Clean Birth Kits to promote safe childbirth: the views and perceptions of policy makers and district health officers in Pakistan

Authors: Hundley, V., Avan, B., Ahmed, H., Graham, W. and Birth Kit Working Group

Conference: International Confederation of Midwives 30th Triennial Congress

Dates: 1-5 June 2014

Journal: Conference CD and booklet


Background: High rates of maternal and neonatal sepsis have been attributed to limited resources and a lack of awareness regarding clean birth practices.

Aim: To explore the views and perceptions of policy makers and district health officers with regard to CBKs as a means of distributing essential supplies and promoting safe childbirth.

Method: Data were collected at both decision makers’ and implementers’ levels: (1) Semi structured interviews with the key federal and provincial level policy makers in Pakistan. Interviews were recorded verbatim, translated into English and coded manually for recurrent themes. (2) Questionnaire survey - 89 District Health Officers (DHO) inquiring specifically about understanding of CBKs, uptake, and optimal distribution mechanisms in community settings. Ethical approval was not required because health service officials not patients were involved, however all the appropriate formal permissions were obtained. All individuals gave informed consent.

Findings: Participants reported that few women experienced clean births in Pakistan. CBKs were seen as a way of distributing commodities and increasing awareness. Knowledge about CBKs varied; federal level decision makers expressed less certainty than provincial policy makers or DHOs. The availability of CBKs was reported to be greater in Punjab than in Sindh province (97% vs 49%), with free distribution through hospitals and health centres. However, interviews suggested that distribution through lady health workers might be a more effective route. DHOs identified the current lack of training and guidelines as a deterrent to CBK use.

Implications: Policy makers and District level implementers need to promote CBK uptake by frontline health workers if the kits are to be an effective way of distributing scarce resources. Although support for CBKs was found to be high, knowledge of where and how CBKs were used was sometimes limited. Guidelines could be valuable in increasing awareness and in supporting health workers in CBK distribution and use.

Source: Manual

Preferred by: Vanora Hundley