Improving maternal and child health in Pakistan: a programme evaluation using a difference in difference analysis.

INTRODUCTION

Pakistan is a country with high maternal and infant mortality. Several large foreign funded projects were targeted at improving maternal, neonatal and child health. The Norway-Pakistan Partnership Initiative (NPPI) was one of these projects. This study aims to evaluate whether was successful in improving access and use of skilled maternal healthcare.

METHODS

We used data from three rounds (2009-2010, 2011-2012 and 2013-2014) of the Pakistan Social and Living Standards Measurement Survey (PSLM). A difference-in-difference regression framework was used to estimate the effectiveness of and its different programme components with respect to maternal healthcare seeking behaviour of pregnant women. Various parts of the were combined to examine the healthcare seeking behaviour response of pregnant women to exposure to .

RESULTS

Trends in maternal care seeking behaviour of pregnant women were similar in districts exposed to and control districts. Consequently, only a weak and insignificant impact of on maternal care seeking behaviour was found. However, women in districts which used vouchers or which implemented contracting were more likely to seek skilled assistance with their delivery.

CONCLUSION

We conclude that the objective to improve access to and use of skilled care was not achieved by . The small effects identified for vouchers and contracts on skilled birth attendance hold some promise for further experimentation.