The document summarizes the results of a mentorship approach used in five districts supported by GIZ in Kenya to improve healthcare leadership and management. It found that limited management skills were a challenge. A two-pronged capacity building initiative included management trainings and mentorship. This led to improved quality of reproductive healthcare services, increased utilization of key services, and improved customer satisfaction across supported facilities. Lessons learned included the importance of leadership skills, functional teams, stakeholder involvement, and training coupled with mentorship of providers.

1. Leaders Drive the Health System
Results of Mentorship Approach in GIZ Focal districts
National LMG Conference
Intercontinental Hotel, Nairobi
January 2013

2. 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

3. 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 institution
3.Strengthening management competencies at both DHMT
and facility level.

4. 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.

5. District Experience
Bondo District

6. 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

7. 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

8. Impact of Intervention
 Improved quality of RH services in the district.
 Improved indicators in all three facilities targeted.
 Improved customer satisfaction

9. Bondo District Hospital

10. Got Agulu Sub-District Hospital
th
4 ANC Visit Facility Deliveries
ANC attendance improved from 38 percent to 53 percent;
Hospital deliveries increased from 90 percent to 102 percent

11. Nyangoma Dispensary
th
4 ANC Visit
Attendance of fourth ANC visit
increased from 45.6 percent to 70
percent.

12. 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

13. Lessons Learnt
 Team 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

15. Facility Experience
Project title: Increasing skilled delivery at Enzaro Health
Centre.

16. 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 care
Thus the purpose of the project was to increase facility
deliveries at the health centre from 9 percent to 43 percent

17. 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

18. Results: Skilled Birth Attendance at Enzaro
Health Centre
Deliveries increased from 9% to 52%

19. 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