Leadership, Management and Advocacy MDI Training for Surgical Healthcare Providers in Kenya

  1. Please read the instructions below before you begin filling out the Application Form

    Please note that the form has several different fields to fill spread over 7 pages. It is an intensive process and the MDI program organisers propose that you complete the application as a team of 2 people.

    Before you start filling in this application make sure you have the following information:

     

    2. Organization Information

    a. Physical and Postal Address, Email Address, website

     

    b. Telephone, Fax 

     

    c. Number of patients/clients served per year; 
    Number of sites, clinical staff, admin staff, and other staff;

     

    d. Which sector is your organization: Govt, NGO, Private?

     

    e. Organization Type: Local Non-Government, National Non-Government, International Non-Government, Faith-Based, Community-Based, Educational Institution, Local Health System, Regional Health System, National Health System, Governmental Institution, Hospital, Other (please specify)

    3. Team Members' information

    a. Personal Information: Name, Email, Phone, Postal Address, Gender

     

    b. Role in Addressing Health Priority

     

    c. Have you ever applied to MDI before?

     

    d. Education: Highest level of education attained; 
    Name of Institutions attended, years attended, name of degree or certificates received.

     

    e. Professional Development: List any management or leadership training you have attended within the last 3 years (e.g., conferences and seminars) relating to your work as a health care executive

     

    f. Employment History: Total number of years worked; List other positions held in the health care industry – Position/Title, Company/Organization, Number of Years

     

    g. Leadership Involvement: List any community and/or health care organization(s) in which you are involved in a leadership capacity, including the scope and length of time of your participation. Note: A minimum of 1 year leadership involvement is required;
    Name of Organization;
    Dates of Participation;
    Leadership Role / Title.

     

    h. Choose one organization and describe, in detail, your leadership role.

    Repeat for EACH Team Member / Applicant

    4. Statements

    a. Team to Jointly Respond: What are the major health care needs, challenges and priorities facing your nation, region or community? What is your entity, department, organization, team or partnership doing, or else are planning to do, to respond to these challenges and to attend to these health priorities?

     

    b. EACH Team member to Respond: Describe your personal role and responsibilities in confronting these challenges.

     

    c. EACH Team member to Respond: What do you anticipate as being the benefits to your management team from participating in the Management Development Institute? What do you, as a member of the team that is attending, expect to gain?

     

    5. Commitment

    a. Commitment Letter from Organization: Upload (Scanned and in PDF) a letter of recommendation from your organization will be included along with the team's program application.

     

    b. Commitment Form: Download the Commitment Form. Print, complete and upload the signed form.

  1. Multipurpose Team

    The selected participants should be meet the following criteria:

    1. 1. The participant works in a surgical health delivery institution with priority being given to surgeons, obstetrician, anesthetists and trauma care providers.
    2. 2. The participant has at least one year experience in organizing, coordinating and or delivering surgical, obstetric, trauma and anaesthesia services.
    3. 3. The participant commit to devote the entire five days (5) to the training program.

     

     

    The participant is recommended and sponsored by a partner institution health care institutions (Public, Private and NGOs) in the region.

    1. 1. The partner institution recommends at least two participants to the program, (You are expected to attend the program as a member of a team consisting of two individuals that are employed by the same organization or partners collaborating across organizations and focused on the same national or regional health priority).
    2. 2. The institution commits to facilitate the implementation of the SHIP. 

     

     

    SPECIAL PROGRAM FEATURE – Surgical Healthcare Improvement Project (SHIP)

    Before finalizing this application, participant teams and their superiors should discuss and identify two potential Surgical Healthcare Improvement Projects (SHIP) that are relevant to their roles and organizations. During the residential portion of the program, one of these projects will be further developed as the SHIP. Each team's SHIP should be aligned with the roles and responsibilities of the team members, and should have the support of their superiors and/or their organization's senior leadership. It is expected that program participants will implement the SHIP as part of their work responsibilities after completing the program, and will secure the resources (including time) necessary to do so. Our objective is to ensure that LMA participants and their superiors will implement and evaluate SHIPs in the context of their healthcare service delivery programs that lead to better health outcomes, and which may serve as models for other organizations.

     

    The program will include a six (6) months follow-up component after the training to provide guidance and support for the implementation of the surgical health improvement project (SHIP) developed by each team of learners to be implemented in the institution where they work

     

    All team members must commit to the full program, complete the Applicant Information pages, jointly respond to the Statements as required as part of this application.

  2.  

