TABLE 4.

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.