Strengthening management and leadership practices to increase health-service delivery in Kenya: an evidence-based approach

Abstract

Background: The purpose of the study was to test the hypothesis that strengthening health systems, through improved leadership and management skills of health teams, can contribute to an increase in health-service delivery outcomes. The study was conducted in six provinces in the Republic of Kenya.

Methods: The study used a non-randomized design comparing measures of key service delivery indicators addressed by health teams receiving leadership and management training (the intervention) against measures in comparison areas not receiving the intervention. Measurements were taken at three time periods: baseline, endline, and approximately six months post intervention. At the district level, health-service coverage was computed. At the facility level, the percentage change in the number of client visits was computed. The t-test was used to test for significance.

Results: Results showed significant increases in health-service coverage at the district level (p = <0.05) in the intervention teams compared to the comparison teams. Similarly, there were significant increases in the number of client visits at the facility level in the intervention group versus comparison facilities (P < 0.05).

Conclusions: Strengthening the leadership and management skills of health teams, through team-based approaches focused on selected challenges, contributed to improved health service delivery outcomes and these improvements were sustained at least for six months.

Figure 1

Leading and Managing Framework. Practices that enable work groups to face challenges and achieve results.

Figure 2

Average coverage rates for health-service delivery indicators selected by each intervention team, Kenya 2008–2010.

Figure 3

Average coverage rates, selected health indicators, district intervention teams.