KARACHI: A recently published study has found that maternal and child health services in the conflict-hit parts of Pakistan are severely affected due to insecurity, unavailability of staff and damage to healthcare facilities, suggesting the need for customised strategies to promote women and child health in these areas.

The study on healthcare in Pakistan’s violence-affected areas is published in BioMed Central’s Conflict and Health journal.

It was conducted by researchers at the Aga Khan University (AKU) and the Centre for Global Child Health at The Hospital for Sick Children in Toronto, Canada, in two areas of Pakistan: Balochistan — with a specific focus on the Makran belt that includes the districts of Gwadar, Kech and Panjgur — and (former) Federally-Administered Tribal Areas (Fata) due to the chronic nature of conflict in these areas.

The study consisted of a qualitative and quantitative analysis of the provision of reproductive, maternal, newborn, child and adolescent health and nutrition services comparing coverage in districts facing minimal, moderate and severe levels of conflict.

Researchers found significantly lower levels of contraceptive use, facility delivery, exclusive breastfeeding, Bacillus Calmette–Guérin (BCG) vaccinations, and care seeking for acute respiratory infections in Balochistan’s districts severely hit by violence when compared to those areas with minimal conflict.

There was no significant difference in coverage levels between moderate and severe conflict areas. A similar quantitative assessment of coverage levels in (former) Fata was not possible due to a lack of reliable quantitative data.

Suggests customised healthcare strategies in such regions

The study found that many primary healthcare facilities in (former) Fata and a few areas in the Makran division of Balochistan were not functional due to insecurity, unavailability of staff and damage to healthcare facilities. Researchers added that roadblocks and curfews in conflict-hit areas further exacerbated supply chain challenges and compromised healthcare by restricting the availability of essential medicines and commodities.

It showed incidents of harassment, targeted killing, security threats and kidnapping of health workforce, specifically polio workers, in conflict-hit areas.

Other factors hampering delivery of health services included stringent government regulations on non-profit organisations and non-availability of health professionals of all cadres, especially female workers.

On a positive note, the study pointed to the success of a health workforce strategy adopted in district Kech in Balochistan. This involved sending senior staff on rotations between the district centre and far-flung areas for a week in a month, thereby helping expand access to healthcare in remote areas.

“Pakistan must develop customised strategies to promote women and child health services in conflict-hit areas,” said AKU’s Dr Jai Das, the lead author of the case study. “At present, we have broad guidance on aiding women and children that do not take into account the long-lasting impact of persistent conflict on the local population and the healthcare infrastructure.”

AKU researchers Zahra Ali Padhani, Sultana Jabeen, Arjumand Rizvi, Uzair Ansari, Malika Fatima, Ghulam Akbar, Wardah Ahmed and Zulfiqar A. Bhutta are co-authors of the paper.

Published in Dawn, January 29th, 2021