Advancing Health Leadership & Management in Kenya

1. Advancing Health Leadership & Management in Kenya Assessing Health Manager Needs in Strengthening Educational Opportunities Peter Maina Maer Associates Dr. Harrison Kiambati Ministry of Medical Services

2. Background • Health education has not kept pace with the demands of the health system, leaving health managers without adequate preparation in leadership and management. • Health Indicators are deteriorating and there is probability of not achieving MDG targets by 2015. • Kenya is decentralizing; however, capacity at the district and facility level remains weak.

3. Challenges • Declining health sector expenditure; • Inefficient utilization of resources; • Inadequate management skills at district level; • Over-centralized decision making; • Worsening poverty levels; Increased burden of disease; and • Human resources for health challenge with respect to recruitment, deployment, motivation and retention.

4. Research Questions • What challenges are health managers facing at all levels and sectors of the health system? • What preparation have health managers received and what training opportunities are available to them? • What additional training do health managers feel they need?

5. Research Design (Methods) Three Phase approach: • Interviews and questionnaires with health managers; • Curricula review; and • Stakeholder discussion to validate findings.

6. Research Design (Methods) Phase 1: • Close ended questionnaires: 255 managers. • Open ended interviews: 133 managers. • Population: • 4 of 8 Kenyan provinces • Ministry of Health headquarters • Public and Private Sector • District to Central levels • Urban and peri-urban.

7. Research Design (Methods) Phase 2

8. Results

9. Results

10. Results Views of Health Managers on Importance of Management Skills

11. Results

12. Results

13. Results “In pre-service we were taught to be in-charges, but the task has been [more] enormous than taught. The training was not adequate. I only learned supply and procurement, human resources in theory and bits but not wider into practice.” ~District Public Health Officer

14. Conclusions • Most health managers were appointed and inadequately trained. • Nearly all health managers were unaware of provisions to enable them remedy their management gaps.

15. Conclusions • Majority of health managers’ career expectations do not include management or leadership. • Poor staff performance and career progression management, and resources scarcity are among non-skills factors that constrain managerial performance.

16. Implications for HRH Education Policy • Content suitability, timeliness and a practical approach to delivery are critical determinants of the value added by any management training to address current competence gaps. • Current availability of management training is extremely limited in designs’ responsiveness to need and accessibility.

17. Planned Next Steps • Development of a health-specific training policy as distinct from the current general training policy, in order to give the necessary legal guidance and authority for implementation of the health leadership and management development strategy. • Development of relevant training modules in collaboration with training institutions (colleges and universities). • Modules to address pre-service and in-service the training needs identified by the assessment.

18. Planned Next Steps • Review of the existing hospital management structures to conform to the aspirations of Vision 2030 which aims at establishing autonomous level 5 hospitals (regional referral). • Implementation of health leadership and management strategic plan through annual operation plan process. • Institutionalisation of leadership, management and systems strengthening as a Core Competence in health sector.

19. Acknowledgements Kenya Ministry of Medical Services Kenya Ministry of Public Health and Sanitation Participating health and training institutions

20. Questions?