Dr Anisa Omar was posted to Kinango Sub-district Hospital as a clinical doctor as soon as she obtained her Bachelor of Medicine and Surgery. She was asked to report there urgently to fill a vacuum.
Within two years, she found herself catapulted to a management position. She was made hospital-in-charge.
Not long after, she became the medical superintendent and then a district medical officer. She found herself supervising and managing numerous health facilities in Malindi.
“Subsequently, there were many administrative issues which were new to me – financial matters and regulations that I had never learnt anywhere; the code of conduct; and personnel management. It was like on-the-job training for me,” says the doctor.
She resorted to books to learn anything about leadership and management.
Dr Anisa only much later benefited from training in health system management, through a USAID programme that helped her to transform the health sector in the coast region.
Last week, She was among the experts who shared their experiences at the first National Conference on Health Leadership Management and Governance.
She says in retrospect that had she undergone training in management before her posting to Kinango, she would have given the public better service.
The conference was organised by the ministries of medical services and public health and sanitation.
It assembled health experts from all over Kenya, and was also addressed by practitioners from Tanzania, Ghana, Ethiopia, Europe and Afghanistan.
Expansion in the public health sector has brought about transitions that have not always contributed to better health outcomes.
Hospital managers are picked from senior clinicians irrespective of their competencies or preparedness for administrative assignments, sometimes with disastrous results.
A survey by the Ministry of Health and USAID in 2007/08 revealed gaps in health systems management occasioned by lack of qualifications to do the job.
According to the survey, 61 per cent of the health managers felt inadequately prepared for the managerial jobs they were charged with.
The survey revealed that resources being channelled into the health sector were not achieving their intended purposes, apparently because the responsible managers were starved of managerial skills.
The general consensus throughout the four-day conference was that most of the challenges in running facilities and the health systems were more about management than clinical.
“Health professionals are appointed as managers without regard to requisite skills, competencies, and preparation,” said the director of medical services, Dr Francis Kimani, at the opening of the conference.
A capacity gap was also found to exist among surveyed training institutions in terms of courses specifically for health managers.
It was these sentiments and experiences as that of Dr Anisa and of others that pushed the government to launch the Kenya Institute for Health Systems Management (KIHSM).
The institute is viewed as a step in implementing quality assurance in health care.
It is meant to create a niche for itself in providing education in health and hospital management.
Based in Karen, Nairobi, at a campus of the Kenya Medical Training College (KMTC), KIHSM will cater not only for public health service providers, but also for the private sector.
The institute’s foundation is based on short courses targeting in-service training.
The head of the institutional advancement Dr Jebichi Maswan, has been coordinating the initial affairs of KIHSM from the KMTC.
Currently, the courses, which are funded jointly by the government and donors like Japan International Cooperation Agency (JICA) and Management Sciences for Health (MSH), have been integrated into real work settings.
They include short courses taking up to six weeks in health systems management and health systems strengthening, currently giving certificates from KMTC.
Mombasa, Kisumu and Nakuru KMTC campuses have been supporting KIHSM activities in the regions.
According to Dr Maswan, a secretariat had been established to work on the inception of the college.
Although the core mandate of the institute will be to train, it will also be engaged in advocacy and institutionalisation of health systems management.
The institute is supposed to enhance leadership, management and governance in the health sector, including research.
It will also be a centre for the standardisation of health systems management curricula and certification for use by other institutions offering related courses like the Great Lakes University of Kisumu, AMREF, and the Kenya School of Government.
The University of Nairobi, Strathmore University, Kenya Methodist University (Kemu) and the Management University for Africa, are the other institutions offering training in health sector management.
“With time KIHSM will also coordinate e-learning and online training to enhance accessibility,” said Dr Maswan.
“By establishing the KIHSM, we will ensure that leadership and management is no longer an afterthought or add-on in the running of our health systems,” said the Minister for Public Health and Sanitation, Mrs Beth Mugo on the opening day of the conference.
The institute will help prepare and improve management cadre in all the 47 counties in the new devolved system.
As Dr Anisa reflects on her journey through the health sector, she stresses that there is a critical need for strong leadership, management and governance skills as the country prepares to give Kenyans their constitutional right to health.