Effectiveness of leadership and governance in public healthcare provision in Meru County Referral Hospital

Hassan, Ibrahim
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Strathmore University
The achievement of sustainable development goal number three SDG3 requires strengthening of all the six pillars for health system which includes leadership and governance; health financing; health information; health service delivery; human resource for health; medicines and technology. Leadership and governance is considered the most important pillar in realizing the successful implementation of the universal health coverage (UHC) and quality healthcare services delivery in public facilities. Kenya is in the process of implementing UHC as part of the “Big 4” agenda. Since devolution of health to the county governments in 2013, successful implementation of UHC will depend on effective health governance at the county level. For the health board to be effective in its leadership and governance mandate, its adherence to the “Mwongozo” code of conduct guidelines is not only of necessity but ultimately vital. “Mwongozo” addresses the matters of effectiveness of Boards, transparency and disclosure, accountability, risk management, internal controls, ethical leadership and good corporate citizenship. This study sought to investigate effectiveness of leadership and governance as an enabler of public healthcare provision at the only county hospital with a management board, that is, Meru Teaching and Referral Hospital, in Meru County. Purposive sampling technique was employed with target population being all 13 board and 11 committee members of Meru Teaching and Referral Hospital, out of which 11 board members and 10 committee members responded to the interview. Data was collected through structured in-depth interview guides, transcribed, organized and analyzed thematically in respect to study objectives. Findings showed no mention of “Mwongozo” code of governance as a guiding by board and committee members which means they are not well acquainted with the values of board members. The study findings revealed some board members had no idea of the important needs of residents of Meru County which is likely due to misrepresentation of residents in the board and could render the board ineffective. There was lack of clear framework for induction programme and no benchmarking activities for the board and committee which greatly undermines the efficacy of the board. The women in the board are less than 33%; there is low youth representation and no representation of people with disability. Study revealed among the challenges to be addressed to strengthen leadership and governance in Meru County: fund the health sector adequately, minimize political interference, increase communication between policy makers and implementers, facilitate good feedback mechanisms, and allocation of enough resources for the training and recruitment of healthcare workers.
A Thesis submitted in partial fulfillment of the requirements for the Degree of Master of Business Administration in Healthcare Management at Strathmore Business School
Governance, Public healthcare provision, Meru County Referral Hospital