29 January 2013

1. Overview of Leadership, Management and Governance in Kenya’s Health SectorFirst National Conference 29 January 2013

2. Progress to dateDr John Odondi, Head Department of Primary Health ServicesMOPHS 29 January 2013

3. Initial Activities Related to 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.

4. 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

5. Assessment Findings • Managers’ career expectations did not include management or leadership. • Managers were appointed while inadequately trained. • Managers were unaware of training opportunities in management. • Curriculum content, suitability, timeliness and a practical approach to delivery were critical in addressing the gaps. • Availability of training was extremely limited in responsiveness to identified gaps and geographical accessibility.

6. Assessment Recommendations • Pre-service training of those likely to take on health leadership and management roles • Urgent remedial action to equip those currently in health leadership and management positions • Institutionalization of leadership and management as core competences to be sustained and continuously improved

7. 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: pre-service, in-service and senior/executive curricula (2009)

8. 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

9. In-Service Training Programs

10. 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.

11. 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

12. 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

13. 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

14. 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

15. The Way Forward Dr Francis Kimani, Director of Medical ServicesMOMS 29 January 2013

16. 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

17. 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

18. 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

19. 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

20. 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.

21. 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

22. 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

23. 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)

24. 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.

25. KIHSM’s Mandate • Advocate for and advance health systems management (HSM) • Develop and provide an induction program for newly appointed or promoted health managers • Coordinate and provide governance, leadership and management training of health professionals • Develop and support a mentorship, coaching and supervision program for health managers • Strengthen governance of health facilities • Support the HSM website and exchange network for health managers

26. 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

27. 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

28. An appeal to participants As we develop recommendations for this conference, please consider the following: How can the information shared in this conference… Be applied to the newly devolved health system? Influence the Kenya Institute of Health System’s Management Strategic Planning and Activities in it’s first years? Be sustained within the health sector for generations to come?

29. Thank You