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Table 5 Facilitators, barriers and recommendation affecting health system in conflict areas of Pakistan

From: Impact of conflict on maternal and child health service delivery – how and how not: a country case study of conflict affected areas of Pakistan

 

Facilitators

Barriers

Recommendations

Health Workforce

- Hiring of qualified local people along with incentives for retention

- Lack of female health workers

- Hire more female staff and reduce gender imbalance

- Absenteeism and lack of capacity of healthcare staff

- Workers hired from outside face language and cultural issues

- Send female staff on rotation basis to conflict areas

- Political influence and favoritism

- Hire local people and provide adequate training

- Security threats

- Provide housing and basic necessities

- Low salaries

- Merit based hiring

- Absence of accommodation and basic facilities for doctors

- Doctors or staff to provide replacements when going on leave

- Quacks are preferred by people over doctors

Service Delivery

- Secondary facilities relatively well maintained

- Non-functional healthcare facilities

- SOPs should be implemented

- Establishment of various new primary and secondary healthcare facilities

- Poor infrastructure

- Work on infrastructure for the uptake of health care intervention

- Political influence

- Ambulatory service with staff care

- Quality of care compromised

- Stringent monitoring mechanisms using technology

- Midwives and lady health workers visit homes

- Unavailability of transport for staff

- Service of institutional deliveries in presence of skilled birth attendant

- Changing demographic pattern

- Improve community awareness and mobilization activities

- No arrangements for transport of complicated cases

- Social mobilization activities

- Improving LHWs functionality

Supplies and Commodities

- Different donors provide different supplies and services

- Curfews during the conflict blocked supplies to the facilities

- Procurement decisions at the district level

- Procurement systems to simplified and made efficient

- Enough supplies were provided

- Insufficient supply for commonly used drugs

- Delay in supplies from government

- Strict monitoring

- Supplements sold in open market

- Allocation of budget for medicines not revised according to present needs

- Absence of diagnostic facilities

Monitoring and Reporting

- Before and after surveys sometimes conducted

- Poor quality of data

- Promote E-Health

- Internal monitoring was done

- No record of training or equipment distribution

- Improve quality of data

- Third party monitoring on monthly basis for Polio

- Preference of manual work over computer use

- Do situational analysis before implementation

- DHIS system for reporting

- Data not used for decision making

- Data to be used for decision

Finances

- Funding is done by donors and the government

- Delay in release of funds from the donors

- To ensure sustainability of funding for existing programs

Cluster meetings

- Seminars held for coordination

- Not regularly held for most programs

- Regular cluster meetings for all issues

- Regular meetings held for Polio at district and provincial level

- Improve communication between center and district

Natural Disaster

- Disaster management authority present at provincial level

 

- Improve the functionality

- Nutrition plan for emergency situations present

Epidemics

- Disease Surveillance and Response Unit in FATA

 

- Proper forecasting and pre-emptive measures

  1. LHW, Lady Health Workers, SOPs Standard Operating Procedure, MnE Monitoring and Evaluation, DHIS District Health Information System