Table 1.

Coded data, sub-themes and themes

Main themes	Sub-themes	Coded data extracts
	Factors facilitating implementation	Key informants Less technical knowledge is needed to administer SMC and vitamin A; enough manpower to deliver the integrated programme as it has less technical requirement (compared to polio or other vaccinations) CHW structure is already in place SMC tools and forms in place Drugs generally available and logistics systems joined up Harmonise intervention timing for the integrated intervention CDDs and supervisors Given additional information about the pilot study and integration of vitamin A Training content was sufficient and taught about drug administration Community leaders important at pre-implementation stage Radio announcements about integration of vitamin A were insufficient Need to involve community leaders in pre-implementation information dissemination
	Perceived disadvantages and implementation barriers	Key informants Reliable data collection needed Need to integrate with routine health system Make sure data capture in place and harmonised The different eligibility age groups for vit A and SMC is confusing to CHWs CDDs and supervisors Some caregivers complain about ‘double medication’ Problems with data recording on tally sheets and SMC cards Caregivers Some prefer to separate administration of SMC and vitamin A
	Effect of integration on programme delivery	Key informants CHWs complain a lot about payment delays and non-payment Need to reduce SMC targets because of 30 min wait Provider workload needs adjusting Needs careful planning to avoid disruption CDDs and supervisors Longer time in the field with the 30 min wait between SMC and vitamin A Workload has increased with need to wait 30 min Explaining the integration and two drugs to caregivers takes time Concern that SMC targets not being met because of the 30 min wait No increase in payment with increased workload CHWs spend own money on transport, no allowance Payments not made, delays in payments Some won’t participate next year if payments not made Need to create separate vitamin A distribution team Caregivers Most CHWs don’t wait 30 min between administering SMC and vitamin A CHWs should be more patient with caregivers Prefer to separate administration of SMC and vitamin A
	Sustainability	Key informants State ownership important for sustainability is the implementer and should own the programme, from the beginning; state should drive the programme; needs willingness from the state for sustainability Explore use of alternative funding via corporate social responsibility /private finance Community accountability Recruit CHWs from communities Recruit more female CHWs who have better access to households CDDs and supervisors Need to select CHWs to work in their own/familiar communities; don’t accept ‘strangers’ or CHWs from out of area Caregivers Reliance on leaders to convince caregivers who reject SMC and vitamin A Community leaders should be more involved in planning and awareness raising
B. Acceptability	Favourable opinion of the integrated strategy	Key informants Some say it can be scaled up Integration is an innovative way of delivering, can be win–win Integration helps get vitamin A to eligible children Integration is welcomed as a vehicle for delivering more than one programme Integration is cost effective Boosts coverage and gets vitamin A to children who were missed If vitamin A is kept at facility caregivers will not come; take it to the household and they accept it Households who rejected SMC now accept it with the addition of vitamin A Demand from caregivers for bednets as well as SMC Integrate net distribution too, for better acceptance CDDs and supervisors Community realised the health benefits of both SMC and vitamin A Community accepts integration Household administration convenient Politics, religion Scepticism about the drugs Vitamin A helps acceptance of SMC Caregiver’s demand bednets as well as SMC Integrate net distribution with SMC Caregivers Generally positive initial view of integration of SMC and vitamin A Children are healthier Caregiver’s report no one refuses Only if caregiver is absent the child will miss the drugs Some caregivers previously rejected SMC Reliance on leaders to convince caregivers who reject SMC and vitamin A SMC has influenced acceptance of vitamin A
	Reports of side effects were uncommon	Key informants The community knows vitamin A and does not reject it, like the polio vaccine Households who rejected SMC now accept it with the addition of vitamin A But gatekeeprs are important to encourage those who reject the interventions, pockets of resistance exist Caregivers No complaints about side effects Sometimes children vomit after taking SMC
	Integrated SMC-VAS is an innovative way of improving access to life-saving medication	Key informants Integration is an alternative/innovative way of delivering, can be win–win Integration helps get vitamin A to eligible children Need ground-breaking innovations to change low coverage rates for vitamin A Need new ways of doing things, to address low coverage Value add/boosts coverage and gets vitamin A to children who were missed
	Demand to widen eligibility for vitamin A	Caregivers Caregivers demand vitamin A and SMC for adults/older people Demand for vitamin A and SMC in older children