Context matters. It influences health worker performance, health worker retention and implementation of relevant knowledge. Between 2010-2013 the International Maternal and Child Health at Uppsala University coordinated the Context Assessment for Community Health (COACH) project – an effort to develop a tool to systematically assess aspects of context influencing the implementation of relevant knowledge in low- and middle-income settings.

The COACH project departed from the notion that there is a need to move from ‘what works’ to generate evidence on ‘what works where and why’. We aimed to develop a tool that focused on modifiable aspects of context, i.e. aspects of context that could be intervened upon to enhance health system strengthening. The development of the COACH tool was undertaken with partners in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua.

The purpose of the tool is threefold

  1. To enhance the opportunities to act on locally identified shortcomings of the health system to increase effectiveness
  2. To guide planning and promote adaptation of implementation strategies to the local context
  3. To link contextual characteristics to outcome indicators of healthcare interventions.

The COACH tool was developed in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua through six different phases resulting in five different versions of the COACH tool where findings from one phase fed into the development of the next version of the tool.

The development resulted in a tool capturing eight dimensions of context as perceived by health workers and is available in in English, Bangla, Vietnamese, Lusoga, isiXhosa and Spanish. Since the development a Portuguese version of the tool has also been developed.

COACH dimensions

  • Organizational resources: The availability of resources that allow an organization (unit) to adapt successfully to internal and external pressures.
  • Community engagement: The mutual communication, deliberation and activities that occur between community members and an organization (unit).
  • Monitoring services for action: The process of using locally derived data to assess performance and plan how to improve outcomes in an organization (unit).
  • Sources of knowledge: The availability and use of sources of knowledge in an organization (unit) to facilitate best practice.
  • Commitment to work: The individual’s identification with and involvement in a particular organization (unit).  
  • Work culture: The way ‘we do things’ in an organization (unit) reflecting a supportive work culture.
  • Leadership: The actions of a formal leader in an organization (unit) to influence change and excellence in practice achieved through clarity and engagement.
  • Informal payment: Payments or benefits given to individual(s) in an organization (unit), which are made outside the officially accepted arrangements, to acquire an advantage or service.

For more information about the development of the COACH tool please visit BMC Implementation Science (link). If you have any further questions please do not hesitate to contact Anna Bergström,

COACH research group

COACH research group
Part of the COACH research group.
Back row from right: Duc, Mats, Sarah, Lars-Åke, Carina, Anna, Lars
Front row from right: Nga, Jesmin, Elmer, Mark, Anisur, Katarina


Dr Anisur Rahman
Dr Jesmin Pervin


Associate Professor Dinh P. Hoa
Dr Nga Nguyen
Mr Duc Minh Duong


Dr Peter Waiswa

South Africa

Professor Mark Tomlinson
Mrs Sarah Skeen


Dr Elmer Zelaya Blandón


Professor Lars-Åke Persson
Principal Investigator
Dr Anna Bergström
Professor Lars Wallin
Professor Petter Gustavsson
Associate Professor Carina Källestål
Associate Professor Mats Målqvist
Dr Katarina Selling
Professor Stefan Peterson


Professor Carole A. Estabrooks
Associate Professor Janet Squires