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Improving maternal and child health in Pakistan: a programme evaluation using a difference in difference analysis.

Muhammad Ashar Malik1,2, Lara Riedige Rohm2, Pieter van Baal2

  • 1Department of Community Health Sciences, Aga Khan Univeristy, Karachi, Sindh, Pakistan ashar@eshpm.eur.nl ashar.malik@aku.edu.

BMJ Global Health
|December 31, 2021
PubMed
Summary

The Norway-Pakistan Partnership Initiative (NPPI) did not significantly improve maternal healthcare access or use. However, voucher and contracting programs showed promise for increasing skilled birth attendance in Pakistan.

Keywords:
cross-sectional surveyhealth economicshealth systems evaluationmaternal health

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Area of Science:

  • Public Health
  • Health Services Research
  • Maternal Health

Background:

  • Pakistan faces high maternal and infant mortality rates.
  • Foreign-funded projects aimed to improve maternal, neonatal, and child health.
  • The Norway-Pakistan Partnership Initiative (NPPI) was one such project.

Purpose of the Study:

  • To evaluate the effectiveness of the Norway-Pakistan Partnership Initiative (NPPI) in enhancing access to and utilization of skilled maternal healthcare.
  • To assess the impact of NPPI on maternal healthcare seeking behaviors.

Main Methods:

  • Utilized data from three rounds (2009-2014) of the Pakistan Social and Living Standards Measurement Survey (PSLM).
  • Employed a difference-in-difference regression framework to analyze the impact of NPPI.
  • Combined various PSLM components to examine pregnant women's healthcare seeking behavior in response to NPPI exposure.

Main Results:

  • No significant difference in maternal care seeking behavior trends was observed between NPPI-exposed and control districts.
  • NPPI demonstrated a weak and statistically insignificant impact on overall maternal care seeking behavior.
  • Districts utilizing voucher programs or contracting services showed a higher likelihood of skilled birth attendance.

Conclusions:

  • The NPPI project did not achieve its primary objective of improving access to and use of skilled maternal healthcare.
  • The positive, albeit small, effects of vouchers and contracting on skilled birth attendance warrant further investigation and potential for future interventions.