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An analysis of the impact of newborn survival policies in Pakistan using a policy triangle framework
Jamil Ahmed1,2, Carmen Huckel Schneider3, Ashraful Alam3
1Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain. jamilmga@agu.edu.bh.
Insights
Pakistan faces the highest newborn mortality globally. Policies to reduce newborn deaths lack clear targets and accountability, hindering progress. Addressing these gaps is crucial for improving newborn survival rates.
Area of Science:
- Public Health
- Health Policy Analysis
- Maternal and Child Health
Background:
- Pakistan has the highest newborn mortality rate globally, indicating slow progress in reducing this burden.
- Existing health policies and strategies in Pakistan are analyzed to identify gaps and barriers to improving newborn health.
Purpose of the Study:
- To analyze current policies, plans, and strategies for reducing newborn mortality in Pakistan.
- To identify policy gaps and contextual barriers hindering newborn survival.
- To propose evidence-based policy solutions for improved newborn health outcomes.
Main Methods:
- Content analysis of federal-level policies on newborn mortality over the past 20 years.
- Case study analysis of policy and program responses in a rural Pakistani province.
- Review of successful policies in comparable countries for feasible implementation in Pakistan.
Main Results:
- Major health policies lacked time-bound targets, despite global commitments.
- Confusion existed regarding institutional roles, responsibilities, and accountability in implementation.
- Incomplete decentralization of healthcare policy-making and service delivery exacerbated implementation challenges.
Conclusions:
- Clear goals and targets are essential for effective newborn survival policies.
- Completion of decentralization in maternal and child healthcare is crucial.
- Policy-making must translate evidence and utilize locally applicable case studies for successful implementation.
Introduction:
Pakistan has made slow progress towards reducing the newborn mortality burden; as a result, it has the highest burden of newborn mortality worldwide. This article presents an analysis of the current policies, plans, and strategies aimed at reducing the burden of newborn death in Pakistan for the purpose of identifying current policy gaps and contextual barriers towards proposing policy solutions for improved newborn health.
Methods:
We begin with a content analysis of federal-level policies that address newborn mortality within the context of health system decentralization over the last 20 years. This is then followed by a case study analysis of policy and programme responses in a predominantly rural province of Pakistan, again within the context of broader health system decentralization. Finally, we review successful policies in comparable countries to identify feasible and effective policy choices that hold promise for implementation in Pakistan, considering the policy constraints we have identified.
Results:
The major health policies aimed at reduction of newborn mortality, following Pakistan's endorsement of global newborn survival goals and targets, lacked time-bound targets. We found confusion around roles and responsibilities of institutions in the implementation process and accountability for the outcomes, which was exacerbated by an incomplete decentralization of healthcare policy-making and health service delivery, particularly for women around birth, and newborns. Such wide gaps in the areas of target-setting, implementation mechanism, and evaluation could be because the policy-making largely ignored international commitments and lessons of successful policy-making in comparable regional counties.
Conclusions:
Inclusion of clear goals and targets in newborn survival policies and plans, completion of the decentralization process of maternal and child healthcare service delivery, and policy-making and implementation by translating complex evidence and using regional but locally applicable case studies will be essential to any effective policy-making on newborn survival in Pakistan.
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