Leadership for Health: Perspectives from Kenya

A conversation with Dr. Harrison Kiambati, Head of Technical Planning, Monitoring, and Coordination in the Ministry of Medical Services, and Ms. Judith Aswa, Programme Officer

MSH: What is the role of the Ministry of Medical Services in Kenya? Is it the same as the Ministry of Health?[Dr. Harrison Kiambati. Photo by Kenya Ministry of Health staff.]Dr. Harrison Kiambati. Photo by Kenya Ministry of Health staff.
JA: The Ministry of Health was split into the Ministry of Medical Services and the Ministry of Public Health and Sanitation in May 2008 following a power-sharing deal that calmed postelection violence in Kenya. The Ministry of Medical Services deals with all curative services in the country, professional regulatory bodies, medical training institutions, and National Social Insurance.

MSH: What obstacles does the Ministry face in making sure that good-quality medical services are available to all Kenyan citizens?
JA: In general, poor leadership and management skills affect the quality of medical services. We need to develop a strategy paper and then come up with pre- and in-service training modules to train all health managers in leadership and management before they take on their managerial duties.

HK: Key areas are fostering partnership in improving health and delivering services, improving the efficiency and effectiveness of service delivery, improving the quality and responsiveness of services, and improving the financing of the health sector. We face numerous challenges and constraints, including disjointed planning and budgeting processes at the national level and weak capacity for planning and monitoring at lower levels.

MSH: What does the term “leadership” mean to you? What is its importance in public health?
HK: Leadership is about providing appropriate direction to and gaining commitment from stakeholders and staff, facilitating change, and achieving better health services through efficient, creative, and responsible deployment of people and of other health resources.

Effective leadership and management are the foundation of quality and responsiveness in the health sector. They provide the cement as envisaged under the National Health Sector Strategic Plan II (NHSSP II), to reduce inequalities in health care and reverse the downward trends in health-related impact through a process of coordinated planning and implementation at all levels. Proactive coordination—through effective leadership and management at every level—is a decisive influence on this success, much more so with the Kenya Essential Package for Health approach and performance monitoring as introduced under the NHSSP II.

Effective leadership and management are the foundation of quality and responsiveness in the health sector.

JA: In my opinion, leadership is the ability to mobilize people to work as a team in order to comprehend their vision for a positive and fruitful future. In public health, quality leadership enables the staff to work as a team and use available resources or mobilize resources from stakeholders and partners to improve our health and environment.

MSH: How has leadership affected Kenya’s public-sector health services or the health system as a whole?
JA: Most of the health managers had minimal expectations about performing leadership and management duties as opposed to the careers they prepared for in college. They are often challenged by managerial issues once appointed to management positions. Poor staff performance and career progression management, and resource scarcity in the health sector are other factors that constrain managerial performance.

HK: Poor leadership and management of health systems and services have been identified as obstacles to scaling up service delivery, improving access to and quality of care, and attaining the Millennium Development Goals in Kenya. These constraints remain despite continuing efforts to train managers and build “management capacity,” due to a shortage of skilled management expertise in the country and an uncoordinated and fragmented approach to management capacity-building. The increases in resources coming from global health initiatives and those that are generated locally can produce the desired health results only if the country and institutions pay more strategic attention to building effective leadership and management capacity for the health sector.

MSH: What are some of the challenges in working to ensure proper leadership in the public sector?
HK: I see four major challenges to ensuring proper leadership:

  1. Increased investments in health, but limited results
  2. Need to scale up coverage and quality of services with limited resources and institutions
  3. Increased demands to invest in good health systems to drive service delivery
  4. Lots of training but management still a critical constraint.

MSH: What are the keys to creating well-managed government health services?
HK: We need to have a critical mass of managers trained in management competencies that include soft skills (for example, negotiation, political, motivating, mentoring, communication, and analytical skills). We also need to invest in management support systems, hold managers accountable for results, and provide incentives to manage well.

MSH: What changes have you seen since MSH launched the Leadership, Management, and Sustainability (LMS) Program in Kenya last year? Have there been improvements since the Ministry developed the Kenya Health Management and Leadership Strategy?
JA: The changes we have seen since the launch of LMS in Kenya are that health managers are able to realize their potential—visions are created and achieved in a given timeframe using the available resources and support from stakeholders and partners. This makes managers feel enthusiastic because they have discovered that they are able to achieve what seemed impossible before. In this regard our health systems are being strengthened dramatically.

For example, a team in one of the local district hospitals in a remote area picked the challenge of finishing construction of an operating theater that had been stalled for 10 years. They equipped and staffed it in six months. The District Medical Officer of Health, Nursing Officer in charge of the hospital, and the District Public Health Officer discovered that their sister ministries, among others, are major stakeholders in their activities, because the Ministry of Water provided water, the Ministry of Roads improved the road for materials to be delivered, the national youth service provided water tanks, and the community provided security for the materials.

The leaders of this project were very happy to learn that they no longer had to refer patients to the provincial hospital, and the number of deaths due to delays in surgery started going down in the project’s sixth month. Project leaders quickly challenged the other staff to pick an area and work on it as a team within a specified timeframe and then evaluate their achievement.

If this practice can be expanded to include all health mangers at all levels, we would fare well in terms of improving worsening health indicators.

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