Theme	Category	Unit meaning
Primary factors: A direct lack of a critical component for policy implementation tangible or intangible	Information (policy)	Top down directives
		Seniors have more access to information that juniors
		Reality on the ground unknown by supervisors and those at the top
	Motivation	High intrinsic motivation
		Demotivated by unresolved challenges staff, material and infrastructural, lack of support, supply chain challenges
	Power	District has no power to create posts, hire or fire staff
		Facilities have no power to hire or fire staff
	Resources	Human resources shortages of nurses, data capturers, cleaners and security
		Infrastructure, old delapidated buildings
		Limited space
		Hospital bed shortages
		New buidings not yet commissioned
		Ownership and responsibility disputes between government and municipality
	Situation on the ground (context entailing all of the above	Material resources, shortages equipment, and cleaning material
Secondary factors	Budget and grants systems	Budget not sufficient for clinics
		Limited Financial delegations
		Disconnect between those who award contracts and those held accountable for service
	Communication processes	Top down, mostly one way
		Unrealistic targets
		Bureaucracy
		Non-response to motivation letters
	Supply chain processes	Long turn around and stock-outs
	Employee Performance, Motivation and Development systems	Waste of time
		Does not reward performance
	Interactions: Supervision systems	Policing supervision
		Erratic visits to facilities
		Lack of power and ability to help facilities solve problems
Tertiary factors	Actor perception	High patient expectations
		Patient attitudes
		Staff attitudes
		Patients demanding care
	Actor responses	Policing supervision (PHC supervisors)
		Buckpassing
		Non-responsive leadership
		Audit driven compliance with NCS
		Ideal reporting
Extraneous factors	National vocational training programmes	Shortage of plumbers and artisans
		Delayed repairs of brocken toilets and taps etc.
		Delayed repairs and maintenance
Systems thinking	Lack of planning ahead and seeing the bigger picture	Transition states not planned for
		Interconnectednesses not seen
		Epidemiological transitions not planned for