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Contact classes work through improving knowledge and/or skills, resulting in improved performance
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An attitudinal change among the participants is needed to achieve the desired results
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Outcomes of training programmes accrue through four hierarchical levels: reaction (to training programme), learning, behaviour, and impact [48]
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Team dynamics affect the individual’s intention for positive change
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Intention to make positive changes
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Motivation of the participant towards positive organisational change – a “can-do” attitude
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Socio-political environment in the taluka/district
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Mentoring participants at workplace facilitates application of knowledge and skills
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Targeting individuals will produce impact through teams
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Workplace environment in healthcare organisations has been identified as an important element explaining application of learning from training programmes [49]
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Nature of supervision and district’s openness to “allow” change
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Identify/seek opportunities to make positive change in the organisation’s performance
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Nature of commitment to organisation
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Decentralised action plans and decision-making at district and lower levels. State and higher levels’ openness to change proposals
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Improved annual action plans – better situation analysis, problem identification, allocation and utilisation of resources
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Self-efficacy
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A capacitated health manager can become an agent of positive organisational change
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Capacity leads to performance
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High commitment management literature shows the potential for change by committed staff in settings where resources could be mobilised [50]
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Change proposals by districts are in line with state (or central) vision and address local needs (allocation and strategic alignment with external environment per Champ et al.’s conceptual framework) [29]
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Taluka and district plans improve. They identify more needs, mobilise more resources from state, and utilise them better
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Claiming and utilising decision spaces; organisational commitment and self-efficacy in negotiating with superiors and community leaders
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The programme could benefit from alignment with existing policy initiatives
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