MoPHS/JICA Project

Strengthening Management for Health in Nyanza Province

Office: Nyanza Provincial Headquarters 4th Fl, P.O.Box 401-40100, Kisumu
Project Mobile Phone: +254- (0)732- 526567

Concept Note; (Draft as of Mar 2010):

The Core Management Training Programme for Health Managers

1. Introduction

Leadership, Management and Governance is essential function for significant

improvement of health outcomes, which will lead to the attainment of the
millennium development goals (MDG). In an attempt to address the perceived
gaps, the Kenya Vision 2030 pursues a two-pronged approach for the Kenya
Health sector, (1) to devolve funds and management of health services to the
communities and district, (2) to shift the bias of the national health bill from
curative to preventive care. Provision of effective health services requires that
the government addresses issues of inadequate health personnel, financing,
drugs, health infrastructure, inefficiency in health delivery, and inequality in
delivery of health services.

This situation makes it necessary to address Leadership, Management and

Governance as a key intervention area to improve chances of success. A health
management and leadership capacity assessment was thus undertaken in
collaboration with development partners in 2007/2008 and culminated in the
development of a health management and leadership strategy.

Responding this national strategy, the Ministry of Public Health and Sanitation
(MoPHS) in collaboration with Japan International Cooperation Agency (JICA)
has implemented a four-year technical cooperation project named “Strengthening
Management for Health in Nyanza Province” since July 2009.

The Project aims at facilitating individual and institutional capacity development

of health management teams in Nyanza province focusing “Mindset Change” of
all health managers mainly through conducting innovative management
trainings and promoting dialogical communication & networking among health
managers, providers, researchers and communities. Hence, with this catalytic
approach, the project finally aims at strengthening overall health system of
Nyanza province, and Kenya’s national health system as ultimate objective, in an
autonomous and self-reliant manner.
Project Outputs

Output1 Core management capacity of health management teams (PHMT&DHMTs) is

strengthened in Nyanza Province.

Output2 Capacities of health management teams on operational cycle process (planning,

implementation, M&E) are strengthened in Nyanza Province.

Output3 Capacities of health management teams to provide supportive supervision is improved

in Nyanza Province.

Output4 Lessons learnt and good practices from output 1-3 are shared with other provinces
and national level and networking among health managers is strengthened through
the process.

Project Concept Diagram

Project Outputs

On November 2009, for the objectives of organising and managing series of

management trainings for health managers, the project organised Training
Management Working Group (TMWG) consisting of members from various
stakeholders

2. Purpose of the Core Management Training Programme

The purpose of the Core Management Training Program is to strengthen core

management capacity of health management teams, through selected topical
areas to provide core competencies required for effective and efficient health
systems management for change.
3. Justification for the Program

Health managers have been exposed to many sets of leadership and management
trainings before. Despite these trainings there has been little progress towards
achieving the MDGs. Evidently, in order to achieve the MDGs, it is necessary to
significantly scale up coverage of priority health services. This generally requires
additional national and international resources, as well as better leadership,
governance and management in using these resources effectively to achieve the
desired results. Good leadership, management and governance are about
providing direction and gaining commitment from partners and staff, facilitating
change and achieving better health services and health outcomes, through
efficient, creative and responsible deployment of people and other resources.
While leaders set the strategic vision and mobilize the efforts towards its
realization, good governors set the process of decision-making and the process by
which decisions are implemented (or not implemented) and good managers
ensure effective organization and utilization of resources to achieve results and
meet the aims.

Some questions that are important to ask include, have the leadership and
management training previously held been adequate enough to strengthen the
health systems management in order to achieve the required change? Do we need
more training? If so, what are the gaps in the previous trainings that justify
another set of trainings?

An emerging perspective that needs to be addressed is the process of leading,

managing and governing change, which brings a paradigm shift in the way that
health systems management needs to be conducted. In achieving this, there is
need for careful selection of core capacities/competencies that the PHMTs and the
DHMTs should be exposed to with an emphasis on the “how to” of the leadership,
management and governance. This process could be improved through
incorporation of performance based models, servant leadership models and
champion models that evidence exist to their successes to develop an innovative
action based hybrid model to facilitate the required change.

To achieve this, a Training Management Working Group (TMWG) was formed

that was made up of 1) Core Members made up of PHMT-Nyanza, DHMTs
(Kisumu West and Siaya), JICA Nyanza project, and Consultant. 2) Technical
Support Advisors made up of AMREF, GLUK, Maseno University, Mzumbe
University, MSH, and KIA 3) Co-opted Members from JICA Nyanza project.
 TMWG Structure

roject Concept
Diagram Project
Outputs

This TMWG has the mission of coordinating and managing the overall training
activities implemented by the project so as to provide mandatory and quality
training chances for provincial and district health management teams at
individuals and institutional levels.

