Pakistan in recent years has faced ongoing conflict and insurgency in the provinces of Khyber Pakhtunkhwa (KP), Balochistan, and the Federally Administered Tribal Areas (FATA). Hence, access to social services,including Maternal and Newborn Health (MNH) services have been significantly reduced in the conflict areas, a crisis which has been further compounded by floods in the recent past. The objectives of this qualitative research study are to: assess MNH situation in the conflict areas of Pakistan; and identify factors that are detrimental for access to and utilisation of MNH services, especially for the most marginalised populations groups. Focus Group Discussions (FGDs) and In-depth Interviews (IDIs) were conducted with users and providers of MNH services to scrutinise both the demand and supply sides of the governance equation. The study also aimed to explore socio-cultural patterns at the community level to evaluate their impact, if any, on the MNH services. Five key thematic areas were explored, in nine districts and three FATA agencies. The themes included: existing MNH Services; access to the available MNH services; referral linkages to higher level health facilities; perceptions and expectations. A literature review was conducted. Results: The acts of terrorism and militancy have adversely affected the MNH services. During attacks, both health providers and patients find it difficult to reach the health facilities. Insecurity, threats by Taliban, fear of militancy and target killing have had a negative impact on the overall socio-economic conditions and socio-psychological environment. Most of the families and health workers have left the conflict areas and moved to safer places. The quality of the MNH services in the security-affected areas is compromised due to staffing issues (shortage of female health providers, absenteeism and political interference in public sector staff recruitment and posting, low pay), health infrastructure (poor maintenance of buildings, absence of staff residential quarters), limited availability of utility services. Users face problems in access and utilization of MNH services, due to short supply of medicines, lack of or worn out equipment, indifferent staff behaviour, short working hours of health facilities, insufficient or remote location of many primary healthcare (PHC) facilities, The dominance of elders and/or male members of the family further restrict the mothers in timely seeking MNH services. Hence, poor and marginalised families generally depend on traditional birth attendants (TBAs) while well off families prefer better equipped private sector facilities. The aforementioned challenges are generally common to all areas, but are much more severe in FATA and Balochistan. Most of the users were not satisfied with the public sector services and criticised the quality of care. Based on the study findings and literature review, an agenda for action is proposed: 1. improved staff recruitment, training and conditions including higher pay in high-risk areas 2. improved coordination and monitoring of MNH services at community level (as in Swat district) 3. improved infrastructure of existing health facilities (including staff accommodation) especially in remote areas.
Bokhari, A.; Naveed-i-Rahat; Haq, M. B.; Batool, S.; Arshad, M. S. Care Plus: Delivery of MNH Services in Conflict Areas of KP, Balochistan, and FATA.