Table 1 Summary of analysis of policies and plans with an impact on newborn mortality in Pakistan
From: An analysis of the impact of newborn survival policies in Pakistan using a policy triangle framework
Health policy analysed | Context | Content | Process | Stakeholders/actors |
|---|---|---|---|---|
National Health Policy 2001 | First significant health policy in the decade | Ten strategies including a target to reduce newborn mortality from 25 to 15% by 2010 | Broad and nonspecific process of implementation Identified service delivery improvement as key area of intervention | Provincial governments Recruitment of community health workers Ambitious goal to regulate private sector |
MNCH PC-1 | Major maternal and child health-related policy aligned with MDGs 4 and 5 | Aimed to improve community access to healthcare Acted merely as policy guidance Did not influence service delivery | Aims too ambitious for the provinces to implement Ambitious goal to establish EmONC facilities was not fully materialized Lower level of healthcare system did not fully benefit | International donor support for implementation Relied on provinces and donors to support, yet driven by the federal office |
National Health Policy 2009 | Generic policy without specific implementation strategy | Lacked in items on funding, timeline, or a direct relevance to newborn survival | Although it reiterated the importance of EmONC, it only superficially touched how would it be done | Federal Ministry of Health was abolished after decentralization in 2010 |
Every Newborn Action Plan (WHO/UNICEF) | Key guiding policy for countries signing to it implement strategy | Strategic objectives comprehensively address all aspects of newborn survival including reducing inequities | Pakistan’s progress on the plan was dismal Major flaw like in other policy implementation has been the time frame | Endorsement by 194 Member States including Pakistan |
National Health Vision Pakistan 2016–2025 | A federal policy developed recognizing a lack of progress in the provinces after decentralization | Newborn healthcare services an important outcome, yet no clear service level target | A lack of identification of monitoring and evaluation of implementation Policy seemed to have gathered a little momentum | Vague listing of wide-ranging private sector involvement |
Miscellaneous health-related policies with a possible impact on newborn health | Various policies with potentially an indirect impact upon newborn survival | Conspicuously lacking newborn survival as the key outcome | Detailed implementation and evaluation process generally missing | UN and international donors developing documents with little commitment from the key public sector stakeholders |
Provincial MNCH Programme after decentralization | Decentralization of programme, with inadequate role definitions and resource allocation | Progressive limitation of the programme mandate to only teaching and training of midwives | Financial constraints and difficulties post-decentralization led to these limitations to the scope of work | Declining support by the donors that financed the federal programme previously |
The Sindh Health Policy 2005 | First provincial health policy linking child health with MDGs | Despite considering child health a priority, newborn health was missing in the document | Vague implementation mechanisms Vague reference to improving child health without pinpointing the key areas of service delivery | Mention of inter-sectoral collaboration, yet no clear roles and responsibilities identified |
Sindh Health Sector Strategy 2012–2020 | Most recent provincial strategy | Addresses the need to improve service delivery by introducing health service packages, yet key information about establishment of EmoNC centres is missing | Implementation actions are largely missing | A failure to identify clear roles and responsibilities Monitoring and evaluation mechanism unclear |
Integrated Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition Strategy 2016–2020 | The first policy that addresses the key issues of access to and quality of MNCH services | Clearer aims to upgrade health facilities, yet no commitment to establish specialized care units for sick newborns | Time frames not available Refresher trainings one of the major strategies Concrete and objectively verifiable goals not identified | Looks to donors for filling the resource gaps |