Table 2.

Systems of meaning among categories of implementers

Category of implementer	Value orientation	Reality judgements	Action judgements
Provincial/district managers and TB coordinators	Patients’ access to care	Waiting lists for treatment at COEs	Compliance with policy
Centre of excellence DR-TB clinicians and managers	Duty to treat challenges of complex treatment	Concerns about quality of care	Discretion in implementing
DR-TB sites facility managers	Health service efficiency	Fear of losing headcount and budget as DR-TB site	Contravention of policy
Satellite site facility managers and TB clinicians	Health service efficiency	Lack of resources for decentralization	Discretion in implementing
	Perception of personal risk	Fear of DR-TB transmission in facilities
Satellite site TB nurses	Patients’ access to care	Waiting lists for treatment at COEs	Compliance with policy
	Health service efficiency	Lack of resources for decentralization	Discretion in implementing