First, why does $k$ need to be secret in ECDSA?
With the question's notation, in ECDSA, $s=k^{-1}(z+q\,r)\bmod n$ where $n$ is the public prime order of the elliptic curve group, $z$ is public since it's the hash of the message, $r\bmod n$ is public since that's the first component of the signature, and $q$ is the private key with $0<q<n$. It follows that knowledge of $k$ would allow to compute $q$ as $q=(r\bmod n)^{-1}(s\,k-z)\bmod n$, allowing to sign any message and breaking the signature's security.
But that does not tell why we need $k$ and the corresponding point $k\,G$ on the curve, which the question also asks.
Attempt at a high-level explanation: for construction of a signature scheme using as sole building block an arbitrary group in which we define scalar multiplication by repeated addition and a generator $G$ (as in ECDSA), all the methods we know require (at least, and for those in practical use, exactly)
- One public group element (the public key) that is a multiple of $G$ by a secret integer (the private key $q$ in the question).
- And, for each message, another public group element that is a multiple of $G$ by another secret integer ($k$ in the question) unique to each signature.
For a more detailed explanation, I recommend this answer to what is the intuition for ECDSA?.
As to why the modular inverse $k^{-1}$ must be computed when it is not the case for other signature schemes using the same kind of groups as ECDSA (e.g. Schnorr signature adapted to elliptic curve group): this is because ECDSA evolved from DSA that also requires a modular inverse. ECDSA differs from DSA only by the choice of the group, and loosing one bit in the representation of a group element (with the consequence that there are two valid signatures, easily derived one from the other, for each choice of $k$ all other things being equal).
As to why DSA has this modular inverse, there are at least two theories (not exclusive):
DSA was inspired by the ElGamal signature scheme, which uses a modular inverse in the equation $s=k^{-1}(m-q\,r)\bmod(p-1)$, where $m$ is the message. DSA differs by:
- Hashing the message (which is necessary for avoiding existential forgery).
- Using a generator of a subgroup with prime and relatively small order $n$ instead of $p-1$, which allows a much smaller signature and faster computation.
- A sign change in the private key, which is minor.
DSA was published after Schnorr signature, which does 1/2/3 above and does not require computation of a modular inverse (a clear advantage), by using an extra input to the hash. For wide adoption without royalty issues, it was desirable that the design of DSA distinguish itself most clearly from the claims in this patent for Schnorr signature (later US version)
And: when we try to remove the modular inversion from the formulas in ElGamal signature, DSA or ECDSA, it seems that for the signature verification to work, another modular inversion must be added elsewhere. As far as I know, all methods to get entirely rid of the modular inversion in these schemes add an additional input to the existing hash (as in Schnorr signature), or an additional hash.