With this mission, the TMWG has the responsibility to guide the development of
the Core Management Training Programme that the project will deliver to
HEALTH MANAGERS who will in turn become the CHANGE AGENTS in the
process of strengthening health management in Nyanza. The health managers
will then have the responsibility of scaling up this whole process to the health
service providers for quality health outcomes in the end.

TMWG Activities

roject Concept
Diagram Project
Outputs
4. Programme Design

Though the series of meetings, the TMWG identified Required Core Capacities
for PHMT/DHMT as follows in line with core functions of PHMT/DHMT defined
in the MoPHS Strategic Plan (2008-2012).
Hence, the training programme, “the Core Management Training Programme for
Health Managers”, was designed and organised with the objectives of
strengthening these required core capacities for PHMT/DHMT.

The programme is composed of 8 courses, logically arranged to provide a

sequential flow of thoughts at the same time providing a basis for critical
analysis of content as applicable to the context of delivery towards strengthening
Health Systems management.

The Core Management Training Programme

for Health Managers

8 Training Courses for 6 months

Leadership, Management and Governance

Strategic Thinking & Management

Health Policy Management in Action

Supportive Supervision and Coaching/Mentoring

Resource Generation, Mobilization and Management

Information Management in Health

Evidence Based Planning and Research skills

Customer Relation Management

The content areas are organized to cover discussion of core concepts, their
relevance to health systems strengthening, and their application to the context of
work for both DHMT and PHMT.

5. Target Group

The Programme is designed for all Provincial Health Management Teams

(PHMT) and District Health Management Teams (DHMT) in Nyanza province.

6. Programme Duration

The programme will be delivered in 6 months. Each course will be organised to

take 3 to 4days.
 7. Training Framework

The Project initially implements the Core Management Training Programme and
Demand Driven Trainings such as Strengthening IT Skills targeting for
Provincial Health Management Team (PHMT), PHMT-Nyanza, and the two pilot
District Health Management Teams (DHMTs), DHMT-Siaya and DHMT-Kisumu
West. After the pilot training period, these trainings will be modified according to
the evaluation and the reflection from the pilot teams, so that the good practices
and the lesson learned will be incorporated into the newly integrated training
programme. Hence facilitators will be trained through the Training of
Facilitators (TOF) in line with the modified facilitators’ guide and other training
materials, and ultimately the training programme will be expanded throughout
the whole DHMTs in Nyanza Province.
8. Course Outline

Course 1: Leadership, Management and Governance

The course is composed of 11 Modules and the content includes broadly

leadership, management, and governance and salient processes that are
enablers to the achievement of the three. The content areas are organized to
cover discussion of core concepts, their relevance to health systems
strengthening, and their application to the context of work for both DHMT and
PHMT. This course is an introductory course for all the other courses to follow
which are all aimed at strengthening leadership, management governance
capacities of the DHMTs and PHMTs in Nyanza province.

Objective of the Course:

The main objective of this course is to strengthen the leadership, management

and governance and capacity of the DHMTs and PHMTs, through selected topical
areas to provide core competencies required to strengthen health systems
management.

Course Duration

This course will be delivered in 4 days

Course Design

The 11 modules making up the course are logically organised to provide a

sequential flow of thoughts at the same time providing a basis for critical
analysis of content as applicable to the context of delivery. The content includes
broadly leadership, management and governance. The content areas are
organized to cover discussion of core concepts, their relevance to health systems
strengthening, and their application to the context of work for both DHMT and
PHMT.

Module Outline

Module 1: Introduction of the Core Management Training Programme (1.5hrs)

Module 2: Overview of Health Systems Strengthening (2hrs)
Module 3: Overview of Leadership, Management and Governance (2hrs)
Module 4: Leadership, Vision and Mission Development (2hrs)
Module 5: Leading Change Management and Paradigm shift (2hrs)
Module 6: Understanding Governance (2hrs)
Module 7: Governance Functions and Practice (2hrs)
Module 8: Team Building and Synergy (2hrs)
Module 9: Information and Knowledge Management (2hrs)
Module 10: Communication and Networking (2hrs)
Module 11: Capacity Assessment (3hrs)
Course 2: Strategic Planning, Implementation, Monitoring and Evaluation

This course is made up of 9 modules, aimed at providing an overview of strategic

health planning as a function of health systems management. The content areas
are organized to cover broadly, planning, implementation monitoring and
evaluation, review of MoPHS Strategic Plan. The course content entails
discussion of core concepts in strategic management, review of health sector
strategic plan II, relevance of strategic management to health systems
strengthening, and application of strategic management to the context of work
for both DHMT and PHMT planning. The course is set to take 4 days.

