Table 1 Description of Themes Influence on Success of PMAs

Context, rules and policies governing the PMAs

The contextual factors that surround the signing and implementation of PMAs are critical to their successful implementation. The organizational culture, government politics, leadership style and capacities provide the context under which PMAs can be implemented to achieve intended objectives. It is important that clear rules, procedures and guidelines are provided to enhance the articulation and implementation of policy initiatives. These will facilitate effective negotiation and engagement with all stakeholders in the agreement [20].

Clarity of content and objectives of PMAs

One of the key objectives of PMAs is to clarify the roles and responsibilities of parties involved [27]. Health managers are enjoined to be abreast with the content and objectives of PMAs in order to facilitate successful implementation [23]

The processes involved in PMAs

The process for developing and implementing the performance agreement framework should be participatory involving all key stakeholders in the setting of goals, objectives, indicators and targets [21]. The process should further be interactive and parties involved must understand the importance of each stage of the process in order to contribute their quota to its success

Alignment of resource allocation with terms of PMAs

The provision of requisite resources that are aligned to PMA targets is for the success of PMA implementation [25]. In the absence of adequate resources, managers are limited in the extent to which they can implement activities that lead to the attainment of outputs and outcomes specified in the agreements [27]

The capacity of directorates to execute PMAs

The strengthening of institutional and staff capacities to implement performance agreements is one of the key ingredients for successful implementation [20]. It is also noted that due to the high transaction cost, government agencies must build the needed capacities for effective engagement, negotiation and implementation of performance agreements.

Managerial perception of its usefulness

Managerial acceptance and orientation to PMAs in terms of the right mindset and psychological disposition affect successful implementation [32]. Similarly, the perceptions of management about the useful impact of performance agreement instill a sense of commitment to its implementation. Managers who are committed to performance agreements use them to attract resources for implementation and can prioritize their activities to achieve the established objectives.