Operational recommendations for the misoprostol program:
• Allow TBAs to pick up the medication from the health facility where necessary and appropriate to ensure a stable supply of misoprostol.
• Heighten communication of the Strategy for the Prevention of PPH at the Community Level to TBAs. TBAs and MNCH nurses should feel confident distributing and administering misoprostol to women who will have a home birth as part of the National Strategy.
• Provide clear information to the community via heath facility staff, CHWs and TBAs about misoprostol and how to use it correctly, alongside messages encouraging facility-based birth to dispel fears and myths in the community.
• Consider clean birth kits distributed through ANC, APEs, and/or directly to TBAs. This would alleviate the concerns TBAs have about infections to themselves, women and newborns while reducing neonatal mortality. This study found no concerns that this might undermine facility deliveries.
Recommendations to increase coverage of births attended by SBAs:
• Transportation, while costly, is a necessary investment to ensure women have access to health facilities. Women and TBAs both strongly support facility deliveries, but requested assistance with transport and communication.