Public Health
Driving demand for safer births in Pakistan
By Bilal Khan & Will Anderson
In North West Pakistan Acasus has been supporting the government to rapidly increase the utilization of recently upgraded public health services. Four strategies in combination are achieving strong results.

Historically, skilled birth attendance has been low

Khyber Pakhtunkhwa (KP) is a northern province that is home to both impressive geography - magnificent peaks as high as 7,400 meters line the horizon - and prolonged conflict. Together, these features make providing essential services to KP’s 31 million inhabitants particularly challenging.

Just three out of every five mothers give birth in a health facility, and of those, most use private facilities. As private facilities are largely out of reach for the most vulnerable, this is a serious concern. Improving public services is therefore a key priority for the government.


Transforming SBA in KP

The government started by upgrading 85 rural health centers to receive patients 24/7, thereby expanding the footprint of public services available to citizens. These facilities (and all public health facilities in KP) were regularly monitored to ensure that they had the necessary inputs in place, with routines in place to address gaps discovered during the monitoring.

Despite these improvements in the availability of services, utilisation remained low. A new phase of work focused on improving demand.

Screenshot 2019-04-15 at 1.37.12 PM-m...

Four interventions are boosting demand for SBA in KP

1. Clustered facilities

The 85 upgraded health centres were selected based on their location to create 85 clusters - distinct areas with a central upgraded facility close to a number of basic facilities. Health workers were trained to educate and refer patients to the 24/7 SBA services in the upgraded facilities, increasing demand for SBA services.

Simplified example of a cluster


2. Spreading the word for public SBA services

Promotional flyers and endorsements by trusted community members, including religious and political leaders, are helping to improve demand for public SBA services. This intervention harnesses the power of word of mouth, a strategy which was effective during similar reforms in Punjab, Pakistan.

3. Utilizing estimated due date (EDD) data

Across KP a large cadre of lady health workers (LHWs) visit communities delivering basic health services to women and children confined in their homes. The LHWs record the EDDs of expectant mothers which are then used by health facilities to send reminders before the birth about the benefits of SBA and how to access services.

Screenshot 2019-04-15 at 1.35.44 PM-m... 

4. Learning based on EDD data

The EDD data is also used to compare the number of expected births against the number of actual births in individual health facilities. Once the best performing facilities are identified (those which deliver the highest proportion of expected deliveries), they are examined to understand best practices which are shared across the system.

About the authors

Bilal Khan supports transformational health reforms in Khyber Pakhtunkhwa, Pakistan. Will Anderson supports business development and research at Acasus.

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