Table 2 Summary of strengths and weaknesses of implementation

Knowledge and ownership of the strategy

High level of knowledge and ownership amongst senior and middle level managers, and to a large extent, amongst CHWs and team leaders;

Primary health care clinic managers less well briefed and not fully owning the strategy;

Early implementation strategy

Establishment of PHC Task team and NGO partnership;

Sustaining intensive communication and engagement processes with local managers and communities in roll out phases;

Alignment of systems (roles with training and M&E systems);

Appropriate sequencing of activities;

Community and local manager participation;

Mobilization of resources and system inputs

Involvement of key directorates (HR, financing, information) in PHC Task team;

Team leaders appointed from existing staff establishments thus creating pressures on PHC facilities;

Integration of strategy into district budgets;

No additional resources to ensure better CHW remuneration;

Limited pool of professional staff to lead teams;

Strains on local clinic infrastructure;

Changes in service delivery

Evidence of widespread adoption of new model;

Uneven integration into local PHC clinics.

Supported by sub-district and local area managers.