Table 6.

Key lesson for the planning and implementation of management strengthening interventions (MSI)

MSI phase	Lesson
Planning	1. An assessment of the perception of externally funded projects and the expectation of additional funding is needed to decide on the suitability and sustainability of the MSI
	2. The MSI needs to be planned as a series of ongoing cycles to support continued learning
	3. In some settings, support for the MSI is needed at higher levels than the district, such as the region or province
	4. Stakeholder expectations need to be managed regarding outcomes of the MSI: developing better management skills will be gradual and motivation for key aspects of management (eg, M&E) may take time to develop; the benefits may include change in organisational climate and effectiveness of the District Health Management Teams
Implementation	5. Care in the selection and training of facilitators is needed to ensure that MSI is faithfully implemented
	6. Sufficient time is needed for a thorough problem analysis before developing strategies to address them
	7. The focus should be more on developing complementary strategies, which are appropriate to the task rather than the exact composition of the bundles