Technical and management coaching for government institutions: Lessons learned and health systems transformations across 8 countries in sub-Saharan Africa and India.

Traditional engagement with local governments often relies on financial and human resources from international or local partners, leading to direct implementation by organizations, which can hinder sustainability. While some organizations include sustainability indicators, few focus on transferring technical and financial ownership to governments. The Challenge Initiative (TCI) uses a phased coaching model-lead, assist, observe, and monitor-to build local government capacity for scaling family planning (FP) and adolescent and youth sexual and reproductive health (AYSRH) programs. TCI ensures local governments take the lead from day one, coaching them to manage and implement these programs sustainably, improving management, coordination, planning, budgeting, and data-driven decision-making. In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted with stakeholders across 24 TCI sites in 8 countries-Benin, Kenya, India, Niger, Nigeria, Senegal, Tanzania, and Uganda-from October 2020 to March 2021. A total of 175 IDIs and 14 FGDs were conducted with 343 master coaches (52 TCI staff, 164 local government staff) and 127 coachees. Participants included TCI staff, local government officials, and health providers at both facility and community levels, all of whom received coaching. Examples were gathered to assess the impact of TCI's coaching model on government FP and AYSRH programs. TCI documented improvements in local government and health service provider leadership, management, and coordination of health programs through its coaching interventions. It linked health system outcomes to its coaching approach, building a cadre of master coaches and coachees at all levels. This strengthened local governments' capacity to lead and sustain the scale-up of FP and AYSRH programs beyond TCI's direct support. Improved monitoring and tracking of coaching quality is needed for further insights.