Table 4 Barriers to the successful implementation of SAIA-SCALE, across two intervention waves in Mozambique, 2018–2020

Barriers in both implementation waves (2018–2019 and 2019–2020)

 Outer setting domain

  Needs and resources of those served

HIV-positive mothers do not show up for institutional births because of inadequate health facility and road infrastructure

 Inner setting domain

  Compatibility (subconstruct of implementation climate)

Challenges that some districts had in managing the small grants provided by the intervention

  Available resources (subconstruct of readiness for implementation)

Inadequate health facility infrastructure: small rooms, lack of privacy, lack of registries and medical and hygiene suppliers and child delivery medical equipment

Some health facilities did not have running water and health workers interrupted work to fetch water

Barriers in the second implementation wave (2019–2020)

 Inner setting domain

  Available resources (subconstruct of readiness for implementation)

Stockouts of medicines for HIV prophylaxis and ART at facility and district prevent meeting PMTCT targets