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Table 1 Using the SURE Framework to identify factors affecting the implementation of role expansion for abortion care

From: Implementation considerations when expanding health worker roles to include safe abortion care: a five-country case study synthesis

Level Factors affecting implementation of policy options included in the SURE Framework [15] Factors affecting the implementation of role expansion for abortion care identified in this study
Recipients of care Knowledge and skills  
Attitudes regarding programme acceptability, appropriateness and credibility Women’s attitudes to and experiences of different types of health workers
Motivation to change or adopt new behaviour  
Providers of care Knowledge and skills Health workers’ knowledge about abortion legislation and services
Attitudes regarding programme acceptability, appropriateness and credibility Health workers’ willingness to provide abortion care Health workers’ understanding and use of conscientious objection
Motivation to change or adopt new behaviour  
Other stakeholders Knowledge and skills  
Attitudes regarding programme acceptability, appropriateness and credibility Co-workers’ attitudes towards role expansion
Motivation to change or adopt new behaviour  
Health system constraints Accessibility of care  
Financial resources  
Human resources  
Educational and training system, including recruitment and selection Health worker training
Clinical supervision, support structures and guidelines Health workers’ access to supervision and emotional support
Internal communication  
External communication  
Allocation of authority  
Accountability Monitoring and evaluation of health workers
Community participation  
Management and/or leadership  
Information systems  
Scale of private sector care  
Facilities  
Patient flow processes Health workers’ access to referral systems
Procurement and distribution systems Health workers’ access to supply chains
Incentives Health worker workloads and incentives
Bureaucracy  
Relationship with norms and standards  
Social and political constraints Ideology  
Governance  
Short-term thinking  
Contracts  
Legislation or regulation  
Donor policies  
Influential people  
Corruption  
Political stability and commitment