Objective of the course

The main objective of this course is to strengthen the strategic management

capacity of the DHMTs and PHMTs, through selected topical areas to provide
core competencies required to strengthen strategic planning processes for health
systems management.

Course Duration

This course will be delivered in 4 days

Course Design

The 9 modules making up the course are logically organised to provide a

sequential flow of thoughts at the same time providing a basis for critical
analysis of content as applicable to the context of delivery. The content includes
broadly planning, implementation monitoring and evaluation; review of MoPHS
Strategic Plan. The content areas are organized to cover discussion of core
concepts, their relevance to health systems strengthening, and their application
to the context of work for both DHMT and PHMT.

5. Module Outline

Module 1: Overview of Health Planning in Kenya (2hrs)

Module 2: Strategic Thinking Paradigm Shift (2hrs)
Module 3: Strategic Thinking for Health Planning (2hrs)
Module 4: Steps in Strategic Planning Process (3hrs)
Module 5: Overview of the MoPHS Strategic Plan (2hrs)
Module 6: Critical Review of the Existing Strategic Plans (2hrs)
Module 7: Implementation of the MoPHS Strategic Plan (2hrs)
Module 8: Monitoring and Evaluation of Strategic Plan (2hrs)
Module 9: Developing a Prototype of Strategic Plan for PHMT/DHMT (4hrs)
**Outline of following courses are currently under development (as of Feb 2010) .

Course 3: Health Policy Management in Action

Health Policy Management is an important governance function that provides

laid down rules and regulations for implementing emerging health policies and
guidelines. This course is designed to broadly cover the policy cycle, policy
analysis framework and policy change. The course will take 3 days

Module 1: Overview of health policy

Module 2: The policy cycle
Module 3: Health policy analysis framework
Module 4: Engaging people in policy process
Module 5: Managing policy change

Course 4: Supportive Supervision and Coaching/Mentoring

Supportive supervision and coaching/mentoring is an important component of

both leadership and management. This course is made up of 6 modules aimed at
highlighting the essential elements of supportive supervision. The content areas
cover what supportive supervision is and what it is not and how it differs from
other closely related concepts. The course is scheduled to take 3 days. Below is an
outline of the modules.

Module 1: Overview of supportive supervision

Module 2: Characteristics and quality of supportive supervision
Module 3: Team management
Module 4: The process of supportive supervision
Module 5: Managing challenges to supportive supervision
Module 6: Contrasting between supervision, inspection, coaching and mentoring

Course 5: Resource Generation, Mobilization and Management

Resource generation, mobilization and management is one of the key areas that
require strengthening. While leaders mobilize resources for health services, and
governors guide the decision making processes for utilization of the resources,
managers ensure effective organization and efficient utilization of the mobilized
resources. To succeed in producing this kind of a health manager this course is
designed to have 5 modules with content that broadly cover the three main
dimensions namely human, financial and physical resources. The content areas
cover what resource management is based on the dimensions, its importance to
health systems strengthening and its application to the context of DHMTs and
PHMTs. The course will take 3 days.

Module 1: Overview of resource management

Module 2: Human Resources for health management
Module 3: Financial resource management
Module 4: Health financing and resource mobilization
Module 5: Management of physical infrastructure
Course 6: Information Management in Health

Information Management is any quantifiable and non-quantifiable information

that can be used by health decision-makers to better understand health systems
issues making it key to strengthening health systems management. This course
broadly covers information generation, management, translation and
dissemination. The content is organized to cover the concepts, relevance to health
systems strengthening and application in the context of DHMTs and PHMTs.
The course will take 3 days. Below is module outline.

Module 1: Identification of relevant information/data

Module 2: Data collection
Module 3: Data processing and Analysis
Module 4: Data reporting and dissemination
Module 5: Information storage
Module 6: Translation and dissemination

Course 7: Evidenced based planning and Research Skills

TBD

Course 8: Customer Relationship Management

Customer (client) relation is an important aspect of service delivery that can

make or break a health care system in terms of performance output and health
outcomes. A health system without customers is a dead system. This course is
aimed at preparing health managers to be able to address consumer issues in the
most appropriate way to ensure continuous utilization of health services. The
content is designed to cover broadly customer relations, consumer expectations
and guideline for consumer care and application of these aspects to the DHMT
and PHMT context of work. The course will take 3 days. Below is the module
outline.

Module 1: Overview of Customer relations

Module 2: The concept of customer
Module 3: Customer needs/wants and expectations
Module 4: Guidelines for Handling customer problems and issues