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BMC Health Serv Res. 2017 Dec 21;17(Suppl 3):831. doi: 10.1186/s12913-017-2656-7.

Mentorship and coaching to support strengthening healthcare systems: lessons learned across the five Population Health Implementation and Training partnership projects in sub-Saharan Africa.

Author information

Partners In Health, Kigali, Rwanda.
Partners In Health, 800 Boylston Street, Suite 300, Boston, MA, 02199, USA.
College of Medicine and Health Sciences, School of Public Health, University of Rwanda, Kigali, Rwanda.
Partners In Health, Kigali, Rwanda.
Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Department of Global Health, University of Washington, Seattle, WA, USA.
Health Alliance International, Beira, Mozambique.
Primary Care and Health Systems Department, Center for Infectious Disease Research, Lusaka, Zambia.
Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA.
Ifakara Health Institute, Dar es Salaam, Tanzania.
Policy, Planning, Monitoring and Evaluation Division, Ghana Health Service, Accra, Ghana.



Despite global efforts to increase health workforce capacity through training and guidelines, challenges remain in bridging the gap between knowledge and quality clinical practice and addressing health system deficiencies preventing health workers from providing high quality care. In many developing countries, supervision activities focus on data collection, auditing and report completion rather than catalyzing learning and supporting system quality improvement. To address this gap, mentorship and coaching interventions were implemented in projects in five African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) as components of health systems strengthening (HSS) strategies funded through the Doris Duke Charitable Foundation's African Health Initiative. We report on lessons learned from a cross-country evaluation.


The evaluation was designed based on a conceptual model derived from the project-specific interventions. Semi-structured interviews were administered to key informants to capture data in six categories: 1) mentorship and coaching goals, 2) selection and training of mentors and coaches, 3) integration with the existing systems, 4) monitoring and evaluation, 5) reported outcomes, and 6) challenges and successes. A review of project-published articles and technical reports from the individual projects supplemented interview information.


Although there was heterogeneity in the approaches to mentorship and coaching and targeted areas of the country projects, all led to improvements in core health system areas, including quality of clinical care, data-driven decision making, leadership and accountability, and staff satisfaction. Adaptation of approaches to reflect local context encouraged their adoption and improved their effectiveness and sustainability.


We found that incorporating mentorship and coaching activities into HSS strategies was associated with improvements in quality of care and health systems, and mentorship and coaching represents an important component of HSS activities designed to improve not just coverage, but even further effective coverage, in achieving Universal Health Care.


Coaching; Ghana; Mentorship; Mozambique; Quality improvement; Rwanda; Tanzania; Zambia

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