MSH Leads Governance and Leadership Reforms at Referral Hospitals in Kenya

At public referral hospitals in Kenya, the development of operating plans typically involves just three people: the hospital medical superintendent, the hospital administrative officer, and the health records officer. Together this small team sets the upcoming quarter’s spending priorities for the entire hospital based on revenues and fees collected in the prior quarter. Scrambling to address the most urgent needs of the immediate future with limited and quickly evaporating funds hampers the realization of a coherent, long-term vision for the hospital. The haphazard process also excludes wider staff participation and prevents team buy-in fostering an atmosphere of disjointed activities.

This was one of the management problems faced by three hospitals chosen by the Ministry of Medical Services to be the first recipients of training and support from Management Sciences for Health’s (MSH) Leadership, Management and Sustainability program in Kenya. Supported by USAID, LMS/Kenya has been coordinating a “Priority Hospital Reforms” initiative that targets referral hospitals in Kenya. The reforms aim at strengthening the governance, leadership, and management capacities of these facilities so that staff can better respond to the challenges they face daily and eventually deliver services more effectively and efficiently.

Beginning with a first cohort of three hospitals – Kakamega, Machakos, and Coast—the LMS/Kenya team helped the hospitals identify priority areas of interventions with the potential to have significant impact on the hospitals’ overall performance. These included:  revitalizing the management structure; strengthening human resources, financial, commodities and information management capacity; and, improving hospital infrastructure. Applying MSH’s Management Organizational Strengthening Tool, a capacity assessment and strengthening tool, the three hospitals have been assisted to come up with key targeted interventions that were further finalized through the development of three-year strategic plans.

“Through the consultative and participatory process of developing strategic plans, the hospitals have been made better able to make out their contribution and linkage to the national health priorities articulated in the Ministry of Medical Services Strategic Plan,” says Dr. Harrison Kiambati, the Head of Technical Planning Department at the Ministry of Medical Services.
  Currently, the LMS team is supporting the three hospitals in developing their annual operating plans, an activity that will be followed by targeted technical assistance in identified priority areas such as financial management, governance and heath management information systems.

“One of our priorities is to cascade the capacity to plan effectively to the hospital staff and departments,” adds Dr. Kiambati. Aligned participation of organized medical staff and sectional heads, coupled with the appreciation of their role in planning, the hospitals’ plans are now better linked to budgets and populated with implementable activities. The activities are now easier to monitor and evaluate.

“With the support of MSH’s integrated planning approach, the hospital medical staff are now appreciating in real terms how planning affects their day-to-day work,” says Dr. David Mwangi, the Deputy Chief Administrator at Coast Province General Hospital. The clinical staff at Coast has been involved in the development of the annual operating plan, especially in the development of the annual performance targets and distilling priority activities that have formed part of the budget. This involvement is expected to lay the foundation for the closer monitoring of performance against the annual operating plan on a quarterly basis.

As Kenya’s new Constitution is implemented in the coming year, health sector reform is expected, including the decentralization of hospital management and financial planning. In preparation for these changes and building on the initial accomplishments at Kakamega, Machakos and Coast, the Ministry of Medical Services has identified an additional four hospitals to receive LMS/Kenya support. In continued partnership with the Ministry, LMS/Kenya hopes to further demonstrate that leadership and management training will boost staff satisfaction and efficiency, improve governance and financial management, and augment nationally set health sector priorities with the ultimate goal of improving the quality health service delivery in Kenya.