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
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)
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