How Good Governance Could Strengthen the Devolved Health System

As the country started to implement the devolution process, I could not help but wonder if the health system would carry with it the loop holes of yester years, such as poor governance, time wasting, weak institutional capacity and an inability to deliver basic services to the citizens. Some health facilities were pretty much nominal facilities with no basic services available.

For the devolved health services to succeed, we need to view good governance as a public good:

Good planning: Planning will help County governments to match and prioritize health needs; demanded health services, finances and the available time.  This should be done through strategic plans, annual plans, and monthly plans and even the daily plans. It is necessary to identify the health tasks to be carried out and anticipate any possible deviations that may occur. To reduce these deviations it is important to distribute tasks into set milestones. The Phases will allow all health care team members to visualize the actual status of health indicators at any time and assess the possible need for replanning and adjustment.

 Implementation: Planning cannot be significant if the said plans will not be operationalized. Once the county health system commits to planning, they need to create logical step by step approach to accomplish the county health objectives. The county health managers should maintain the momentum for change by providing resources, developing competencies and skills and building a support system for the health workforce.

Resources mobilization: Resources should be readily available to ensure availability and accessibility of health services by citizens in a timely way. The counties should not expect the allocated money to be adequate for all the health needs. Competing needs will always be there and hence the need to mobilize resources through inviting the needed investors. The county health managers should create a worthy public private partnership (PPP) environment to attract Non-governmental organizations (NGOs), Community based organization (CBOs) among other partners.  It does not hurt, to come up with creative ideas like the first ladies half marathon to raise funds for various health activities.

Team work: Health systems are made up of people of different cadres working together to achieve a common goal. The people are frequently required to work as a group, hence the need to focus on team work. The county health sectors will need to improve the effectiveness of health workforce with particular attention to performance, collaboration and knowledge of individual roles in relation to the county health sector.

Use the generated data for decision making: The greatest expectation of the county health sectors is guiding the health system in maintaining an environment of accountability. Effective county health leaders will use data extensively to guide them in decision making. The generated data will help clarify issues, identify alternative solutions to problems and target resources more effectively leading to evidence based decisions. In fact the real question in the county health sectors should not be whether to integrate the use of data in decision making, but how?

Monitoring and Evaluating: Tracking down the health inputs, activities and outcome will enhance transparency and accountability. The county’s health sector should frequently take stock of their progress. Monitoring and evaluation should not only apply to money but also to performance and the satisfaction to service delivery in the eyes of users. The county health sectors should set indicators and put measures in assessing them and reviewing the actual results compared to the goals established.

Invest in the health work force: A motivated worker is a productive worker. And a productive worker is a more profitable one. Now more than ever, the counties need motivated health workforce. Given the limits of the various theories of human motivation, counties health managers should focus their attention to the real world and what has worked. A strong work culture with no bossy bosses, stable work environment and good benefits like the pension plan, health financing for family members and other little incentives is the ideal work culture.

The county health managers should provide dialogue opportunities for expressing self. Everyone likes to believe their opinion matters and that they too matter. Giving frequent feedback to the health personnel will make them embrace and feel that they are part of the devolving system. A few counties view capacity building as a liability and a waste of time, hence no budget allocation, however investing in capacity building of the health care workers is one of the most motivating factors. Let's face it; it makes more sense to retain employees than hiring new ones all the time. One of the best ways I know to retain the health workforce is to make them feel appreciated. Never underestimate the value of simply acknowledging the workforce for the good work. Formal recognition may acknowledge performance but the informal one has a greater impact.

Embrace change: While change cannot happen overnight, there are a few things that county health sectors can do to better the health sector and deliver better services to citizens. Allow the entry of new technology to the counties; ‘digitalize’ some department or the health facilities to start with, this will boost overall performance by increasing productivity and health services

The Power of Post training Coaching in Strengthening Health Workforce Performance

Coaching is a unique and effective approach to sustainably develop health care providers’ capacity to deliver health care services. This has been demonstrated by the results of various training's which conduct the post training coaching and follow ups. The post workshop coaching develops the teams’ capability and competencies allowing participants to discover new perspectives around their actions leading to greater performance. The coaching and follow up should be done a few weeks after the training workshop as agreed with by the facilitator and participants. Facilitators visit teams at their work places, providing the participants an opportunity to deal with challenges and issues in their own environment. The facilitators get the chance to meet the larger teams in the facilities that were not participating in the training and share with them practical skills on how to overcome the challenges to achieve results.

