Innovative coaching improves health system governance in Bungoma County, Kenya

Posted: 24/04/2019

Leadership and governance have long been acknowledged as critical elements in the development of strong and successful health systems.

Here we talk through the lessons learnt on The Maternal and Newborn Improvement (MANI) project, which used an executive coaching package to build the leadership and management capacity of the Bungoma County Health Management Team (CHMT) from June – September 2018.

The objective was to go beyond a one-off training where learning can be lost upon returning to work – largely due to confounding external factors impeding one’s ability to implement what has been learned. This sustained and innovative coaching methodology aims to ensure a long-term adoption of strong leadership capacity that is engrained into individual and collective processes.

Innovative coaching vs. classroom courses

This coaching approach is very different from classroom-based short courses, which have been more the norm for public sector officials. It starts and ends by bringing together all participants to share and learn as a group. This shows them that everybody is facing the same kind of challenges, including feeling helpless and powerless to tackle the real problems around the provision of healthcare in the county – helping to enable a bond within the group. Additional coaching sessions focus on individual development, this takes place both in a group setting and in one-to-one sessions.

This approach helped the health team to learn and use management and leadership tools, which allowed them to analyse what was ailing the current system and come up with strategic interventions to help overcome the challenges. These interventions were then used to identify strengths within the individuals which could be built upon and used as objectives for leadership and management development. Finally, a one-to-one coaching tracked the individuals implementation of this objective allowing them to develop their leadership and management skills.


Figure 1: The process of applying objectives in coaching

What did participants think?

Despite the initial perceived preference for a classroom-based approach, the health team appreciated the opportunity to use real-life examples from which to grow and learn.

For many, the personal development plans and coaching exercises were an eye-opener to their strengths and areas that they should further develop, such as self-confidence, analytical approaches to problem solving such as the use of process mapping, why techniques and and evidence-based decision making.
Throughout the process we saw and heard many benefits to the approach:

“The coaching sessions have improved my way of approaching challenges, I sometimes felt as though an individual attacking me.” …

“This has helped me to think about my success, the coach asked me to identify my personal strengths and I was hard tasked to identify them, he asked to go home and really think about it and name at least 10”…

“When you implement the initiative, it gives you the will to move on as you feel you are making an impact.”

Evidence this approach worked

The project used a capacity tracking tool to measure the health team’s progress throughout the coaching. This showed that substantial improvements had been made in:

The amount of capacity to manage and use leadership tools
The drive for change initiatives
The team’s sphere of influence and ability to enrol and expand their networks
Coaching impact across the management team, with an average increase across all four indicators of 65% from baseline.