A district-based health facility assessment for maternal and newborn care across Pakistan

Background: The shift from home to facility births has not translated into substantial mortality reduction in Pakistan. Therefore, we assessed whether health care facilities (HCFs) offer or have the capacity to offer critical maternal and newborn interventions. We aimed to propose tailored facility-based maternal and newborn care strategies, especially for the perinatal period. Methods: We conducted an HCF assessment in 275 public and private HCFs across 141 districts of Pakistan. We employed a comprehensive, quantitative tool to assess the availability and readiness of resources needed for critical maternal and newborn interventions, including Basic Emergency Obstetric and Newborn Care, Comprehensive Emergency Obstetric and Newborn Care signal functions, and Every Newborn Action Plan interventions. We analysed the data using Stata, version 13.0. Results: A high proportion of facilities offered delivery services (93%), yet lacked specialised staff, especially paediatric surgeons (18%) and neonatologists (18.5%). Availability of neonatal nurses was also critically low, especially in Balochistan (19.4%) and Gilgit-Baltistan (22.2%). Clinical guidelines, especially for newborn resuscitation (8.8%), kangaroo mother care (KMC) (8.4%), and use of injectable antibiotics (10.9%), were largely unavailable. Notable regional disparities were observed, with Balochistan displaying the poorest service availability and readiness. Only 8.3% of facilities in Balochistan had newborn resuscitation equipment, and none had guidelines. Conclusions: To make a substantial impact on reducing maternal and newborn mortality, data-driven, equitable allocation of funds and resources to HCFs is crucial. The availability of skilled health care providers, basic newborn care, and low-cost, high-impact interventions, such as the optimal use of antenatal corticosteroids, KMC, newborn resuscitation, and injectable antibiotics, should be prioritised and scaled up.