Table 4.

Perceived challenges related to regular monthly team meetings

Challenge	Key quotation
Transportation/distance	“CHWs stay too far away so they can come late for meetings and to collect drugs. Sometimes they have to use their own money to get here. Some CHWs have bikes, some don't.” Health center in-Charge, Malawi
	“Ooh! You see we came from far for the QI team meeting and later after travel long distances to visiting CHWs in their villages. We do all this per volunteerism but it is really difficult for us. As we do not have time to perform our ordinary work, it would be better if we can have transport allowances to facilitate us to properly achieve our responsibilities.” CHW, Rwanda
Length of meeting and lack of refreshments/allowances	“No there are no problems – we have bicycles – but the main problem is having to spend a long time there without taking any food.” CHW, Malawi
	“The challenges are related to lack of means, you see we come and attend those meetings; we leave our homes while we would be working on other living activities in our families, maybe if we could get something to facilitate us in transport to attend in the meeting or a Fanta when we attend in that meeting it will be good.” CHW, Rwanda
Other competing obligations	“In June, the 1st was on a Sunday so the CHWs failed to come. Some came on Monday to get their products. Some came on Tuesday.” CHW supervisor, Malawi
	“Yes, QI team meetings were important because they helped us to identify problems and find solutions. Considering their importance, we wish they may continue, and if possible find from the central level how to provide allowances as motivation. For example, we travel for about 2 h to reach the health center, which means 4 h traveling to getting back home. So if it is a meeting day, all other activities are abandoned.” CHW, Rwanda
Lack of district engagement and feedback	“I think people from the district are lacking seriousness, of late they are not even asking us why we are not meeting.” CHW, Malawi
	“We tried to re-launch in February but were very busy with other activities. We've been talking about how to get the meetings started again. We have a plan to restart at the beginning of June. We have a meeting next week to discuss this issue.” District pharmacist, Rwanda