Table 5.

Qualitative data from rounds 2 to 4: key reasons for the major factors of poor performance

Domains of analysis	Reasons given
Conceptualization	Difficult to expect any measurable impact on a HSS program of 3 years
Implementation	Resources for ISS do not reach the regions
Governance	Steering Committee not functioning adequately Incompatibility between public service administration and GAVI administrative procedures Turnover of senior personnel in the MOH – new personnel did not understand the spirit of the HSS project
Level of funding	Level of funding considered adequate
Human resources	Turnover of senior personnel is a major bottleneck
Community level	It was not addressed
External factors	Political and military instability

HSS: Health System's Strengthening;GAVI: The Global Alliance for Vaccines and Immunization; MOH: Ministry of Health.