Scaling up the “24/7 BHU” strategy to provide round-the-clock maternity care in Punjab, Pakistan: a theory-driven, coproduced implementation study

Health Research Policy and Systems

Study Protocol

Amy Barnes¹  Sarah Salway¹  Jeremy Dawson²  Afshan Bhatti³  Gian Singh Jhangri⁴  Zubia Mumtaz⁴ 

[1] Faculty of Social Sciences, University of Sheffield, Elmfield Building, Northumberland Road, S10 2TU, Sheffield, UK;Management School, University of Sheffield, Conduit Rd, S10 1FL, Sheffield, UK;Real Medicine Foundation, 328 Service Road, E-11/4, Islamabad, Pakistan;School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Ave, T6G 1C9, Edmonton, AB, Canada;

关键词: Scale-upprogrammes;    Maternal healthcare service;    Rural;    Low- and middle-income countries;    Coproduction of knowledge;   

DOI  :  10.1186/s12961-022-00944-w

 received in 2022-08-19, accepted in 2022-11-25,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundPakistan’s maternal mortality rate remains persistently high at 186/100,000 live births. The country’s government-run first-level healthcare facilities, the basic health units (BHUs), are an important source of maternity care for rural women. However,BHUsonly operate on working days from 8:00 am to 2:00 pm. Recognizing that this severely constrains access to maternity services, the government is implementing the “24/7 BHU” initiative to upgrade BHUs to provide round-the-clock care. Although based on a successful pilot project, initial reports reveal challenges in scaling up the initiative. This implementation research project aims to address a key concern of the Government of Punjab: How can the 24/7 BHU initiative be successfully implemented at scale to provide high-quality, round-the-clock skilled maternity care in rural Punjab?MethodsThe project consists of two overlapping work packages (WP). WP1 includes three modules generating data at the directorate, district and BHU levels. Module 1 uses document analysis and policy-maker interviews to explicateprogrammetheory and begin to build a system model. Module 2 compares government-collected data with data generated from a survey of 1500 births to assess BHU performance. Module 3 uses institutional ethnographies in 4–5 BHUs in three districts to provide a detailed system for understanding and identifying processes that influence scale-up. WP2 includes two modules. First, two workshops and regular meetings with stakeholders integrate WP1 findings, identify feasible changes and establish priorities. Next, “change ideas” are selected for testing in one district and 2–3 BHUs through carefully documented pilots using the PDSA (plan–do–study–act) improvement approach. An integrated knowledge translation approach will engage key policy and practice stakeholders throughout the project.DiscussionThis theory-driven implementation research project willcoproducesignificant new understandings of the wider system in which the 24/7 BHU initiative is being implemented, and actionable knowledge that will highlight ways the implementation processes might be modified to enable BHUs to meet service provision goals. This study will also produce insights that will be relevant for other South Asian and low- and middle-income countries (LMICs) that experience similar challenges of programme scale-up and delivery of maternal health services to remote and marginalized communities.

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

Fig. 6