Literature Review (including Systematic Review) of Published and Unpublished Literature on the Impact of Platforms of Service Provision in Conflict Areas on Maternal and Newborn Health and their Applicability In Pakistan
Abstract
Various models and strategies have been implemented over the years in different parts of the world to improve maternal and newborn health in conflict affected areas. These strategies are based on specific needs of communities and whether they can be accepted by the local population. By evaluating these strategies and health care delivery systems we can identify issues that may have caused hurdles in planning and implementation. We can also identify solutions to these problems and come up with guidelines that can be utilised in the future. For this reason we undertook this review to establish a framework of maternal and newborn healthcare needs that can be applicable to the current situation in Pakistan and conflicts in other parts of the world. Our literature search revealed very few published and unpublished studies that evaluated the impact of strategies for MNH service delivery in conflict areas. We included 11 studies that describe such MNH service delivery platforms. These studies are from Afghanistan, Pakistan, Myanmar (Burma), Sudan, Tanzania, Liberia, Guatemala, and Democratic Republic of Congo. We did not come across any randomised control trials or studies comparing intervention with a control arm. A few of the included studies are narratives with no quantitative data, but are included to highlight different models of healthcare used in efforts to uplift MNH. Most of the studies and reports were found in grey literature. The results of our search show that with utilisation of community services, the greatest impacts were observed in skilled birth attendance and antenatal consultation rates. Results from different studies evaluating such programmes in Eastern Burma and Afghanistan show that skilled birth attendance increased between 12 to 42%, and antenatal consultation rates increased by approximately 33%. Outreach services increased antenatal consultation rates from 55 to 88%. It also increased prenatal and childbirth care by midwives from 71 to 89%. Facility level services show that with labour room services provided for an IDP camp in Balochistan, Pakistan, unregistered deliveries decreased from 17 to 8%, ANC decreased from over 350 to 197 per 100,000 live births. Consultative meetings and discussions in both Quetta and Peshawar revealed that no systematic models of MNH service delivery, especially tailored for conflict areas, are available. During conflict, even previously available services and infrastructure suffer due to various barriers specific to times of conflict and unrest. A number of barriers that hinder MNH services are discussed. Suggestions for improving MNH services in conflict areas are also given. The literature review identified some important steps that can be taken to mitigate the effects of conflict on MNH, which include: improving access to infrastructure and equipment for antenatal care, EmONC and essential newborn care; developing and training healthcare providers on protocol-based case management and behaviour-centred communication for improved maternal and newborn care; and lastly, advocating at different levels for free access of pregnant women and women with children to healthcare services, and for the introduction of the programme model in existing healthcare system. Finally, for a sustainable programme, it is important to work closely with both the IDP and host community, and collaborate with the government and NGOs.
Citation
Bhutta, Z.A.; Soofi, S. B.; Lassi, Z.S.; et al. Literature Review (including Systematic Review) of Published and Unpublished Literature on the Impact of Platforms of Service Provision in Conflict Areas on Maternal and Newborn Health and their Applicability In Pakistan. Aga Khan, Pakistan, (2013)
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