Leaders Drive the Health System

Results of Mentorship Approach in GIZ Focal districts

National LMG ConferenceIntercontinental Hotel, Nairobi

January 2013

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

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:

1.The integration and scaling up of the management and mentorship approach. 2.Ensuring sustainability of the initiative by strengthening the mentorship component and having the training offered by a recognized training institution3.Strengthening management competencies at both DHMT and facility level.

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.

District Experience

Bondo District

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

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

Impact of Intervention

Improved quality of RH services in the district.

Improved indicators in all three facilities targeted.

Improved customer satisfaction

Bondo District Hospital

Got Agulu Sub-District Hospital

4th ANC Visit

Facility Deliveries

ANC attendance improved from 38 percent to 53 percent; Hospital deliveries increased from 90 percent to 102 percent

Nyangoma Dispensary

4th ANC Visit

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

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

Lessons LearntTeam 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

Facility Experience

Project title: Increasing skilled delivery at Enzaro Health

Centre.

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 careThus the purpose of the project was to increase facility deliveries at the health centre from 9 percent to 43 percent

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

Results: Skilled Birth Attendance at Enzaro Health Centre

Deliveries increased from 9% to 52%

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