2018/19 MTRH BOARD RETREAT: BREAKING AWAY FROM ROUTINE TO CONSOLIDATE GAINS MADE TOWARDS ATTAINMENT OF UHC

Board members and Senior Managers at the Great Rift Valley Lodge Retreat

Moi Teaching and Referral Hospital (MTRH) Board together with members of Senior Management held a two day Board Retreat from 4th to 6th April 2019 at the Great Rift Valley Lodge in Naivasha. The retreat, held under the theme “MTRH Strategic Leadership, Governance and Management Role in Attainment of Kenya’s Universal Health Coverage/ Care” covered various presentations of strategic significance from Senior Managers intended to enhance improvement and delivery of health care services.

In his opening remarks, the MTRH Board Chairman, Hon. Godana Doyo, said “the Retreat is an important activity for the Board to break away from the routine Board deliberations and get time to interact with members of Senior Management on a more indepth and focused way looking at important issues regarding MTRH Strategies and Policy directions of the Hospital”.

CEO, Dr. Wilson K.Aruasa emphasizing a point during the retreat

The CEO, Dr. Wilson K. Aruasa, on his part, welcomed the Board members and Senior Managers to the retreat and appreciated the full attendance of the Board membership in the retreat. He informed the session that the retreat is one of the few activities in the Board calendar where the Board and Management interact in a strategic and bigger Vision to Share, Inform, Approve strategic decisions and make Resolutions that will shape the agenda of the Hospital for the next one year and beyond.

Presentations dominated the retreat followed by deliberations and decisions touching on various strategic topics. Dr. Saratiel Nyabera, Dr. Philip Kirwa and Dr. Polycarp Mandi presented the status update of MTRH Decongestion Strategies. The Board noted that the Decongestion Strategies is one of the assignment the Cabinet Secretary, Ministry of Health gave to Management to undertake when she visited the Hospital and through the Performance Based Management System. It was noted that the strategies developed by MTRH have been lauded as the best in the country and are being implemented and the Board was informed on implementation status.  Non-

Board Chairman, Hon. Godana Doyo making a point during the presentations

Communicable Diseases (NCDs) as the leading causes of morbidity and mortality at MTRH was presented by Dr. Jesse Opakas and Mr. Richard Ole Kuyo. The Board noted that NCDs are now competing with infectious diseases in terms of mortality and there is need to look at the causes particularly of emerging issues like suicides which have been on the increase and make concerted efforts to address them. Performance contracting plays an important role in achieving results. The implementation status 2017-2022 Strategy, 2018/19 Performance Contracts and implementation status of MTRH approved Policies was presented by Mrs. Christine Tonui and Mr. Stanley Kulei. The Board got an opportunity to look at the role of diagnostics in the transformation of MTRH and what more needed to be done as presented by Dr. Ezekiel Kimutai and Eng. Jacob Chelagat. In order to reduce waiting time at various service points, MTRH Management undertook measures to improve patient flow and a status update on its implementation was presented by Dr. Victor Kipyegon and Ms. Priscah Chelemek.  In enhancing business efficiency, ICT will continue to play a central role and the Board was informed on what is being done and status of upgrading MTRH Business Enterprise Platform and the way forward as presented by Mr. Bethwel Cheruiyot and Dr. Kipyegon.

