Table 7.

Challenges related to stakeholders’ participation in district-level decision-making

Stakeholder	Perceived challenges	Illustrative quote(s)
Politicians	Potential for competing interests between political priorities and those generate from data and evidence	[s]o, the politicians also now come in… and if you don’t have a good backing of your priorities, then they have their own political priorities (Technical expert, District B).
District technical experts	None identified	N/A
Donors	Donor priorities may influence or overpower local priorities Potential mis-alignment between organizational priorities and local priorities	Yea donor money is conditioned. You can’t use money from donors for something else (Technical expert, District C). …the donors because of their input, because if they put in money and they say well this money should go A B C D, there’s no way that we’re going to say we’re going to take this money for roads (Technical expert, District C).
NGO/CSOs	Organizational priorities may influence or overpower local priorities	Then at times as they [NGOs] come in with their support they also give conditions that we must fulfill (Technical expert, District C).
Cultural and traditional leaders	Balancing evidence from technical expert with religious doctrines and traditional beliefs	We realize there are some church doctrines that try to conflict with the health practitioners’ strategies in terms of maybe HIV struggle. When a health practitioner says condoms should be distributed and used, a religious leader will preach something different (Politician, District B).
Public/community	Lack of awareness about how priorities are determined	They are not aware. We try to use the centre, actually the office of the Prime Minister tries to create awareness… You are given so much money, what did you do for the community? (Technical expert, District A).