PLOS ONE: Exploring Managers’ Perspectives on MNCH Program in Pakistan: A Qualitative Study. Introduction. Since the introduction of the primary health care (PHC) concept (Health for All, Alma Ata), community based health worker (CBHW) programs flourished substantially, especially in developing countries . National mnch program sindh. Click here to download national mnch program sindh. National mnch program sindh Pakistan is a signatory to. Najeeb-ur-Rehman Siddiqui. Communications Officer at National MNCH Program Punjab. Location Pakistan Industry Hospital & Health Care. Maternal, Neonatal & Child Health Program. Pakistan aims to bring the maternal. These programs have served as a panacea for the human resource for health shortages . These community based health workers, usually women, provide home based care for high priority health areas such as maternal and child health and nutrition, access to family planning services, and control of diseases such as malaria, tuberculosis, polio, measles and HIV/AIDS . The potential of community based health workers is especially useful in increasing access, reducing inequality and improving key health indicators in rural and underserved populations . A change in economic policies and political ideology, World Bank’s . The PHC concept has, however, had a renaissance in the past decade . This program was a major initiative, based on the International Conference on Population and Development’s Program of Action, for providing universal health coverage. The program currently employs over a 1. For a summary of MCHIP work that has ended in Pakistan, click here. Start and end dates: February 2013 to September 2017. MCHIP Partners Involved. Maternal Neonate and Child Health (MNCH) research in Pakistan: Trend and transition Najma Lalji, Ameera Kamal (Mustashaar Social Development Advisors. Background Pakistan’s Maternal, Newborn and Child Health (MNCH) Program is faced with multiple challenges in service delivery, financial and logistic management. Pakistan with the LHWs recognized as an integral part of the primary health care system . Although the scale up has been phasic, management of the program has been turbulent due to frequent turn over of management and logistics staff, inefficient disbursement of funds and supplies and a limited integration with the health system and other health related programs . Under this program, midwives were trained and licensed to practice maternal health care services (Ante Natal Care, Delivery, Post Natal Care) in rural communities, with the aim to increase skilled birth attendance and reduce maternal mortality . So far, research body on this program reports that this program is faced with implementation challenges in service delivery, financial and logistic management, training and deployment of human resources, and integration with the health system . Theoretically, devolution provides enhanced opportunities for provinces to introduce reforms and have prioritized provincial health policies. However, in case of Pakistan, this reform is a daunting challenge due primarily to lack of a national health policy and provincial health strategies . Under this reform, all functions of the federal ministry of health, except the vertical programs’ management have been devolved to the provincial health departments . Save the Children focuses on strengthening the health system of Pakistan, ensuring access and availability of Maternal, Newborn and Child Health (MNCH), Nutrition.The vertical programs will continue to be managed by the Planning Commission till the year 2. Considering the weak provincial policy units, unstable district health systems, inadequate health sector financing, and lack of quality assurance standards for health, management of the HR intensive community health worker programs pose a daunting challenge for the provincial health departments. The existing literature on Pakistan’s community midwifery program focuses primarily on service delivery, distribution and access aspects of the deployed midwives. There is a lack of evidence on managerial aspects of the MNCH program management and implementation. The present paper’s objective is to explore the challenges national, provincial and district program managers have faced in implementing a community midwifery program in a rural district of Punjab and the future directions for the program under a devolved health system. Methodology. The data presented in this paper are part of a larger mixed- methods study that aimed to assess challenges faced by the Pakistani CMWs in providing services to women in rural Punjab, Pakistan. Data for this study were collected over a 3- month period in 2. Attock, Punjab. To explore the range of challenges involved, qualitative data were collected from program managers, community midwives and local community members (mothers, their husbands and mothers- in- law). Alongside, a comprehensive review of relevant policy and planning documents was also conducted. Study setting. District Attock was selected for this research as it was among the first regions in which MNCH program was launched and had sufficient numbers of CMWs deployed, for a significant time period (almost 3 years), to assess coverage. The overall development, geographical and social characteristics of the district matches that of Northern Punjab and Khyber Pakhtunkhwa provinces of Pakistan. Furthermore, MNCH program in District Attock is funded and managed