Members of Management interacting with Board members during Tea Break

Staying true to its mandate of participating in national health planning, Universal Health Coverage (UHC), as one of the agenda of Government, featured prominently in the presentations and discussions. The Board therefore was keen to see the extent of contribution by MTRH and AMPATH in the implementation of UHC. The presentation on UHC was made by Dr. Jeremiah Laktabai and Ms. Selina Chebii. As MTRH focuses on the new 2,000 bed Multi-Specialty Hospital, planning for staff requirements calls for strategic planning. Mrs. Ann Chemworsio presented current and future MTRH staff requirements from a Human Resource Plans perspective.  Board was informed that MTRH takes great cognizance of stress that can have a negative impact on staff lives and work output in the workplace and the Board was updated on the role of Employee Assistance Programme (EAP) as presented Mrs. Jane Karuiki. Further, MTRH plays a key role in Research, Development and Innovation and will continue to place research at the core of its operations. Dr. Benjamin Tarus and Ms. Catherine Okwiri presented opportunities for MTRH in Research, Development and Innovation and how research has contributed in policy decisions and improvement of clinical and operational efficiencies. The strategic role of Supply Chain in contributing to clinical and operational outcomes through consistent availability of quality supplies was recognized. The Board therefore looked at the opportunities and challenges of Procurement Plans as presented by Mr. Bill Saina. MTRH Draft Bill, Legal Audit and Compliance Matrix were presented by Ms. Sylvia Nyariki. It was noted that MTRH is founded on a Legal Notice basis and there was need to have an MTRH Act of Parliament.

The presentation on day two of the retreat covered updates on implementation of MTRH Finance Manual, Credit and Waiver Policy and other Finance Policies, Performance of Income Generating Units as presented by Mr. Mathew Birgen, Dr. Stephen Ondigo, Mr. Thomas Ngetich and Mr. Eliud Cheres. The role of infrastructure in improvement of operating environment and enhancing service delivery was presented by Mr. Silas Tarus, Eng. Joseph Atogo and Ms. Florence Tum through a status update on implementation of capital projects that the Board had approved and also projects supported by MTRH partners.

Members of MTRH Board

During the retreat, presentations that required Board approval were made and the Board approved: safe custody of Hospital Strategic documents at KCB, Nursing Organization Structure and Consultants Clinics and approval for investments of AMPATH Surplus Funds in Treasury Bills. The Board also approved MTRH Draft Bill and approved its submission to Ministry of Health and the onward to Attorney General and that MTRH to engage with the National Assembly Departmental Committee on Health on sensitization/lobbying for the MTRH Draft Bill;

At the end of the retreat, Dr. Wilson K. Aruasa, as the Secretary to MTRH Board, read the Resolutions of the retreat through a Communique. The communiqué covered key aspects and some of the resolutions in the communiqué included;

  1. MTRH to continually strengthen the close working relationship with the Community and County Health Facilities through Medical Outreaches and Camps;
  2. As part of strengthening the Referral system, MTRH to partner with lower facilities (through capacity building, coaching and mentorships) to build confidence in the public that they can get equivalent quality services in the County Facilities as at MTRH;
  • Work closely with referring facilities to ensure basic diagnostic investigations are done before patients being referred to MTRH. MTRH will only focus on specialized investigations and any other investigations recommended by Consultants;
  1. MTRH to participate in comprehensive review of the National Referral Policy and Strategy whose review is ongoing;
  2. MTRH to prepare and participate in the upcoming Health Summit, whose idea was mooted during the recent National Assembly Departmental Committee on Health visit to MTRH. To present on issues such as the Kenya Essential Package of Health (KEPH) levels, Healthcare Financing, Efficiency in Procurement of Health Commodities – Pharmaceuticals and Non-Pharmaceuticals.
  3. MTRH to also focus on Adolescents on the trends in NCDs affecting them and partner with County Health and Education departments to reactivate the School Health Program and effect relevant policy changes. e.g. increase HPV vaccinations in schools and focus on mental health issues;
  • Utilize Placement/Leasing of Medical Equipment as one of the most cost-efficient ways of procuring medical equipment and should be deployed for heavy capital/long term use equipment so long as a proper sound business model is worked out;
  • The Hospital to continue to implement the report on Improvement of Outpatient and Emergency Services at MTRH;
  1. Continually adopt Multi-disciplinary approach to resolving operational issues in a Service Industry like MTRH; lesson learnt from the Taskforce on improvement of Outpatient and Emergency Services a MTRH.
  2. MTRH to refine its Universal Health Coverage/Care Model by working with key Stakeholders like National Hospital Insurance Fund (NHIF), Counties, Moi University, Indiana University and sell the model to the National Ministry of Health for possible adoption nationally;
  3. The Hospital through AMPATH’s Population Health Initiative to bring on board Patients suffering from Neglected Surgical Diseases in the efforts towards attainment of Universal Health Coverage/Universal Health Cover;
  • MTRH College of Health Sciences to develop courses relevant to Universal Health Coverage/Care – Family Medicine Nursing, Community Extension Workers e.t.c.
  • To continue using the stringent and well controlled revenue collection methods of integrated MPESA, Agency Banking and Direct Banking by the Hospital Clients;
  • MTRH should be pro-active in seeking innovative ways to enhance its resource base through the College and participate in building Human Resources for Health by also offering short-term (in-service, pre-service trainings) in various areas of need in the Health Industry e.g. Emergency Obstetrics Care, First Aid e.t.c. Additionally, e-learning programmes can also be pursued;
  1. The role of NHIF as a Key Stakeholder in Financial Performance of the Commercial Services was noted. Most Corporate Entities are now covered by NHIF as compared to the Private Insurers;
  • MTRH should take the lead in costing Emergency Care treatment to inform the Ministry of Health in funding requirements for the Emergency Care Fund.
  • MTRH to work towards being a safe Hospital by maintaining sufficient capacity for utilities e.g. water, electricity, telephones/communications , etc;
  • The need to support development partners e.g. Indiana University to obtain Tax exemption for VAT, IDF and other taxes through lobbying for signing of bilateral agreement between Kenya Government and US Government. MoH processes for tax clearances where agreements already exist needs to be improved.
  • Performance measurements to be holistic in approach in Organizational Performance Measurement including receiving and analyzing customers’ feedback, Suppliers’ Feedback, Clinical Audits, Efficiency Audits, Financial Audits by the Office of the Auditor General (OAG), Quality Audits by Kenya Bureau of Standards and Kenya National Accreditation Service (KENAS), Peer Reviews e.t.c and these should be adopted at all times;

