Overview of Leadership, Management
and Governance
in Kenya’s Health Sector
First National Conference
29 January 2013
Progress to date
Dr John Odondi,
Head Department of Primary Health
Services
MOPHS
29 January 2013
Leadership and Management
• Various training programs were offered through
Galilee College, Strathmore, USIU, KMTC, KSG
(formerly KIA), KIM, AMREF, USAID, etc.
• As more members of MOH began to access
these courses and request support to attend
them, there was a greater need to document
the gap in leadership and management (L&M)
and develop a strategy with clear direction to
address it.
Assessment of Leadership Development Gaps for
Kenyan Health Managers
Conducted in 2007/2008 by MOH and USAID funding
through Leadership, Management, and Sustainability
(LMS) Project. The purpose of the Assessment was to:
• Objectively assess the perceived concern that
resources being sent into the health arena were not
obtaining maximum returns, possibly due to managerial
limits
• Assess the impact of various past ad hoc trainings in
management for health workers
Assessment Findings
1. Managers’ career expectations did not include
management or leadership.
2. Managers were appointed while inadequately trained.
3. Managers were unaware of training opportunities in
management.
4. Curriculum content, suitability, timeliness and a
practical approach to delivery were critical in
addressing the gaps.
5. Availability of training was extremely limited in
responsiveness to identified gaps and geographical
accessibility.
Assessment Recommendations
1. Pre-service training of those likely to take on health
leadership and management roles
1. Urgent remedial action to equip those currently in
health leadership and management positions
1. Institutionalization of leadership and management as
core competences to be sustained and continuously
improved
Actions Taken by MOH and Partners
• Leadership and Management was included as a
priority in each of the Health Ministries’ Strategic
Plans (2008-2012)
• At the request of MOMS and with wide stakeholder
input, three standard curricula were developed: preservice, in-service and senior/executive curricula
(2009)
Pre-service Curricula
• Integration of examinable and practical L&M modules
into existing health worker curricula by USAID/LMS
– Kenya Medical Training College (all cadres)
– University of Nairobi, College of Health Sciences,
(all the degree courses)
– Egerton University (Nursing and Medical)
– Nursing Council of Kenya (Standard Curricula)
*With plans to continue this work with other schools and
regulatory bodies
In-Service Training Programs
Name of Program
Trained
Donor
Implementer
Leadership Development
Program (LDP)
715
USAID
LMS, KMTC, CHC,
KNH
Health Systems
1,200
Management (formerly HSS)
WHO, Danida,
Dfid, UNICEF,
USAID, MOH
MOH, KSG, KMTC,
GLUK, Moi Univ.,
AMREF(10 sites)
Strengthening Management 389
for Health, Nyanza (SEMAH)
JICA
JICA and MOPHS
Strategic Leadership
Development Program
(SLDP)
190
MOH / MSPS
Kenya School of
Government (KSG)
Senior Management Course
(SMC)
196
MOH / MSPS
Kenya School of
Government (KSG)
Management for Effective
Health (MEH)
Supervision Skills for Effective
Health (SSEH)
114
GIZ
Kenya School of
Government and
GIZ
Leading High Performing
Health Organizations
(LeHHO)
77
USAID
LMS and
Strathmore
Business School
Governance for Health
• Good governance enables and facilitates good
Leadership and Management.
• Together they help ensure stronger health systems
and greater health outcomes.
• Good governance does not just happen. We need to
invest in its continuous development and
enhancement.
