Table 2 Rating of 24 interventions that emerged from the ideation meeting

1

Disciplinary measures for nurses and clients

• Simple disciplinary measures for bad nurses

• Community to create bylaws for clients who abuse nurses

10

10

10

10

8

10

58

2

Awards and recognition for good nurses

• Establishment of awards for nurses (monthly/yearly) at the level of facility, district, and region

• Giving letters of congratulations and posting good nurses on hospital notice boards or recognizing them in formal meetings

9

10

10

7

10

10

56

3

Improving complaints mechanisms

• Having a separate entity for gathering handling and communicating complaints

• Improving suggestion boxes by educating clients on how to complain, strengthening privacy and feedback to clients

• Conducting Exit interviews with clients before they leave the facility

• Having a performance evaluation desk for nurses

10

10

10

8

8

6

52

4

Improving nursing curriculum

• Increasing the number of hours and credits on the communication skills course

• Adding customer care courses to the nursing curriculum

• Improving practical learning environment for nurses to practice ways of improving relationships with clients

10

10

10

8

2.5

9

49.5

5

Improving the availability of resources

• Improving procurement process for medications out of stock at MSD

• Increasing availability of medicine and medical equipment

• Improving healthcare infrastructure

• Engaging stakeholders in the availability of resources

• Designing internal income generation activities without burdening the clients

9

10

10

8

5

7.5

49.5

6

Improving the efficiency of nursing leaders

• Encouraging leaders to adhere to leadership ethics

• Conducting regular mentorship to leaders

• Training on good leadership

• Punishment for leaders with many complaints

8

10

10

6

6

9

49

7

Improving patient/Client-Centred Care

• Emphasis on clients’ rights e.g., the right to choose providers

• Offering information to clients on deficits at the facility

• Avoidance of discrimination during care provision

• Encourage clients to speak freely

• Engaging clients in treatment decisions

• Informing clients in advance on the process of care (steps to go through to receive care)

• Continuous client education on the care they deserve from nurses

8

8.5

9

7

7

8.5

48

8

Improving health service delivery

• Using professional meetings to remind nurses of the need to adhere to ethics

• Encourage equality in nursing care

• Establishment of service packages for different income groups without conflicting quality

• Training nurses on different aspects of nursing care

9

10

8

8

7

6

48

9

Improving and dissemination of service delivery guidelines

• Improving existing service guidelines

• Ensuring that service guidelines are disseminated to all nurses

8

10

10

5

5

9

47

10

Improving the implementation of the National Health Policy

• Ensuring the availability of resources as promised in the national health policy

• Strengthening cost recovery mechanisms for groups who receive free care

• Improving the effectiveness of health facility governance committees

• Developing and dissemination of clients’ service charters

8

10

9.5

5

4

9

45.5

11

Improving workplace policy and procedures

• Improving work policy and procedures

• Improving shift arrangements by putting good and bad nurses on a similar shift for co-learning

• Rotating nurses in different departments

7

10

8.5

6

5

8.5

45

12

Community sensitization

• Educating community on early healthcare seeking, early clinic attendance, healthcare service delivery process and the importance of and responsibilities of nurses

• Continued community education through media outlets (TV & Radio), community meetings, and health education sessions at the clinic CHWs

• Establishing soci al welfare and community education department at the facility

• Establishing a system for monitoring and controlling of the correctness of health-related social media content

8

10

7

8

5

7

45

13

Continued professional development for nurses

• Establishing orientation packages and orienting new employees on customer care

• Using formal meetings for reminding nurses about nursing ethics

• Mentorship for less experienced by experienced nurses

• Putting less experienced nurses on a similar shift with experienced nurses

• Frequent training on customer care skills, Nursing delivery process, clients’ rights, use of electronic health information systems and mental health (online or face-to-face)

7

10

10

5

4

9

45

14

Improving nursing workforce

• Hiring more new nurses

• Use of nursing volunteers

5

10

10

5

5

9.5

44.5

15

Team building activities for nurses

• Design and implement team-building activities that bring together nurses from within and outside facilities

• Training on team-building skills

• Team building trips within and outside the facility, district, region, and country

8

10

10

4

3

9

44

16

More research on provider–client relationships

• Stakeholders to conduct more research on effective strategies for improving provider–client relationships

5

10

10

2

10

6.5

43.5

17

Use of religious leaders

• Inviting religious leaders to train nurses on ethics and loving care

2

10

10

1

10

10

43

18

Dialogue between facilities and communities

• Engage health facility committees in coordinating dialogues between facilities and community members

• Using community meetings to educate communities on the healthcare delivery process

5

10

10

5

8

4.5

42.5

19

Improving salaries and Allowances

• Salary increments for nurses

• Improving allowances for nurses

• Timely salary payments

• Establishment of low-interest loans for nurses

5

10

10

5

3

9.5

42.5

20

The motivation of secondary school students to join the nursing cadre

• Nursing boards/associations to sensitize and encourage secondary school students to join a nursing cadre

• Establish nursing carrier guidance in secondary schools

• Improving enrollment procedures to identify students who are self-motivated to become nurses

7

10

9

6

2

8

42

21

Reducing politicization of nursing cadre

• Encouraging political leaders to avoid interfering with nursing and healthcare service delivery by creating false expectations for clients

• Educating clients and community members on the reality of healthcare services (to avoid being swayed by politicians)

5

10

10

5

3

8.5

41.5

22

Improving the effectiveness of nursing profession Boards

• Nursing professional boards to promote their work to nurses (visiting nurses in their facilities or media outlets)

• Nursing boards to organize frequent seminars and forums at the district, regional and national levels

• Nursing Boards to approve customer care and communication skills as CPD courses for nurses

• Nursing Boards to train nurses in customer care and communication skills

6

10

10

5

2

8

41

23

Improving client’s healthcare purchasing power

• Roll of universal healthcare insurance

• Encourage engagement in income-generating activities

• Training clients on entrepreneurship skills

• Implementing poverty elimination strategies

• Customer segmentation- establishing service packages based on the client’s income without conflicting service quality

8

10

5

8

4

5.5

40.5

24

Mental health support for nurses and clients

• Development and distribution of Information, Education and Communication materials on mental health

• Strengthening the linkage of clients and nurses to mental health support entities

• Establishing mental health support office/ personnel at least at the health centres and hospital level

• Posting telephone numbers of mental health personnel/entities on hospital noticeboards

• Training nurses on mental health skills

1

10

8

1

8

4.5

32.5