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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

 FacilitatorsBarriersRecommendations
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