Upon participating in coaching sessions after the workshops, participants demonstrate noticeable improvements in their work. Following the post workshop coaching, the health care providers chose sustainable alternatives of achieving results.  The teams discover ways of undertaking corrective actions and exploring alternative solutions for the encountered challenges. Coaching and follow up make a difference and enhance the team’s capability to reach their potential as high performers through stretching themselves and setting higher aspirations. This achievement is a motivation and inspiration and gives participants an opportunity to put the skills learned into practice. In this way, the trained personnel get to practice what has been taught and demonstrate to others staffs the skill gained.

Post workshop coaching and follow ups foster team spirit and mutual trust that were essential in working towards shared goals. During coaching, participants involve and invite the larger team and colleagues at work. This strategy enables the whole team to understand better what was expected, to discuss and brainstorm on most effective ways to achieve the results. The larger teams support one another to realize goals.

Coaching and follow up following the workshop helps to reinforce concepts that are learned. Teams embrace higher values such as courage, motivation and altruism and prioritize aspects of their work that were previously pushed aside to achieve results.

The coaching and follow-up following training holds significant promise to sustainably improve the performance of the health workforce and could potentially save many organizations a lot of resources used repeatedly in training the health workforce in almost a similar topic.

THE YEAR 2013; DEFINING MOMENTS

THE YEAR 2013; DEFINING MOMENTS

As we come to the end of this year 2013, I would like to take this opportunity to wish all my blog readers a Merry Christmas and a Happy New Year 2014. The year 2013 has had a record of lessons established.

General Elections: It all started in January. The country was feverish with the General Election campaign. It is always said, we can learn from all situations. I kept a keen eye on the different candidates, assessing how they managed their teams. I realized the team that wins had some unique characteristics.

Ø  Team Spirit: The team logos, t-shirt and all gadgets incorporated the values of each partner in the team, indicating that none of them could do it alone. Be wary of wanting to be the winner who takes it all. It can derail the team spirit.

Ø  Chemistry between team leaders: The winning team could easily be mistaken to be in “love”. The candidates held hands, smiled at each other often and even high-fived. When the public sees such an attitude, the morale and trust is boosted. Truly chemistry can make or break the whole team.

Ø  Networking:  It has always been said that network is your net worth. The team made use of every individual and this made everyone in the team feel valued. As it has been said, it is just about making the invisible, visible.

Ø  Finances and mobilizing resource is very crucial to win.  As a leader it is good to accept all types of resources. From experience, skills, material things or even a simple advice. These will always come handy.

Ø  Use of new technology: I loved the persuasion techniques by embracing technology like Face book, twitter, text messages appreciation. This was a new era in political campaigns.

Planning and preparation for change: The country saw its first ever devolution of all sectors. The health sector is an important aspect of development. However, as all other sectors had meetings, planned and gave feedback on the constitutional issues that would affect them, our health counterparts may have left this chance to by-pass them.  The health workers Unions later put up spirited fight with the hope to right the wrong. But change is good and must be graduated with caution to avoid any failure.

A sad year with deaths: There were many Deaths. I personally commemorated anniversaries of many close relatives who had passed on, including my father and grandparents, cousins, aunts and uncles. Memories seem so close. It seems just like yesterday. The country was also not spared with deaths from terror attacks and grisly road accidents.

Becoming a writer: I decided to seriously start writing. I have procrastinated about this for long and as the saying goes; procrastination is the thief of time. I have snapped out of it and started writing my memoirs, acknowledgements, manuscripts, blogs etc.  After the first writing, everything became very easy and clear on expressing what I want, and to celebrate all those funny and unique moments of life.