Challenges in Good Governance for
Kenya’s Health Facilities
• Conflicts of Interest among Board Members and the
organization
• Lack of good leaders to help boards
• Roles and responsibilities not clear
• Board members lack experience
Successes to Date
• Widespread acknowledgement and enthusiasm
surrounding the importance of leadership,
management and governance for health and its
impact on improved service delivery and health
outcomes
• Kenya is working to comprehensively address L&M
gaps at all levels of the system – tailored programs
for each level to address specific management needs
• L&M Trainings are yielding results and promising
practices that could be replicated in the sector
Successes to Date
• Development of Hospital Guidelines for Public and
Faith Based Hospitals
– 75% of Hospital Management Committees trained
– 90% of Catholic Hospitals Trained
• Before Facilities can receive HSSF Funding, they must
undergo training in roles and responsibilities, finance,
accounting and other critical areas for management
of HSS
Opportunities
• Development partners and Ministries have shown
strong commitment and willingness to collaborate with
each other and amongst themselves
• Devolution creates new opportunities to integrate
LMG into structures and systems
• High demand for leadership, management and
governance training from those working in the health
sector – many are already sponsoring themselves
• Abundant examples of best and promising practices in
LMG from Private, Public and Faith Based health
sectors that we can learn from and scale up
The Way Forward
Dr Francis Kimani,
Director of Medical Services
MOMS
29 January 2013
Recommendations
• To avoid confusion and duplication there is a need for
greater coordination among donors and implementers
• Need for health workers to be aware of the training
opportunities available – mapping LMG training
• Need to expand geographical accessibility or develop
online/e-training programs
• Need to document and generate demand for best and
promising practices in LMG
• As we move toward devolution there is a critical need for
strong leadership, management and governance skills at the
county level
• Need to pro-actively plan for capacity development of
County Health Management teams
Recommendations (continued)
• Conduct an assessment on training gaps for Hospital
Management Committees
• Identify a means of training boards without having to
pay costly sitting fees
• Training for committees / boards in the areas of:
–
–
–
–
–
–
–
Smarter Meetings
Creating a Culture of Integrity and Ethical Governance
Champions for Quality
Champions for Financial Stewardship
Relations with Management
Human Resources Development
Creating Culture of Celebration
Way Forward
Based on the recommendations outlined in the
previous slide, we should fully focus on taking up the
third recommendation from the Assessment on
Leadership Development Gaps:
Institutionalization of leadership and management as
core competences to be sustained and continuously
improved
Rationale for Institutionalizing LMG
• Ensure sustainability of leadership, management and
governance initiatives beyond the time bound funding
of various donors and partners
• Ensure LMG remains a priority well beyond the
current staff and leaders within the health system
• Standardization of LMG Training for quality purposes
• Coordinate the activities of various players and
implementers of leadership, management and
governance activities - eliminating duplication
• Create a working culture that values and rewards
strong leadership, management and governance
Rationale for a
Scheme of Service for Health Managers
• The challenges of running facilities and the health
system are managerial and not clinical. The
changing context requires dynamic health
managers
• Health professionals are appointed as managers
without regard to requisite skills/competencies,
and without adequate preparation
• Current schemes do not adequately and
progressively define the leadership and
management skills required at each level.
Rationale for a
Scheme of Service for Health Managers
A Scheme of Service defines career progression of specified cadre and
addresses the issues of Recruitment, Training and Development,
Retention, and Promotion
A scheme of service for health managers will allow those who
choose a career in health management to opt in and free those
who want a career in the clinical areas to do so without being
disadvantaged
*Scheme of Service for Health Managers is currently under development by
the MOH, MSPS and USAID/LMS
Devolved Health Sector
• Strong LMG are pre-requisites to devolution and
decentralization. In fact the success of devolution
depends on it.
• Skills in the areas of: resource mobilization, advocacy,
financial management, planning and supportive
supervision and mentorship will be particularly
critical
• There is a need to provide a coordinated response
to this gap so that County Health Management
Teams are not overwhelmed as they take up their
new roles
Kenya Institute of Health Systems Management
We propose that Leadership, Management and
Governance for health should be institutionalized in the
Kenya Institute of Health Systems Management
(KIHSM)
Kenya Institute of Health Systems Management
Mission:
To advance and provide governance, leadership and
management research, development, training and
support within the health sector to improve health
services and ultimately health outcomes.
Vision:
A leading institution in the development of health
leaders and managers to improve health services and
ultimately health outcomes in Kenya and beyond.
KIHSM’s Mandate
1. Advocate for and advance health systems management (HSM)
2. Develop and provide an induction program for newly
appointed or promoted health managers
3. Coordinate and provide governance, leadership and
management training of health professionals
4. Develop and support a mentorship, coaching and supervision
program for health managers
5. Strengthen governance of health facilities
6. Support the HSM website and exchange network for health
managers
KIHSM
• An independent Institute eventually but as it begins, it
will be housed a KMTC
• Will be overseen by an Advisory Committee, chaired
by the PS for Medical Services or MOH. Membership
includes MOH, KMTC, Attorney General’s Office,
MSPS and representatives from Development
Partners
Establishing KIHSM
KMTC has to date:
• Assigned a Coordinator to start up and head KIHSM
• Established an Implementing Committee made up of KMTC staff
and stakeholders to manage the day to day KIHSM activities
• Assigned an Leadership Development Program Coordinator
• Provided a secretariat office including support staff
• In collaboration with JICA & MSH conducted HSM capacity
assessments of KMTC Mombasa, Kisumu, Nakuru, Embu and Meru
campuses
• Engaged KMTC Mombasa, Kisumu and Nakuru campuses to
support KIHSM activities in the region
• Received written support from MOMS and MOPHS
An appeal to participants
As we develop recommendations for this conference,
please consider the following:
How can the information shared in this conference…
1. Be applied to the newly devolved health system?
2. Influence the Kenya Institute of Health System’s
Management Strategic Planning and Activities in it’s
first years?
3. Be sustained within the health sector for
generations to come?
Thank You