Table 1 Theoretical concepts & their meaning for this study

Context can be political, economic and social, at LGI, national and international levels [25]. The politico-economic and social context where UPHCSDP was conceived and implemented also played a major role in supporting and hampering its roll out and eventually to the overall outcome and impact. Both global and national contexts were delved into and attributes external and integral to the health system were separately regarded.

Actors refer to individuals, groups, or organizations who influence the CO approach and its implementation via beliefs, expectations, and position in power structure [25]. Initially, individuals, groups of individuals or organizations, and governments were considered as actors. As our analysis proceeded, to explore the role of actors at several tiers, we grouped them into international, national, local (government, project level), public health providers and health personnel. Their involvement, interest and opposition to UPHCSDP were the aspects of our inquiry.

Content of a health policy, or in this instance, the CO contract, is a reflection of contextual factors and constellation of actors involved, and their interests or ideologies [25]. It provides the basis for implementation and monitoring of the contract’s success. This study therefore captures changes in the content of partnership contracts across the three phases and what influenced these changes; not issues of policy effectiveness and impact [26].

Process is comprised of a range of activities starting from policy initiation, development/ formulation, negotiation, communication, implementation, and evaluation [25]. In this study, we were interested in the effect of the first three concepts on UPHCSDP implementation process.