Celebrating my successes: I realized that when everybody gets up in the morning, they go to work with an intention of doing the best, and contributing towards the best possible outcome. There is need to celebrate the little successes achieved. Education wise, 2013 was a great year for the academic achievements and implementation of what has been learnt.  It has been said that, when something happens, you have three choices. You can let it define you, let it destroy you, or you can let it strengthen you. I will let all those that have happened strengthen me.

The Thin Line between life and death: All of a sudden, I was sick and scheduled for a surgery. Wow, who would have thought I would be on an operating table, under anesthesia, oxygen on my nostrils and intravenous fluids and a unit of auto transfused blood in my veins (details for another day). As I lay in my room recuperating I decided to take time and celebrate every day, minute and second. It all counts.  I celebrated my birthday on Christmas day, 25^th December.  At all this time, I realized the importance of Family and Friends. How everybody surprised me.

As I sign off the year 2013, I wish all of you the very best for 2014, and hope that we will regularly get in touch through my blog. Will see you next year.

Millennium Development Goals Beyond 2015

Millennium Development Goals Beyond 2015: Improving Access to health for the mother and child.

      Although a lot has been done worldwide to reduce child mortality and improve maternal health, mothers and children in most parts of Africa still have a hard time accessing health care. I would therefore propose that in the millennium development goals (MDG) beyond 2015, we should include the goal of improving access to health care for the mother and child.

      The main reason for lack of accessibility to health care is due to lack of health facilities and the poor distribution of these facilities hence making it difficult to reach them. In most areas of Africa, especially the rural areas, people walk for over 5 km to access the nearest health facility. This becomes very difficult for a pregnant woman or for a child needing health care or basic immunization. Women in their last months of pregnancy opt to camp near a health facility just in case the labor commences. At the same time the facilities have no room to lodge the women who are not in labor yet. They are asked to go back home and come when in labor. This only leads to women walking back for the many kilometers and either deliver on the way or when labor commences, the family decides to take the nearer option which is the traditional birth attendant (TBAs).

      Apart from the long distances, most health facilities in rural areas lack essential medications, necessary equipment's and skilled attendants. A number of health facilities are manned by only one nurse and a support staff. In case of a referral or a need to accompany a client to the referred hospital, then the facility is closed for this period. In case the health care worker gets an off or a personal emergency, then there is no option, but for the health facility to remain closed. The clients would not risk relying on these facilities and walking for long distance just to meet it closed. Of course this has encouraged TBAs, home deliveries and also self prescription and buying of the over the counter antibiotics for those who are sick.

      Another contributing factor for the lack of access to health facilities is the poor referral system and poverty. Many people would prefer to be locally treated due to the fact that if a client gets some complications in the facility, it would be difficult to reach a main hospital in the urban areas because the health facilities have no ambulances or staffs to escort during the referral. In addition, clients are expected to pay out of pocket for the health care. This is very difficult especially because most of the time an illness or an emergency always strikes when people have no money at all. Due to this, many would prefer to get services from traditional healers and TBAs due to the believe that they are cheaper and families can pay for the services through giving goods or farm products available.

      Coupled with the above problems, there is no adequate data collected to identify, how many mothers deliver in homes, how many die and how many get complications. Monitoring and evaluation is poorly done and hence no evidence is presented on the need to enhance access of health care.

The Political Implication of the Proposed MDGs Beyond 2015:

·         This will can increase coverage and reduce barriers through coordinating actions and policies across the health system

·         With this goal in place the governments will place maternal and child health, in particular high on its political agenda of reform.

·         The governments will fast-track system wide reforms in maternal health

The sub goals that may need to be put into attention are:

·         Operationalizing the health facilities and Improve the referral system

·         Employment and retention of skilled health care workers

·         Strengthen monitoring and Evaluation and acting on the results

·         Free services for the mother and children under 5 years.

