Table 2 Process monitoring subthemes

Acceptability of P4P

- Size of bonus payment and fairness, and rationale (support or control).

- Extent to which targets are achievable.

- Effect of P4P on working relations between stakeholders

- Difficulties/ ease of implementing P4P

- Extent to which bonus payments are motivating, and changes in perceptions over time

Context of implementation

- District leadership and governance of health services

- Supervision

- Access barriers to care (geographical, transport, cultural; other)

- Other interventions underway that target maternal and child health and may influence observed outcomes;

- Other changes in society that may affect access and utilization of health services.

Implementation process

- Training process

- Awareness and understanding of P4P

- Availability and use of guidelines and/or operating procedures, ease of following

- Contracting process

- Reporting process

- Bank accounts

- Bonus payment transparency

- Timeliness of bonus payments

- Methods for dealing with misreported indicators

- Use of bonus payments - adherence to guidelines, transparency, fairness?

System changes

- Effect on procedures and practices of recording and reporting of information.

- Fund management

- Supervision frequency and content