Governance Milestone Reached as Hospital Guidelines Rolled Out in Kenya

Governance Milestone Reached as Hospital Guidelines Rolled Out in Kenya

Permanent Secretary of the Ministry of Medical Services, Ms. Mary Ngari, (Right), hands over the new Governance Guidelines to HMC Board Member and Deputy Provincial Commissioner of Central Province, Francis Sila, while USAID/Kenya HRH Specialist Peter Waithaka, LMS/Kenya Project Director Karen Caldwell, and Central Province Provincial Director of Medical Services Gichaiya M’Riara, look on. (Photo courtesy of Hosea Kunithia.)


Kenya’s new constitution, promulgated on August 4, 2010, mandates significant transformations in the health sector. Hospital reforms are a key part of these transformations. For MSH’s Leadership, Management and Sustainability Program in Kenya (LMS/Kenya), the opportunity to work closely with health sector partners, including the Ministry of Medical Services, to support the hospital reform agenda is an exciting and rewarding experience.

On Monday, June 6, the Permanent Secretary of Kenya’s Ministry of Medical Services, Ms. Mary Ngari, attended the opening of a training workshop in Thika, Central Province to officially launch the nationwide roll-out of Governance Guidelines for Hospital Management Committees. With funding support from USAID, LMS/Kenya was able to work with the Ministry to develop the guidelines, train provincial trainers, and produce a national roll out plan and budget.

“Hospital Management Committees and Hospital Management Teams are expected to use these Guidelines to provide cohesive strategic direction in hospitals,” the Permanent Secretary said, adding that “This training is critical to successful implementation of hospital reforms and hence is a very important exercise.”

Dr. Wacira Kariuki, Hospital Management Committee Chair from Provincial General Hospital, Nyeri, attended the Governance Guidelines training workshop in Thika. In an interview, he shared his expectations of how the guidelines will help his committee run the hospital more effectively.

Funding from the central government to support hospitals is funneled through the Health Management Services Fund. Hospital Management Committees were set up as an oversight mechanism to ensure sound management of this funding by the Hospital Management Teams. The Committees consist of civil society and community members as well as medical personnel and provincial government officials. The Teams are made up of government-employed hospital staff. The aim of the Committees, the Permanent Secretary said, “is to improve health service delivery and empower communities in the process of decision-making in service delivery.”

In the absence of governance guidelines, however, the responsibilities of committee members have often been confused creating inefficiencies and occasionally conflict. Dr. Godrick Onyango, Provincial Director of Medical Services in Western Province, who attended an earlier training and is already disseminating the guidelines in his province, said “These guidelines are good because the majority of our hospital committee members don’t understand what their roles are, so [they] tend to underperform.”

Mr. Sam Munga, Head of the Hospital Management Services Fund (HMSF) Secretariat, which spearheaded the guidelines development process, expects the guidelines to have a significant impact on hospital performance by increasing efficiency and financial management. He said, “We expect, now, better programming, budgeting, and priority setting in the hospitals … so that available resources can be linked to felt needs at the hospitals.”

The new constitution mandates devolution of power and resources away from the central government to newly formed county governments. In the health sector, devolution will increase county government responsibility in running local hospitals. The guidelines are intended to strengthen the HMCs in anticipation of the establishment of the county governing structure and are an example of the Ministry of Medical Services’ commitment to constitutional implementation.

LMS/Kenya is also supporting the Ministry‘s efforts to prepare hospitals for these changes by working with targeted priority referral hospitals around the country. Ms. Beatrice Sabana, Chair of the National Hospital Services Committee which oversees the HMSF, expressed appreciation for LMS/Kenya’s approach to working with the Ministry calling it “very participatory.” LMS is very demand-driven, she said, adding that “Even for this project, the training, they just responded to our needs and we have very much been in the driving seat, but with them coming in with their technical and financial support.”

With another national elections cycle approaching next year, public scrutiny of progress toward constitutional implementation is strong. A report highlighting corruption in the health sector was recently published by the Kenyan Anti-Corruption Commission, contributing to the general sense of urgency as well as optimism about the value of leadership and governance work.

Kate Steger, MA, MPH is the Communications and Knowledge Exchange Coordinator for the Kenya Leadership, Management and Sustainability Program at MSH.