Dr Salim Hassan stood in the theatre thunderstruck with a scalpel in hand gaping at his assistants in the room.
The patient on the operating table needed urgent attention, but as much as he would want to help, his conscience held him back.
He had just reported to Makindu Sub-district Hospital that morning as a manager, when a group of staff accosted him to help organise the operation. Quickly they escorted him to theatre and there, everyone stood waiting for his commands.
It took him time to organise everyone for the delicate task. “It was not because I doubted any of them, no. But how was I going to organise a team. I had never done that before,” recalls Dr Salim.
This incident was his plunge into health systems management. He learnt how to manage medical professionals by chance. But he is not alone.
According to a survey conducted in 2008 by the Ministry of Health, 61 per cent of health managers were found inadequately prepared for their leadership and management roles, a scenario that negatively impacts health service delivery.
Almost all doctors we spoke with gave similar account — if not worse — of their roles as first-time managers in hospitals across the country.
Dr Jebichi Maswan, head of institutional advancement at the Kenya Medical Training College (KMTC) is one whose story many doctors share.
She performed her duties well until one day she was asked to account for the money disbursed by the ministry. “I was asked where the money was,” she said. “But I replied, what money?”
Dr Maswan, like others promoted to administrative positions, had failed to recognise that financial and human resource management were part of her work. She was no longer the medic in charge of nurses, but a manager running the institution.
All she thought then was, her work ended at signing papers whose content came back to haunt her, resulting to massive loss of money in public facilities. Some of the losses run into millions of shillings, doctors told Business Daily.
Untrained health managers have emerged as the biggest impediment to service delivery. Their lack of knowledge on management has led them to unconsciously mismanage health facilities, resulting to loss of money and most importantly lives of people.
A clear example is, a medic-manager, who is not aware of the distribution channel and how it affects the patient in his hands.
Following up on the results on the survey findings, which pointed to untrained medical managers, the Ministry of Health (MOH) with the partnership of Japan development corporation (Jica) and Management Sciences for Health (MSH), a non-profit international organisation working in public health areas, set on track a six-month training programme for health managers.
The first to be trained were directors from referral hospitals and prisons health departments.
Since the training was conducted, there is remarkable improvement both in service delivery and management. Doctors now value financial management.
“We now know that whatever funding we receive is an investment from the people, and we should do something better with it,” said Dr Maswan.
She is also a member of the secretariat set up to oversee the establishment of Kenya Institute for Health Systems Management (KIHSM). KIHSM will be a centre of excellence for training heath managers. The institute will be located in Karen at the KMTC School of Nutrition.
“You no longer need to take up surgery, doctors who want to be a manger can enrol in management,” said Dr Salim who is now the head of health promotions at the Ministry of Health. He is trained in management.
Doctors are also beginning to contribute to the debate on non-medical managers, from a point of knowledge.
They are acknowledging they need managers like Richard Lesiyampe, the director of Kenyatta National Hospital (KNH) for survival of these institutions.
Since Mr Lesiyampe, a manager by training, took over two years ago, he has been working on several reforms at the giant referral hospital.
Although there is a new dawn in managing the health facilities, some groups are still not convinced it was the right step to take in curing what is ailing the hospitals.
Karen Hospital, a private facility, has benefited from the experience of its chairman James Mageria. “We need people who have knowledge on management to head hospitals,” he said.