TABLE 2.

Themes and subthemes.

Themes	Subthemes
1. Importance of PMDS in healthcare	PMDS as a strategic, administrative and developmental managerial tool.
2. The system is flawed	Experiences of poor implementation of PMDS Inconsistencies in the application of PMDS across sub-districts. Weak Accountability
3. Rewarding Performance	Rewarding system Favouritism
4. Key considerations for effective performance management	Re-evaluating administration of the system Providing adequate training on PMDS for complete staff Facility managers’ competency and capacity to evaluate nurses’ performance Team dynamics and their consequences
5. Experience of health system’s reforms	Change is good and bad
6. Improving quality of care	Quality of care requires staff, resources and time

PMDS, performance management and development system.