Ahmed Jamil, Schneider Carmen Huckel, Alam Ashraful, Raynes-Greenow Camille
Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.
Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
Health Res Policy Syst. 2021 May 25;19(1):86. doi: 10.1186/s12961-021-00735-9.
Pakistan has made slow progress towards reducing the newborn mortality burden; as a result, it has the highest burden of newborn mortality worldwide. This article presents an analysis of the current policies, plans, and strategies aimed at reducing the burden of newborn death in Pakistan for the purpose of identifying current policy gaps and contextual barriers towards proposing policy solutions for improved newborn health.
We begin with a content analysis of federal-level policies that address newborn mortality within the context of health system decentralization over the last 20 years. This is then followed by a case study analysis of policy and programme responses in a predominantly rural province of Pakistan, again within the context of broader health system decentralization. Finally, we review successful policies in comparable countries to identify feasible and effective policy choices that hold promise for implementation in Pakistan, considering the policy constraints we have identified.
The major health policies aimed at reduction of newborn mortality, following Pakistan's endorsement of global newborn survival goals and targets, lacked time-bound targets. We found confusion around roles and responsibilities of institutions in the implementation process and accountability for the outcomes, which was exacerbated by an incomplete decentralization of healthcare policy-making and health service delivery, particularly for women around birth, and newborns. Such wide gaps in the areas of target-setting, implementation mechanism, and evaluation could be because the policy-making largely ignored international commitments and lessons of successful policy-making in comparable regional counties.
Inclusion of clear goals and targets in newborn survival policies and plans, completion of the decentralization process of maternal and child healthcare service delivery, and policy-making and implementation by translating complex evidence and using regional but locally applicable case studies will be essential to any effective policy-making on newborn survival in Pakistan.
巴基斯坦在减轻新生儿死亡负担方面进展缓慢；因此，该国是全球新生儿死亡负担最重的国家。本文对旨在减轻巴基斯坦新生儿死亡负担的现行政策、计划和战略进行分析，以找出当前的政策差距和背景障碍，从而提出改善新生儿健康的政策解决方案。
我们首先对过去20年在卫生系统权力下放背景下涉及新生儿死亡率的联邦层面政策进行内容分析。接着，以巴基斯坦一个主要为农村地区的省份为例，在更广泛的卫生系统权力下放背景下，对其政策和项目应对措施进行案例研究分析。最后，我们审视可比国家的成功政策，考虑到已确定的政策限制因素，找出有望在巴基斯坦实施的可行且有效的政策选择。
在巴基斯坦认可全球新生儿生存目标和指标后，旨在降低新生儿死亡率的主要卫生政策缺乏有时限的目标。我们发现，在实施过程中各机构的角色和责任以及对结果的问责存在混乱，而医疗保健政策制定和卫生服务提供的权力下放不彻底，尤其是针对分娩前后的妇女和新生儿，这加剧了这种混乱。在目标设定、实施机制和评估方面存在如此大的差距，可能是因为政策制定在很大程度上忽视了国际承诺以及可比地区国家成功政策制定的经验教训。
在新生儿生存政策和计划中纳入明确的目标，完成母婴保健服务提供的权力下放过程，以及通过转化复杂证据并运用具有地区特色但适用于当地的案例研究进行政策制定和实施，对于巴基斯坦任何有效的新生儿生存政策制定都至关重要。
