National health policy process formation and implementation regarding antenatal care health services delivery and utilization at district level in Baluchistan Province, Pakistan

Abstract

Objectives: To assess the current implementation of health services delivery mentioned in the national health policy 2001. 2) To explore the local factors effecting the policy implementation. 3) To assess the cultural factors effecting the policy implementation for health services delivery. 4) To recommend approaches and interventions to improve policy implementation of health services delivery at district level METHODS: The study had an exploratory and descriptive design with both qualitative and quantitative methods. Focus group discussions, observations and in-depth interviews were conducted at different levels of health administration including federal, provincial, district and community, and a quantitative survey was also conducted in community among pregnant mothers. Qualitative data was analyzed through grounded theory and thematic approach, quantitative data was analyzed in SPSS version 16, using descriptive, Chi Square and regression analysis. RESULTS: Qualitative data revealed that agenda setting, policy formulation and implementation of maternal health services according to NHP 2001 was almost done by federal government. Services are delivered through district health management. Provinces role was limited in policy process in context of Baluchistan province. The respondents were also on view that the health policy was a part of poverty alleviation program of the government. The respondents also expressed that policy was built on biomedical model of health system. The implementation was also poor. In real the policy was not implemented properly in the Baluchistan. The Quantitative study in the community revealed that people in the community were not using the facilities. ANC utilization was 14% among pregnant ladies and 60% complained perceived problems. The barriers proved to be significant were distance, education, income, and cultural factors and autonomy of the women. The knowledge of the pregnant ladies was low. The availability of health facilities was not proper and people developed negative attitude toward government health services. The pregnant ladies don’t have proper awareness and males were not concerned about their health. Social support from the mother in law, husband and friends was significantly associated with ANC. CONCLUSION: Study revealed that there were gaps between ANC services delivered and utilization by the community. It is an opportunity for the provincial government to understand the local culture and social setting and generate a broad policy based on proper evidence.