Exploring knowledge translation practices in a global health program: case study on the establishment of the Pakistan National Maternal, Neonatal, and Child Health Program

Abstract

To describe the major knowledge translation processes, decisions, and organizations involved in the landmark decision to institute a national, federal program in one of the most populous countries of the world. The Maternal, Newborn and Child Health (MNCH) program was a vertical program that was established in 2006 in Pakistan. Using the case study methodology, we conducted a peer and grey literature review, with key informant in-depth interviews for meeting the study objectives. We used Wilson et al’s Knowledge to Action (K2A) Framework to explore the knowledge translation processes, the major decisions, and the national and international organizations involved during the 7-year period preceding the decision. The time period was selected based on the change in government in late 1998, which continued till the establishment of the national program. Using the framework, we categorized knowledge translation practices and major decisions into phases of research, translation, and institutionalization. We were able to identify 20 organizations that had played a part in the institution of the program, of which six national and international were considered significant towards effecting decisions. While organizations such as the World Bank and Pakistan Ministry of Health played important roles, we highlight the pivotal role of the Health Secretary’s office, as an unusual ‘knowledge broker’ situated within the Government. While effective program planning in low middle-income countries can greatly benefit from knowledge translation practices, explaining processes from evidence generation to the final step of key decisions is valuable in understanding the complexities involved in such settings. The study begins to fill a critical gap in literature in illustrating real-world program planning in resource-constrained countries, lagging in maternal and child health indicators.