Lastly, unlike national level managers, lower level managers considered the health management information system as being insufficient for service planning.
In large businesses, top managers break up their responsibilities into smaller, more manageable chunks and distribute them to middle and lower level managers, delegating their responsibilities.
From 2004, the cartel was run by lower level managers through the companies' German subsidiaries and information was exchanged by email.
Disagreement between national and lower level managers on HMIS sufficiency for service planning existed, with lower level managers believing that the HMIS is insufficient.
Deliberative processes engaged end users and lower level managers and (to some extent) front line providers in participative decision-making.
Lower level managers particularly felt that the current inability of the HMIS to capture children and adolescents is a major gap.
We adapted and applied the concept of 'decision-space' (traditionally used to measure transfer of administrative authority from higher to lower level managers).
The difference in opinion regarding workforce sufficiency between the lower level managers on the one hand; and district and national level managers on the other hand reflects relativism, where the lower level managers' opinions might be shaped by their contextual understanding of the health system, which is driven by perceptions of their sub-district.
Mid and senior health managers see these processes as " providing standardized frameworks to guide lower level managers and, more specifically, providers, to work differently to better meet population health needs" (Manager interview notes, 19th July 2010).
Lastly, the position of the PI as a Ugandan medical doctor with extensive experience in national and district health systems could have inhibited the lower level managers and biased their depictions of the health system.