The CEO implored the members of Management to ensure implementation of the Resolutions as they carried strategic significance on the operations of the Hospital and when implemented fully, will take the Hospital and by extension, the Country to a higher level of excellence.

Dr. Ogaro receiving gift of appreciation for long service during the retreat

The retreat was also used to appreciate the contribution of Dr. Francis Ogaro, Senior Director of Clinical Services who, after serving the Hospital from 1990 to 2019 was retiring after long and active public service. The Board Chairman appreciated his role in contributing to transformational leadership and pediatric healthcare at the Hospital. Dr. Aruasa appreciated his leadership support and clinical service and remarked “Dr. Ogaro was retiring but not tired”. It is on this basis that Dr. Ogaro indicated that he would volunteer to mentor students and support the Asthma programme he had championed through sponsorship of Glaxo-smithkline. Also appreciated and commended was Mrs. Ann Mworia whose tenure as a Board member had expired after serving the Board for 6 years from 2013 to 2019. She received accolades from the CEO and Board members for her strategic and valuable contributions during her tenure.

Mrs. Ann Mworia giving her remarks

The CEO particularly lauded Madam Mworia who never missed any Board Committee or Full Board meeting during her 6 years tenure on MTRH Board. She fully participated in shepherding MTRH and providing stewardship that turned around the institution to be now one of the best tertiary level Hospitals in East and Central African region. Mrs. Mworia on her part, appreciated the opportunity to have served on MTRH Board and was very happy of the reputation of the Hospital in service delivery and hoped that MTRH Management and its current Board will continue working for even better and greater achievements. She particularly praised Dr. Aruasa for being straightforward and able leader/manager full of integrity. Both Dr. Ogaro and Mrs. Mworia were presented with tokens of appreciation for their services.

The Board Chairman concluded the retreat by thanking the Board members and the members of Management for their valuable strategic presentations and contributions and spirit of teamwork they continuously exhibit in discharging their responsibilities and expressed confidence that the resolutions made, will play critical role in contributing to the success of MTRH.

Retreat Article by: Silas Tarus-Principal Health Administrative Officer-Capital Investments
Reviewed and Approved by: Dr. Wilson K. Aruasa, MBS, MTRH CEO

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