This brief summarizes describes how a report by the Countdown collaboration in Pakistan was used to build consensus around key priorities and generate change in policy and programs. Content of the brief is reprinted below:
Development of the report
Pakistan does not have an annual review of progress and performance mechanism for the health sector. A major event, however, is the annual national public health conference organized by the Health Services Academy (HSA), a parastatal institution working closely with the Ministry of Health. The HSA Director-General decided that it would be important to inform the annual conferences with thorough reviews of progress on critical topics and reproductive, maternal, newborn, child and adolescent health (RMNCAH) was selected as the first.
The Countdown to 2030 collaboration in Pakistan formed a technical team to summarize the current situation using all relevant data sources. The team included RMNCAH focal point from the Ministry of National Health Services, Regulation and Coordination, Health Strategy and Policy Implementation Unit (HSPIU) experts and technical focal points from the development partners, HSA, University of Manitoba and the Hospital for Sick Children in Canada. The formation and inclusion in the group was a simple process of engaging on virtual calls and e-mails, gradually recruiting additional people who were working to improve RMNCAH.
The key questions posed at the review of the first draft was “Are the findings of this report sufficient to mobilize debate and action?” and “Should this be a forward-looking or a backward-looking report?” The desire to inspire action through the report motivated the team to re-think presentation of important findings, balancing achievements with gaps and adding a forward-looking Lives Saved Tool (LiST) analysis to highlight the potential impact of the research uptake.
Strategic Dissemination of Findings
The conference was postponed because of the COVID-19 pandemic. Although the report was ready by end of November 2020, the team delayed releasing it until the health minister was available to help organize the launch. All the members of Ministry’s RMNCAH technical working group were invited, including provincial RMNCAH focal points and NGO partners. This allowed a high level of participation from the health ministry and a media presence at the launch.
The report was launched in March 2021, with the Ministry of Health and Health Services Academy and Countdown collaboration partners’ logos, and disseminated on the Health Services Academy’s website, Countdown’s website and social media, through the RMNCAH Technical Working Group and at Pakistan’s Annual Public Health Conference which was attended by more than 3000 participants. The findings were subsequently included in the reproductive health teaching module of MPH programme of Health Services Academy. The Offices of Research Innovation & Commercialization, which are part of Pakistan’s Higher Education Commission, also organized discussion seminars related to the report’s content. The research team was fortunate to be a part of the formulation of Pakistan’s Universal Health Care Investment Case, being developed through the World Bank Group’s Global Financing Facility; the PHC Global Action Plan mission, and the Comprehensive Sexual and Reproductive Health and Rights guidelines. The Planning Commission of Pakistan’s Health and Population committee shared the report for inclusion into the next long-term sector plans.
Initial Uptake of Report Recommendations
Although and multiple activities contribute to policy changes, the following positive changes are noted:
- Report recommendations are reflected in UHC investment case and the PHC GAP mission report, bringing greater clarity and consensus on key priorities.
- Family planning and optimal birth spacing are being given increased attention by health sector both at national and provincial levels. For example, the Ministry of National Health Services, Regulation and Coordination created a new director general technical position which is responsible both for population and health sectors.
- Areas with highlighted quality gaps have been included in the national strategy for quality of care, which is being developed in collaboration with the ministry and UNICEF.
Commodity security is gaining increased attention with focus on strengthening logistics management information system (LMIS).
- Maternal and perinatal death surveillance and response (MPDSR) activities are being scaled to more districts, and Punjab province has held a training for all districts with support of WHO.
- Newborn care signal functions have been added to emergency obstetric and neonatal care assessment recently being conducted by UNFPA. UNICEF has partnered with the Pakistan Paediatric Association to define newborn functions at each level of service delivery as well as to define staffing criteria for neonatal intensive care units.
- The gaps identified in the report are highlighted for inclusion in the sexual and reproductive health and rights guidelines, as well as the related allied training package, which are being developed by WHO and the Ministry of National Health Services, Regulation and Coordination.