Leaders Drive the Health System Results of Mentorship Approach in GIZ Focal districts

1. Leaders Drive the Health SystemResults of Mentorship Approach in GIZ Focal districts National LMG Conference Intercontinental Hotel, Nairobi January 2013

2. Background • German Development Cooperation supports the Government of Kenya to improve equitable access to quality healthcare with a focus on Reproductive Health • GIZ Target areas: Bondo, Butere, Gucha, Kisumu East & Vihiga • Limited management competencies and limitations in translating theoretical technical skills in resource poor settings were identified as key challenges in health service delivery in the GIZ focal districts in the year 2009. • With the participation of district partners, GIZ designed a two pronged capacity building initiative

3. Mentorship-Management Approach In 2012 the capacity building initiatives on leadership focused on three areas. These were jointly agreed between GIZ and participating district teams: • The integration and scaling up of the management and mentorship approach. • Ensuring sustainability of the initiative by strengthening the mentorship component and having the training offered by a recognized training institution • Strengthening management competencies at both DHMT and facility level.

4. Training Components • The trainings were run as three distinct courses: • Management for Effective Health (MEH) Plus • Management Basics for Effective (MEH) 2012 • Supervisory Skills for Effective Health (SSEH) • The first phase of the training, facilitated by trainers from Kenya School of Government, consisted of face to face lectures. • The second phase of the training, facilitated by a clinical mentor in close collaboration with trainers from KSG, involved implementation of a transfer project.

5. District Experience Bondo District

6. Indicators Targeted for Transfer Project • Increasing number of women attending the fourth ANC visit • Increasing uptake of FP services • Improving capacity of health providers on cervical cancer Screening and increasing number of eligible population screened. • Improving number of women accessing skilled birth attendance

7. Key Activities • Regular supervision and review meetings between mentors and mentees applying skills learnt during MEH and SSEH • Capacity building of staff on FANC, EOC,PAC,AMSTIL,FP, comprehensive RH, neonatal care and cervical cancer screening • HIS- strengthening use of diaries and phones in defaulter tracing; strengthening and upscaling CHW inventory of ANC clients • Health education-Advocacy targeting male involvement; community dialogues. • Community mobilization- through use of community health workers • Conducting outreaches • Rapid Results Initiative (RRI) • Collaboration with stakeholders

8. Impact of Intervention • Improved quality of RH services in the district. • Improved indicators in all three facilities targeted. • Improved customer satisfaction

9. Bondo District Hospital

10. Got Agulu Sub-District Hospital ANC attendance improved from 38 percent to 53 percent; Hospital deliveries increased from 90 percent to 102 percent

11. Nyangoma Dispensary Attendance of fourth ANC visit increased from 45.6 percent to 70 percent.

12. Customers Perception on Services Offered at Supported Facilities • Staff have become more friendly • Improvement in quality of services offered • Waiting time has reduced immensely • Facilities are more sensitive to clients’ needs • Infrastructure has improved • Facilities are cleaner

13. Lessons Learnt • Team development and leadership skills have a big influence on health service delivery outcomes • Functional teams with effective leaders produced better results compared to teams that were struggling and had no clear leadership • Selection of mentors should be based on demonstrable capacity to mentor/coach • Improving on existing structures vis a vis adopting new ones is more cost effective in improving health service delivery • Stakeholder involvement is important in achieving desired objectives

15. Facility Experience Project title: Increasing skilled delivery at Enzaro Health Centre.

16. Project Focus Enzaro Health Centre recorded low rates of facility deliveries (8.7 percent).This arose from a number of issues including: • Existence of certified TBAs in the catchment population • Poor facility-community linkage • Poor infrastructure • Lack of a proper referral system in the community for mothers in labour • Inadequate knowledge and skills among the technical staff particularly on management of labour, FANC and customer care Thus the purpose of the project was to increase facility deliveries at the health centre from 9 percent to 43 percent

17. Key Activities • Refurbished maternity ward • Updated 10 skilled health providers on AMSTL, use of partograph, FANC and customer care • Introduced customer care desk • Collaboration with key stakeholders • Re-orientated TBAs to refer pregnant women to health facility for skilled attendance • Used TBAs as birth companions • Conducted regular home visits to expectant mothers • Used motorcycles to refer mothers in labor to facility • Introduced hot drink and warm water for bathing after delivery • Strengthened maternal data collection and utilization at the facility

18. Results: Skilled Birth Attendance at Enzaro Health Centre Deliveries increased from 9% to 52%

19. Lessons Learnt • Training health providers on management and mentoring them to improve technical skills is effective in improving of health service delivery • Community participation contributes immensely towards uptake of RH services • Team work and commitment to change are key in improving services • A facility can move to greater heights by using its own resources