We used in-depth interviews, observations, and document review to collect data. We developed semi-structured interview topic guides for different types of respondents and these were pre-tested with SRH INGO representatives and GHS managers outside the study site. Interviewees were purposely sampled, as the objective was to collect data on perceptions of different categories of actors (e.g. DHMT, INGO, District Assembly, community leaders, etc.) operating at different levels (e.g. INGO headquarters, INGO national office, district representation of the INGO). We conducted 23 in-depth interviews and a further 13 informal discussions with resource persons. The study was explained in detail to all interviewees, and informed consent obtained in all cases. The duration of the interviews ranged from 45 min to two hours. Interviews were recorded when allowed by the interviewee. The recorded interviews were transcribed by an experienced Ghanaian transcriber, who was bound by a confidentiality agreement.

As formal DHMT-(I)NGO meetings were not held regularly during our stay, we used any opportunity that arose during the visits. For instance, we attended a half-day regional forum of the Ghana Coalition of NGOs in Health, where GHS representatives were invited to speak and a meeting between a District Chief Executive and a District Director of Health Services. Additional opportunities for observation were provided during our visits to health facilities in the district.

Documents reviewed include project descriptions of SRH INGO programmes, GHS annual reports and GHS half-year performance reviews at different levels, GHS policies, guidelines and tools, reports from the district administration, policy reviews from donors and INGOs, and articles in the press.