    II. Organization(s) Information

  3. Primary Organization Name:(*)
    Invalid Input
  4. Secondary Organization Name
    Invalid Input
    (if more than one organization is applying)
  5. Primary Organization Physical Address:(*)
    Invalid Input
  6. Postal Address/Postal Code
    Invalid Input
  7. City and Country(*)
    Invalid Input
  8. Organization Telephone:(*)
    Invalid Input
    (Add Country Code)
  9. Fax:
    Invalid Input
  10. Web Site(s):
    Invalid Input
  11. Organization E-mail address(*)
    Invalid Input

  12.  

    III. Scope of Organization

  13. Number of Patients/Clients Served per Year:(*)
    Invalid Input
    (unduplicated)
  14. Number of Sites:(*)
    Invalid Input
  15. Number of Clinical Staff(*)
    Invalid Input
  16. Number of Administrative Staff(*)
    Invalid Input
  17. Number of Other Staff(*)
    Invalid Input
  18. Sector(*)


    Invalid Input

  20. Organization Type(*)
    Invalid Input
  21. Other (Organization Type)
    Invalid Input

  1. Please Fill Out for EACH Team Member Applying. At Least One Team Member Should be of Senior Level.


    All members of a team must fill out the applicant information section

  2.  

    IV.1 Applicant Information - This Section is for the First Person of the Team

  3. Name(*)
    Invalid Input
  4. Organization Name(*)
    Invalid Input
  5. Position(*)
    Invalid Input
  6. No. of Years in Current Position(*)
    Invalid Input
  7. Role in Addressing Health Priority listed in Section I:(*)
    Invalid Input
  8. Postal Address/Postal Code:
    Invalid Input
  9. City and Country:(*)
    Invalid Input
  10. Telephone:(*)
    Invalid Input
    (Add Country Code)
  11. Fax:
    Invalid Input
  12. E-mail Address(*)
    Invalid Input
  13. Gender(*)
    Invalid Input

  15. Have you previously applied for MDI?
    Invalid Input
  16. If Yes Which Year
    Invalid Input

  17. Educational Background

  18. Highest level of education attained(*)
    Invalid Input
  19. Please list schools attended, beginning with most recent.
  20. Name of Instutution(*)
    Invalid Input
  21. Number of years attended(*)
    Invalid Input
  22. Degree or certificate received (if any)(*)
    Invalid Input
  23. _________________________________________________
  24. Name of Instutution
    Invalid Input
  25. Number of years attended
    Invalid Input
  26. Degree or certificate received (if any)
    Invalid Input
  27. _________________________________________________
  28. Name of Instutution
    Invalid Input
  29. Number of years attended
    Invalid Input
  30. Degree or certificate received (if any)
    Invalid Input
  31. _________________________________________________

  32. Professional Development:

    Please list any management or leadership training you have attended within the last 3 years (e.g., conferences and seminars) relating to your work as a health care executive
  33. .(*)
    Invalid Input

  34. Employment History

  35. Total number of years worked(*)
    Invalid Input
  36. Please list other positions held in the health care industry.
  37. Position/Title(*)
    Invalid Input
  38. Company/Organization(*)
    Invalid Input
  39. Number of Years(*)
    Invalid Input
  40. _________________________________________________
  41. Position/Title
    Invalid Input
  42. Company/Organization
    Invalid Input
  43. Number of Years
    Invalid Input
  44. _________________________________________________
  45. Position/Title
    Invalid Input
  46. Company/Organization
    Invalid Input
  47. Number of Years
    Invalid Input
  48. _________________________________________________

  49. Leadership Involvement:

    Please list any community and/or health care organization(s) in which you are involved in a leadership capacity, including the scope and length of time of your participation. Note: A minimum of 1 year leadership involvement is required.
  50. Name of Organization(*)
    Invalid Input
  51. Dates of Participation(*)
    Invalid Input
  52. Leadership Role/Title(*)
    Invalid Input
  53. _________________________________________________
  54. Name of Organization
    Invalid Input
  55. Dates of Participation
    Invalid Input
  56. Leadership Role/Title
    Invalid Input
  57. _________________________________________________
  58. Name of Organization
    Invalid Input
  59. Dates of Participation
    Invalid Input
  60. Leadership Role/Title
    Invalid Input
  61. _________________________________________________
  62. Choose one organization and describe, in detail, your leadership role:
  63. .(*)
    Invalid Input

  1.  

