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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

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