of the binational Border Health Commission.
CONCLUSION:
In conclusion, I wish to thank the many contributors that have gone unnoticed or unnamed that have worked so admirably during this past year to make this a better neighborhood for us all.
I wish to again emphasize, as many of you have already heard me mention on numerous occasions, those “Principles of Practice” that I encourage for the U.S. – Mexico border region. First, that in every effort, initiative, program or project, that there be respect for the community, its people, its practices, its culture, and its history. Second, that in every aspect of our actions, we should promote a transparency of decision making on all primary issues. And, third, that we should always remember that success in our neighborhood for the long-term is based on the quality of our relationships, not of our technology.
I thank the members for having given me this opportunity. I hope that I have contributed in some small way to the benefit of our communities and the people that we serve.
Thank you very much.
Dan