by the Government of Pakistan with no donor support. The program hence has resource constraints reflective of the situation in most of the districts of Pakistan. This unique perspective of the district made this area an ideal location for exploring the challenges faced by community based health workers in providing maternal health care services. Data collection procedure. Data for this manuscript has been drawn from program policy documents reviewed and interviews conducted with program managers. The reviewed policy documents included Planning Commission documentation (PC– 1) and Deployment guidelines for Community Midwives. These policy documents detailed program objectives, interventions to be adapted and services to be provided to improve infrastructural and behavioral issues associated with low utilization of maternal health services in rural areas of Pakistan. Deployment guidelines developed for community midwives were also reviewed in detail to develop an understanding of CMWs’ scope of work and responsibilities. Open ended, in- depth interviews were conducted with purposefully selected key actors involved in program planning and implementation process at the federal, provincial and district level, namely nine national, provincial and district program managers. Group interviews were conducted with seven (0. Table 1). All the interviews were conducted in interviewees’ offices at a time convenient to them. Interview guides were used to obtain information from the interviewees. Interview questions developed and refined by the core research team were aimed at soliciting experiences and opinions of the participants about the study question. Data analysis. All interviews were recorded and transcribed into English for further analysis. A random sample of the transcripts was checked by the authors for translation accuracy. A thematic content analysis approach was adopted for analyzing content of the interviews, as an on- going iterative process through which issues and challenges regarding program management and implementation were identified early on. This allowed for a rigorous probing in subsequent interviews . Open codes were developed and process was repeated for all transcripts. Emergent categories were identified without imposing a priori categories . Based on the identified categories, an initial thematic framework was developed, discussed iteratively between the authors and adjusted where appropriate. The identified themes, sub themes and categories conformed to the Health Policy Analysis triangle defined by Walt and Gilson . All the policy makers involved in the implementation of the program were included in the study. Data triangulation included use of policy documents and primary data collection through individual and group interviews. A peer coded two interviews independently and codes were reviewed for consistency. Throughout the data collection and analysis debriefing within research team (which comprised of public health professionals with experience in conducting qualitative studies), peer discussions and respondent validation were undertaken, thereby ensuring interpretative accuracy of the results. Ethical clearance. Ethical clearance for this study was obtained from bioethics committee of Pakistan Medical Research Council. A formal letter was sent to each interviewee to explain objectives of the study while requesting an appointment for conducting the interview. Interviewees were assured anonymity. Written, informed consent was obtained from all participants prior to the interviews, while ensuring complete anonymity and confidentiality. Results. In depth interviews with nine (0. Pakistan’s MNCH program, namely the national, provincial and district managers, development partner and representative of the midwifery training regulatory authority (Pakistan Nursing Council–PNC) were conducted. The interviews were analyzed using the policy analysis framework developed by Walt and Gilson . Results of the analysis are detailed under four themes identified using the framework. Theme I: Relevant stakeholders not involved in program development and implementation. Stakeholders are at the heart of policy and program development, influencing program design, content, strategies, and implementation modalities; however, they cannot be separated from the organizations within which they work. This theme attempts to identify the different actors involved in the MNCH program development process, the level of influence they exercised and their authority within the context of this program. Program planning and policy development. The Maternal, Newborn and Child Health program for Pakistan was developed in the wake of an MNCH strategy, launched in 2. The main actors involved in the development of the MNCH PC - 1 were the then Ministry of Health (Mo. H) and Department for International Development (Dfid). The respondents shared that during development of the program policy and implementation plans, relevant personnel were not involved. Although the Director General for Health was part of the team developing the program but inputs were not taken from provincial and district Health Departments. Principals of Nursing Schools where midwives were to be trained were also not engaged in this process; especially planning pertaining to training and deployment of midwives for community services.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. Archives
December 2016
Categories |