    IV.2. Applicant Information - This Section is for the Second Person of the Team

  2. Name(*)
    Invalid Input
  3. Organization Name(*)
    Invalid Input
  4. Position(*)
    Invalid Input
  5. No. of Years in Current Position(*)
    Invalid Input
  6. Role in Addressing Health Priority listed in Section I:(*)
    Invalid Input
  7. Postal Address/Postal Code:
    Invalid Input
  8. City, Country:(*)
    Invalid Input
  9. Telephone:(*)
    Invalid Input
    Add Country Code
  10. Fax:
    Invalid Input
  11. E-mail Address(*)
    Invalid Input
  12. Gender(*)
    Invalid Input

  14. Have you previously applied for MDI?(*)
    Invalid Input
  15. If Yes Which Year
    Invalid Input

  16. Educational Background

  17. Highest level of education attained(*)
    Invalid Input
  18. Please list schools attended, beginning with most recent.
  19. Name of Instutution(*)
    Invalid Input
  20. Number of years attended(*)
    Invalid Input
  21. Degree or certificate received (if any)(*)
    Invalid Input
  22. _________________________________________________
  23. Name of Instutution
    Invalid Input
  24. Number of years attended
    Invalid Input
  25. Degree or certificate received (if any)
    Invalid Input
  26. _________________________________________________
  27. Name of Instutution
    Invalid Input
  28. Number of years attended
    Invalid Input
  29. Degree or certificate received (if any)
    Invalid Input
  30. _________________________________________________

  31. Professional Development:

    Please list any management or leadership training you have attended within the last 3 years (e.g., conferences and seminars) relating to your work as a health care executive
  32. .
    Invalid Input

  33. Employment History

  34. Total number of years worked
    Invalid Input
  35. Please list other positions held in the health care industry.
  36. Position/Title
    Invalid Input
  37. Company/Organization
    Invalid Input
  38. Number of Years
    Invalid Input
  39. _________________________________________________
  40. Position/Title
    Invalid Input
  41. Company/Organization
    Invalid Input
  42. Number of Years
    Invalid Input
  43. _________________________________________________
  44. Position/Title
    Invalid Input
  45. Company/Organization
    Invalid Input
  46. Number of Years
    Invalid Input
  47. _________________________________________________

  48. Leadership Involvement:

    Please list any community and/or health care organization(s) in which you are involved in a leadership capacity, including the scope and length of time of your participation. Note: A minimum of 1 year leadership involvement is required.
  49. Name of Organization
    Invalid Input
  50. Dates of Participation
    Invalid Input
  51. Leadership Role/Title
    Invalid Input
  52. _________________________________________________
  53. Name of Organization
    Invalid Input
  54. Dates of Participation
    Invalid Input
  55. Leadership Role/Title
    Invalid Input
  56. _________________________________________________
  57. Name of Organization
    Invalid Input
  58. Dates of Participation
    Invalid Input
  59. Leadership Role/Title
    Invalid Input
  60. _________________________________________________
  61. Choose one organization and describe, in detail, your leadership role:
  62. .
    Invalid Input

  1.  

    V. Statements

    Please respond to the following questions. Limit each response to one page

  2. 1. Team to Jointly Respond

    What are the major health care needs, challenges and priorities facing your nation, region or community? What is your entity, department, organization, team or partnership doing, or else are planning to do, to respond to these challenges and to attend to these health priorities?
  3. .(*)
    Invalid Input

  4. 2. Each Individual to Respond

    Please describe your personal role and responsibilities in confronting these challenges.
  5. Applicant 1(*)
    Invalid Input
  6. Applicant 2(*)
    Invalid Input

  7. 3. Each Individual to Respond

    What do you anticipate as being the benefits to your management team from participating in the Management Development Institute? What do you, as a member of the team that is attending, expect to gain?.
  8. Applicant 1(*)
    Invalid Input
  9. Applicant 2(*)
    Invalid Input

  1.  

    V.I Commitment Letter from Organization

  2. Upload (Scanned and in PDF) a letter of recommendation from your organization will be included along with the team’s program application.

  4. Upload in PDF
    Invalid Input

  5.  

    VII. Commitment Form

  6. Download the Commitment Form by clicking on the image below: Print, complete and upload the signed form.

    Download Commitement Form

  7. Upload Form in PDF
    Invalid Input

  8. For questions, please contact:   

    Patrick Mwai
    Regional Advocacy Officer - East, Central, and Southern Africa
    The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care - The G4 Alliance
    Mobile / WhatsApp: +254 714 470 500 | +255 762 934 621

    [email protected] | www.theg4alliance.org  | @theg4alliance 
  9. Submit