Table 1.

Diary entry themes

Theme	Description
Health system deficiencies	Complaints about emergency medical services (EMS) Poor referral system Shortages of medicines or consumables
Human resource challenges	Shortages of all categories of staff (e.g. nurses, pharmacists, cleaners) Staff absenteeism Avoidable mistakes by staff, insubordination, or lack of professionalism
Unsupportive management environment	Negative remarks made by clinic supervisor Tension between supervisor and other district-level managers Poor communication (from supervisor or about meetings) Delays in responding to requests for additional staff Failure to honour appointments Demands for health information (monthly statistics, information for research and/or monitoring, and evaluation purposes)
Leadership and governance	Lack of strategic planning Tensions between clinic manager and staff or senior managers Lack of delegation and authority (e.g. of the budget) Difficulties in managing staff or their performance
Emotional impact of clinic management	Feeling scared, tense, being overwhelmed, feeling abused, burnout, exhaustion, frustration, anger, demotivation Includes personal crises at work or at home Patient, community or political complaints about service delivery Perceived burden of urgent or unscheduled meetings Getting positive feedback from clinic supervisors, or feeling supported Sense of achievement or feeling happy