ArticleGlobal health, science and practice2019
Scaling Up Misoprostol to Prevent Postpartum Hemorrhage at Home Births in Mozambique: A Case Study Applying the ExpandNet/WHO Framework.
Article in Global health, science and practice, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.
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Who cites it
9 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Perceptions and experiences of the prevention, detection, and management of postpartum haemorrhage: a qualitative evidence synthesis.The Cochrane database of systematic reviews · 2023Pooled it
- Community health workers at the dawn of a new era: 6. Recruitment, training, and continuing education.Health research policy and systems · 2021Pooled it
- Reducing inequities in access to postpartum hemorrhage prevention: Reframing advance distribution of misoprostol as a test case for health system responsiveness and adaptation.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Article
- Integrating a single-dose intravenous iron therapy (ferric carboxymaltose) for maternal anaemia in Nigeria: Insights from stakeholder engagement.Journal of public health in Africa · 2026Article
- From pilot to national roll-out of the improved Community Health Fund (iCHF) in Tanzania: lessons learnt and way forward.Cost effectiveness and resource allocation : C/E · 2024Article
- A pilot to promote early child development within health systems in Mozambique: a qualitative evaluation.Annals of the New York Academy of Sciences · 2022Article
- The scale-up and integration of contraceptive service delivery into nursing school training in the Democratic Republic of the Congo.Health policy and planning · 2021Article
- Scaling up Business Plans in Tajikistan: a qualitative study of the history, barriers, facilitators and lessons learnt.Global health action · 2021Article
- Misoprostol for the prevention of post-partum haemorrhage in Mozambique: an analysis of the interface between human rights, maternal health and development.BMC international health and human rights · 2020Article
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6 authors.
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Abstract
backgroundMozambique 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.
methodsQualitative 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.
resultsThe 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.
conclusionThis 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.
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