The study applied qualitative methods to source data, as well as simple descriptive statistics, including quantification of multiple responses, where applicable.
Feasibility of Developing and Using Coaching Skills for Health System Strengthening
Coaching training: Out of 8 subjects having participated in the training, including 5 SPOs and 3 coordinators, 5 (63%) indicated that the training duration (3 days) was too short to grasp coaching skills sufficiently to apply them effectively in their work. Consequently, most needed time to gain confidence before initiating coaching conversations with HMT, and did not begin coaching until three months after completing the training and after participating in a quarterly group meeting with the coaching agency where they could express their concerns and receive support. Chart 1 presents the reasons given for delaying application of the new skills (n=8).
Identification of HMT participants: Of the 5 SPOs and 3 coordinators trained in coaching skills, 5 (63%) identified HMT participants to coach at the sub-county level, 1 (13%) at the county level, while 2 coordinators (25%) did not identify any, citing work demands.
Consistency of formal coaching sessions: Competing responsibilities, particularly project implementation activities, and physical distance between SPOs’ and HMTs work locations created barriers to regular coaching sessions. SPOs reported that work scheduled left little time for coaching sessions, as expressed by one SPO:
“…I have been having a lot of competing activities, including meetings … they are like every other day. In some weeks I have three to four meetings in a day, and then I have to go to the field to implement activities, and then I still have coaching to do… I have to postpone some activities in order to cope with the pressures.”
Supervision and continuous support: Coach supervision was provided off-site quarterly by an accredited coach supervisor. SPOs and coordinators were supervised both as a group and individually. Group supervision meetings provided opportunities for collaborative learning through reflection and sharing of experiences and for the practice and strengthening of coaching skills. These meeting also allowed participants to explore their coaching relationships and to build cohesiveness amongst themselves. In this regard, the coach supervisor observed that:
“…from where I was sitting, I felt that the group session was creating a common thinking and I could see how they were connecting one experience to another. That provided a space for collective learning.”
Individual supervision sessions were more intense, providing each subject with time to examine in detail their personal experiences with coaching without fear of being judged by colleagues. The analysis revealed that the subjects found both individual and group supervision approaches beneficial and empowering as indicated in Chart 2 (n=9 - 5 SPOs + 3 coordinators + 1 coaching supervisor).
Perceived efficiency of the approach: Six respondents (75%) suggested that the effectiveness of the coaching was enhanced by the combination of training and follow-on supervision, which allowed them to practice their coaching skills. Due to funding constraints, it was not possible to extend the training to HMTs at the county level. However, the 8 respondents felt that this training could have had a significant impact on strengthening health systems at the county level.
Sustainability of the coaching intervention: Questions on the perceived sustainability of the intervention were asked to the 8 SPOs and coordinators and to HMTs and their supervisors (n=20). Up to 80% of them indicated that extending the coaching intervention to county HMTs would make the intervention more sustainable. Fourteen (70%) opined that establishing forums to allow managers who have gone through coaching skills training to mentor and supervise colleagues and health workers would raise productivity. However, 11 (55%) were of the view that establishing appropriate measures for retaining HMTs coaching knowledge and skills would minimize losses that occur when skilled managers exit, as turnover among HMT is high.
Impact of Coaching on SETH Project Officers’ Work Performance
Out of the 5 SPOs and 3 coordinators and their coaching supervisor (chart 4), 8 (89%) indicated that coaching training changed SPOs approaches to supporting health mangers. Seven (78%) suggested that the training enabled SPOs to change their approach from prescribing solutions to helping managers find their own. Six (67%) indicated that coaching training improved SPOs skills in coaching, including: engagement, listening, reflecting, questioning and challenging, and five (56%) indicated it improved SPOs’ participation in meetings by enhancing their communication skills. As one SPO expressed it:
“…initially I could sit in those meetings and feel like am not at that level, but coaching has really empowered me, I can have very candid discussions with whoever…a donor or a UNICEF representative…we can have very good engagement by asking them relevant questions and provoking their thinking.”
Chart 5 shows that out of 5 SPOs and 3 coordinators, 6 (75%) stated that coaching skills enabled them increase the number of interactions with HMTs and having gone together through a challenging new activity such as coaching improved teamwork and cohesion among them. Interestingly, most did not consider that the informal coaching improved their coaching skills, possibly as opposed to the formal coaching training and sessions, as informal coaching is defined here as the use of coaching skills in daily work routine activities.
Impact of Coaching on HMTs Work Performance and Relationships
Although it was not the primary aim of the coaching training and supervision, the study looked at the perception of HMTs on the impact of coaching by SPOs. Chart 6 shows that out of 14 HMT subjects who participated in the KII, 9 (64%) asserted that the coaching they received improved their knowledge of contextual issues affecting delivery of services. Again, 7 (50%) felt that coaching by SPOs motivated HMTs participants to tackle problems that impeded work performance. In one instance, a SPO indicated that:
“…when we started coaching sessions, I guided the HMT participant to identify and prioritize various issues constraining his work performance. We started tackling the challenges based on the order of severity. However, I came to realize that the HMT participant went ahead and used the new skills to tackle other challenges, which suggests that the HMT participant is motivated to address issues around his work.”
7 (50%) hinted that the introduction of coaching skills, which entailed sensitization about coaching, purpose and potential benefits strengthened the working relationships between SPO and HMT. However, 5 (36%) indicated that the coaching they received increased their apprehension, particularly around sharing information on personal challenges at work.
 Some open-ended questions required participants to provide more than one response (multiple responses). In such situations, the responses are quantifiable and can be computed as percentages, based on number of respondents (sample size) or based on the total number of responses. In this study, the percentages have been computed based on the unique number of respondents.