Table 2

Themes, subthemes and categories emerging from the interviews

  • Active leadership by the book

  • Rationalised review process

  • Emphasising importance of time and context

Desire to get it rightAccomplishing by ambition
  • Thinking and acting for the baby

  • Eye opener/exposure to new perspectives

  • Feeling remorse and responsible

Getting emotionally involved
  • Innovative solutions to lack of resources

  • Discovering discrepancy of data

  • Enhanced accountability

  • Policy changes

Producing change
  • Incomplete training cascade

  • Poor dissemination and utilisation of the guideline

  • Focusing on routine and formalities

  • Using incomplete information

Substandard implementationA flawed system
  • Selection process driven by hierarchy not need

  • One man show

  • Detached system

  • Relying on development partners

Hampered by organisational culture
  • Leaders expect themselves to be firm

  • Leaders perceived as harsh and breech confidentiality

  • Acting out of fear of blame

  • Hot meeting/arguing and conflicts

Assigning and avoiding blame
  • Need for continuous supervision

  • Discouraged by lack of implementation of actions

  • Repeated mistakes

  • Discouraged by lack of incentives

Caught up in a demotivating environment