Abstract
BackgroundRecognizing the need for improving maternal and newborn care, the Punjab public health department (Pakistan) launched emergency obstetric neonatal care (EmONC) services under WHO guideline. Unfortunately, the program implementation is facing some serious problems. The purpose of this study was to identify barriers to implementation of EmONC in district Bahawalnagar (Pakistan).MethodsThis study used sequential exploratory design. Specifically, a qualitative study was conducted to identify barriers to EmONC. Subsequently, the relative importance of these barriers was determined in a quantitative study. Participants were health service providers involved in 24-hours basic EmONC services in the basic health units of district Bahawalnagar (Pakistan). Qualitative data were gathered by interviewing the participants using key informant guide. Quantitative data were collected in a rank order survey of the same participants. The methodological quality was assessed using mixed methods appraisal tool (MMAT) version 2011.ResultsThe results indicate that lack of teamwork, conflict management, communication, and improper power distribution are important interpersonal barriers. The significant organizational-level barriers include job insecurity, lack of organizational culture, human resource deployment issues, and lack of role clarity. Lack of target management, lack of resource availability, house job requirement, and dual practice issues were identified as major system-level barriers.ConclusionBarriers to EmONC implementation must be addressed for improving maternal and neonatal care in district Bahawalnagar.
Highlights
Maternal mortality is a big global issue with 216 deaths per 100,000 live births [1]
The results indicate that lack of teamwork, conflict management, communication, and improper power distribution are important interpersonal barriers
The respondents of this study considered these issues as barriers to emergency obstetric neonatal care (EmONC) implementation in district Bahawalnagar
Summary
Maternal mortality is a big global issue with 216 deaths per 100,000 live births [1]. Pregnancy and childbirth related problems are causing 830 maternal deaths around the world per day[2]. Despite the fact that the Millennium Development Goals (MDGs) provided the global community with an exciting opportunity to improve women health and reduced maternal mortality [5], they fell short in achieving the target of reducing 75% maternal mortality between 1990–2015 [1]. The recent Sustainable Development Goals’(SDGs) target of reducing maternal mortality to less than 70 deaths per 100,000 live births between 2015–2030 may fall short until attendance and access to skilled antenatal care is improved [6]. The purpose of this study was to identify barriers to implementation of EmONC in district Bahawalnagar (Pakistan)
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