Facilitators and Barriers to Scaling Up Misoprostol for the Prevention of Postpartum Hemorrhage in Mozambique, by ExpandNet/WHO Framework
| Factors | Facilitator | Barrier |
|---|---|---|
| Planning Phase | ||
| Environment | ||
| 1. Financial situation | ✓ | |
| 2. Government support including champions | ✓ | |
| 3. Changes in abortion law | ✓ | |
| 4. Limited capacity of health system | ✓ | |
| 5. Wavering support for TBAs | ✓ | |
| Innovation | ||
| 1. Clear, concise, well-defined | ✓ | |
| 2. Adaptation of criteria | ✓ | |
| 3. Flow of distribution | ✓ | |
| User Organization | ||
| 1. MOH Central | ✓ | |
| 2. MOH MNCH health staff | ✓ | ✓ |
| 3. MOH pharmacists | ✓ | |
| 4. APE (dependent on TBA relationship and distance) | ✓ | ✓ |
| 5. TBA recruitment (close to health facility) | ✓ | |
| Resource Team | ||
| 1. Members | ✓ | ✓ |
| 2. Existence of SWAp MNCH Technical Working Group | ✓ | |
| 3. SWAp MNCH Technical Working Group irregularity of meetings | ✓ | |
| Management Phase | ||
| Type of Scale-Up | ||
| 1. Horizontal (phased expansion) | ✓ | |
| 2. Limited sites in each district (5 health facilities in selected districts) | ✓ | |
| 3. Untrained health staff due to mobility | ✓ | |
| 4. Vertical (institutionalization) | ✓ | |
| Dissemination and Advocacy | ✓ | |
| 1. Development of National PPH Strategy | ✓ | |
| 2. Communication of PPH Strategy | ✓ | |
| 3. Training of health staff, APEs, and TBAs | ✓ | ✓ |
| Organizational Process | ||
| 1. MOH Central | ✓ | |
| 2. MOH Provincial | ✓ | ✓ |
| 3. MOH District | ✓ | |
| Costs/Resource Mobilization | ||
| 1. Available Budget | ✓ | |
| Outcomes | ||
| 1. Utilization and access in Nampula province | ✓ | |
| 2. Utilization and access in Inhambane province | ✓ | |
| 3. Logistics system | ✓ |
Abbreviations: APE, Agentes Polivalentes Elementares (community health worker); MNCH, maternal, newborn, and child health; MOH, Ministry of Health; PPH, postpartum hemorrhage; SWAp, Sector Wide Approach; TBA, traditional birth attendant; WHO, World Health Organization.