OKUMU: Kenyan hospitals don’t need doctors or managers, just competent leaders

As universal health coverage rolls out, the wrong leadership could cost lives.

Globally, the debate is heated. Should the CEO be a doctor who understands patients, or a manager who understands balance sheets? The evidence points both ways.

A 2020 German study of 370 hospitals found that physician-CEOs reduced pneumonia deaths and boosted patient satisfaction. But hospitals led by managers with economics or business training had stronger finances and better outcomes in hip and knee surgery.

In the United States, the very best hospitals are often physician-led, yet a 2022 study of more than 6,000 hospitals found no clear overall advantage for doctors.

The lesson? Doctors bring credibility with staff and insights into patient care. Managers bring fiscal discipline and operational efficiency. Both strengths matter. Both can fail if leadership is reduced to a job title.

And here’s where Kenya must be especially careful. Our hospitals do not operate in the safety nets of Boston or Berlin. When leadership fails at Kenyatta National Hospital or at a county referral facility, the consequences are not lower rankings — they are patients dying because oxygen ran out, or nurses walking off the job in protest.

This is why the debate cannot stop at “doctor vs manager”. We cannot afford to appoint CEOs simply because they once held a stethoscope or because they have an MBA. What we need are competent leaders who can command the trust of clinicians, keep the books balanced and steer hospitals through the politics of reform.

The path forward is not mysterious:

• Competency-based hiring. Boards should assess candidates against proven skills in finance, operations, and clinical alignment — not just degrees.

• Leadership training for clinicians. Doctors who rise to management must be equipped with governance and finance skills, not set up to fail.

• Balanced boards. Governance structures should blend financial and clinical expertise so neither bean-counters nor clinicians dominate.

The truth is, Kenya cannot afford a false choice between doctors and managers. We need leaders who can blend clinical insight with financial discipline, empathy with strategy. Hospitals are not factories, but they are also not immune to the laws of management. They demand both.

And so perhaps the real question isn’t whether hospitals should be run by doctors or managers. The question is whether Africa will finally insist that those who lead — in boardrooms and in State Houses — are chosen not for their credentials, but for their ability to combine compassion with competence, vision with execution.

Okuku is a surgeon, writer and advocate of healthcare reform and leadership in Africa