·         Health care financing

Coaching to Strengthen Health System Performance

The Power of Coaching and Follow up: Lessons in strengthening health system performance

 

   Following various training's in leadership, management and governance in the Eastern region of Kenya, It evidently showed that coaching is a unique approach to developing health care providers potential in a more effective and sustainable way. During the post training coaching, one could not help but notice the uniqueness of making the follow up coaching sessions to participants in their work place other than converging them to one venue.

      A number of organizations use a lot of resources for training and updating the health care providers, with the expectation that the outcome would be positive and sustainable. But in most cases, change does not happen and when it happens it does so very slowly and after consuming a lot of resources and time. Upon participating in various coaching session, the genuine value added by this activity is noticeable as described below.

           

Value: During the coaching session, many team members expressed that these strategy of coaching after training, made the teams feel valued. The Coaching focused on practically building the skills and resources of the team. While at the work place, the teams do not rely on a review schedule, but now support one another along the path to meeting their goals. It was easy to realize that the best learning moment for many teams and the majority of these people were not direct participants of the training. During coaching, the teams start getting the time and space to explore areas of their work that get pushed to the side and they start believing in higher values like courage and altruism to achieve results.

Team Work and Mutual Trust: During coaching the direct training participant are encouraged to involve and invite the larger team and colleagues at work. This strategy has made the whole team to understand better what is expected and they were all able to discuss the anticipate had results and brainstorm on alternative ways to achieve their results. It was realized that coaching language was adopted within the organization. In one of the health facility, one nursing officer in charge, once said that “We realized coaching after trainings was the best way to make follow up for our staffs after continuous medical educations (CMEs) or any updates. In this way the trained personel gets to practice what was taught and to demonstrate to others the skill gained” Isaac Ithiki, Nursing Officer in charge, Siakago Hospital. Most teams that were coached voiced out the realization of a positive change among all staffs because of continuously being acknowledged and involved during the coaching sessions and this was building a more workable workplace.

 Enhancing Governance: During the post training coaching, the teams understood the value and importance of giving continual performance feedback to their larger supporting teams, both positive and corrective. To strengthen performance and support all the teams consistently gave feedback and meeting held were well documented.   The teams focused on progression and this was a motivation to many. The coaching provided staffs with the opportunity to grow and achieve optimal performance through the consistent feedback.

      One mistake that a number of Organizations offering capacity building to health care providers commit is the overlooking or avoiding the performance issue and assuming the health worker understands the significance of the training. This is a typical mistake. To support the team in improving their performance, the trainers must be able to make follow ups to the institution and recognize the nature of issue, challenges and opportunities available for enhancing the changing behavior. This can best be done through a coaching session at the work environment.                                                                                                                        

Keep Growing and exploring alternatives:  The coaching sessions helped the health care workers choose sustainable alternatives ways of achieving results.  After discussions, a number of teams gave their verbal commitment regarding what action will be taken and when it will be taken. The teams explored ways that an issue can be improved or corrected by brainstorming alternative solutions and maximizing the number of choices to consider. One facility wanted to meet their measurable result of immunizing 1250 children with Vitamin A. They had a number of challenges and one of them was the lack of a community unit which could not be formed for that level of hospital.  During the coaching sessions with the larger team many of who were not the direct participants of the training, they found a way of linking a dispensary with a community unit, to the hospital. The team surpassed their target and by the end of 6 months they had immunized 1608 children with vitamin A and achieved a number of secondary results too. Dr Ann, the district Medical officer and the acting medical superintendent, was one of the training participants, and she pointed out that the coaching that was conducted to all the facility staffs made the difference and enhanced the team to reaching their potential as high performers. Dr Ann said “It seems people fear to ask enough from themselves.  When you stretch yourself, and set higher aspirations, then you know you have it in you. This achievement was a motivation and inspiration”.

Conclusion

Post training coaching develops the team capability and competencies allowing people to see new perspectives around their actions leading to greater performance. A number of capacity building organizations have expressed their admiration to using this strategy to strengthen the health workers performance. A Chinese philosopher, Wang Yang-Ming (1472-1529) believed that knowledge is incomplete until it becomes conduct, and conduct is not complete until it becomes knowledge at work. Coaching can be the key to achieve and replicate this success.