Facilitators and Barriers to Scaling Up Misoprostol for the Prevention of Postpartum Hemorrhage in Mozambique, by ExpandNet/WHO Framework

Planning Phase
1. Financial situation
2. Government support including champions
3. Changes in abortion law
4. Limited capacity of health system
5. Wavering support for TBAs
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
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.