OBJECTIVES: Assessment was carried out to determine perceived health service leadership and management skills, competencies and ability possessed by health care managers working in level 3, 4 and 5 hospitals. METHODS: Cluster sampling method was used where  list of counties in Nyanza  was compiled in November 2013; three out of six counties  were randomly selected, 8 hospitals and 2 county health offices purposively selected.  Thirty two health care professionals at management positions were selected for assessment using  self administered questionnaire. Information was collected on perception of skills, competencies, ability and knowledge possessed on pre-selected 24 leadership and management aspects. A five step Likert rating scale was used.  SPSS computer program was used to analyze data and results presented in percentages, graphs and tables. RESULTS: Assessment showed that all respondents perceived themselves to be fair, poor or very poor in at least 70% of 24 management and leadership skills and competency aspects. Forty seven percent had never attended any training on health service management and leadership before. Forty one percent of those who had attended similar training only attended once and training period was “too brief”. Ninety one percent said the training be sandwiched with international exposure of whom 66% were willing to raise own air ticket and accommodation. Leadership, financial, management of health care resources, ISO certification and communication skills were identified as top priority gaps health managers required urgent training. Forty one percent said the training will help them improve on quality of health care provided in their hospitals. CONCLUSIONS: The assessment concluded  that majority of health care managers have not been adequately prepared to handle health service management and leadership roles. Therefore ,there is need to equip them with these skills in order to be able to handle critical  leadership challenges they face in their day to day professional experience.