Table 3 Action points, observations and their status related to the ‘collaborate’ and ‘create’ functions of management from quarterly review meeting minutes

Collaborate:

Promoting open communication empowerment of others and stakeholder participation skills

Orientation of different stakeholders, and forming of work teams was observed and acted upon, e.g. community development officers were empowered and actively engaged. However, fear and anxiety during meetings was observed in the first two quarterly review meetings since stakeholders with different power relations were involved; a tendency to ‘let things be’ was noted

Free and open discussions between stakeholders started to improve with time, increasing stakeholder buy in, trust and commitment were noted.

Growth of teamwork in implementation of project activities was observed across stakeholders; nonetheless, some stakeholders (e.g. politicians) were observed to have remained suspicious of health managers in particular

Sharing of ideas and identification of local resources was noted. An increased sense of political responsibility and trust between stakeholders was stronger

Discussions about how to continue implementing the project activities started in the last quarter of 2014 and continued in the whole of 2015

Create:

Promoting change and encouraging adaptability

Limited generation of local ideas and solutions was observed; a high dependency on the MakSPH project team members was notable Stakeholders were careful not to ‘step on each other’s feet’ when challenging the status quo They were not sure of how much to trust the Project team members in attendance of the review meetings. Rigid mind sets about usual procedures, constraints and limitations observed. A low willingness to change was also observed initially

With increased stakeholder trust and commitment, free brain storming of local ideas and testing them out started and was sustained throughout the year The desire to cause change through critical thinking begun to grow, especially at district level, lead by the district health officers; for example, health worker motivation was debated and embedded in the district plans

Discussions of maternal health issues such as death audits and health worker discipline was started

Prioritising maternal health in budgeting was improved; for example, sub-counties begun to budget for VHT incentives as well as motorcycle ambulances; at least one sub-county actually bought a motorcycle ambulance for referral purposes by the end of the project, while several others engaged politicians who donated motorised ambulances