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Glob Health Sci Pract. 2019 Mar 29;7(1):66-86. doi: 10.9745/GHSP-D-18-00475. Print 2019 Mar 22.

Scaling Up Misoprostol to Prevent Postpartum Hemorrhage at Home Births in Mozambique: A Case Study Applying the ExpandNet/WHO Framework.

Author information

1
Menzies School of Health Research, Charles Darwin University, Casuarina, Australia. Karen.hobday@menzies.edu.au.
2
Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
3
Bixby Center for Population, Health and Sustainability, University of California-Berkeley, Berkeley, CA, USA.
4
Department of Women's and Child Health, Ministry of Health, Maputo, Mozambique.
5
Menzies School of Health Research, Charles Darwin University, Casuarina, Australia.
6
Burnet Institute, Melbourne, Australia.

Abstract

BACKGROUND:

Mozambique has a high maternal mortality ratio, and postpartum hemorrhage (PPH) is a leading cause of maternal deaths. In 2015, the Mozambican Ministry of Health (MOH) commenced a program to distribute misoprostol at the community level in selected districts as a strategy to reduce PPH. This case study uses the ExpandNet/World Health Organization (WHO) scale-up framework to examine the planning, management, and outcomes of the early expansion phase of the scale-up of misoprostol for the prevention of PPH in 2 provinces in Mozambique.

METHODS:

Qualitative semistructured interviews were conducted between February and October 2017 in 5 participating districts in 2 provinces. Participants included program stakeholders, health staff, community health workers (CHWs), and traditional birth attendants (TBAs). Interviews were analyzed using the ExpandNet/WHO framework alongside national policy and planning documents and notes from a 2017 national Ministry of Health maternal, newborn, and child health workshop. Outcomes were estimated using misoprostol coverage and access in 2017 for both provinces.

RESULTS:

The study revealed a number of barriers and facilitators to scale-up. Facilitators included a supportive political and legal environment; a clear, credible, and relevant innovation; early expansion into some Ministry of Health systems and a strong network of CHWs and TBAs. Barriers included a reduction in reach due to a shift from universal distribution to application of eligibility criteria; fear of misdirecting misoprostol for abortion or labor induction; limited communication and understanding of the national PPH prevention strategy; inadequate monitoring and evaluation; challenges with logistics systems; and the inability to engage remote TBAs. Lower coverage was found in Inhambane province than Nampula province, possibly due to NGO support and political champions.

CONCLUSION:

This study identified the need for a formal review of the misoprostol program to identify adaptations and to develop a systematic scale-up strategy to guide national scale-up.

PMID:
30926738
DOI:
10.9745/GHSP-D-18-00475
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