Israel’s Health Ministry is heading into winter after nine months in which its staff increasingly suffered from burnout, friction with the political establishment, daily criticism by the public – and a wave of departures by key officials that have left important managerial positions vacant.
The departures have hamstrung the ministry’s day-to-day operations in areas that are not necessarily related to the coronavirus pandemic. They have weakened its capacity to control the entities that provide medical services, and have also made it difficult for the ministry to stand up to political pressure over policies related to the crisis.
In addition, in the midst of the pandemic, the ministry has been forced to transfer part of its authority to other government bodies, such as the Israel Defense Forces Home Front Command. In the near future, an outside spokesperson’s office will be handling dissemination of information relating to COVID-19 policy. That arrangement is the result of an understanding that the crisis will remain on the scene here for at least another year, but also a reflection of the erosion of the staff of the ministry and its weakness.
One of the most recent departures was Itamar Grotto, deputy director general of the ministry, who announced his resignation a week and a half ago. Prof. Grotto, the last surviving member of the senior staff that handled the first wave of the virus earlier in the year, was considered a central figure at the Health Ministry, and news of his departure was unsettling. Among the exodus of the top ranks, Grotto was preceded by Director General Moshe Bar Siman Tov and the ministry’s director of public health, Prof. Siegal Sadetzki, who have since been replaced.
In addition to those three prominent figures, there have been a number of other resignations for various reasons of key people who are less known to the public. They include Avi Ben-Zaken, the ministry’s senior deputy director general and head of medical institution development, planning and construction; Dr. Erez On, head of the government hospital division; On’s deputy, Shlomo Pashkos; Morris Dorfman, head of the department of regulation, digital health and information systems; Nir Keidar; deputy director for strategy and economic planning; and Revital Topper, deputy director of the department supervising HMOs. Some of these positions are still vacant.
The resignations come at a particularly difficult time as the country heads into the winter. Ministerial staff have expressed concern over the upcoming season of influenza, and the strain hospitals and community health clinics could face due to the similarity between its symptoms and those of COVID-19.
In any event, health care officials hope as many Israelis as possible will get flu shots. The ministry also hopes that the public will weather the flu season relatively well by observing the same practices that are essential to curb the coronavirus – including wearing masks and social distancing.
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Unrelated to the pandemic, the wave of departures at the ministry has weakened its ties with the country’s four health maintenance organizations, the strongest players in the medical establishment.
“The problem is what remains of all of the fields the ministry is supposed to routinely deal with when the coronavirus subsides, and how it will look the morning after,” one former senior ministry official said. “The ministry has developed a very determined regulatory approach toward the HMOs. The current period, however, has led to a regression of many years – going back to the days when in reality there was an HMO that had a ministry and not a ministry overseeing the HMOs.”
At the Health Ministry too, people are saying that control over the HMOs has eroded, that some of their colleagues’ positions remain unfilled and that some of those who have left are now working at the HMOs. Some of the HMOs are taking advantage of the ministry’s diminished standing to advance policies that don’t necessarily benefit the public, sources warn.
“There are a lot of underhanded moves – particularly by the HMOs – now that there isn’t a deputy director general tasked with supervising them,” one health official said. “All kinds of things have been approved for them due to COVID-19 and they are taking advantage of it.”
Early on in the crisis, for example, the ministry allowed the HMOs to schedule oncology treatments on a single day at the hospitals instead of spreading them over a number of days.
“However, there are cases,” the official continued, “in which that’s not appropriate from the standpoint of medical protocol and doctors in the hospitals want their patients to come in every week, but then the HMOs refuse and have to wait for ministry approval for one of the treatments, and that negatively affects treatment.”
“The feeling is that other than the coronavirus, everything is stalled,” another ministry source said. The political situation and the absence of a state budget are also affecting the ministry’s work, which in normal times would be focused on drawing up a work plan for next year, he added.
“The ministry is facing uncertainty,” he said. “Without a budget and the ability to know how the coming year will look, the ministry is in a very problematic position. Projects are stalled.”
According to a health official who works with the ministry, “there are currently two main problems there. The first is that a number of important positions are vacant. The second problem involves the people who actually remain.” There are many excellent workers at the ministry, he acknowledged, “but the absence of some of those who have left is very apparent.”
The current Health Ministry director general, Chezy Levy, was appointed in the middle of the pandemic.
“Prof. Levy took over during a very problematic period,” one ministry official said. “During routine times, the director general works with the health minister and that’s it. In this instance, he’s also working under a large number of [other] officials with many demands, and must answer to a large number of people, including the [coronavirus] cabinet, the prime minister, the National Security Council, etc. That leaves him with very limited ability and time to lead and manage the ministry.”