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RAF Themes
RAF has five overall themes for research and advocacy. These priority themes are reviewed periodically in consultation with relevant stakeholders.
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The intention of the GoP MNCH Programme is to “ensure that maternal and child health interventions are equitably distributed and readily accessible” and one of its five implementation strategies is to increase demand for health services. Social, economic and cultural inequities, along with physical and geographical barriers, contribute to the low uptake of primary health care in Pakistan. More equitable access to maternal health services - in particular, access to skilled birth attendants, family planning and EmONC services - will result in improved health and contribute to the MDG targets in maternal and child mortality. Research and/or advocacy proposals focussed on stimulating demand for and improving access to MNH services might address, for example:
- Demand-creation strategies to address inequitable access.
- Financial barriers to access.
- Socio-cultural barriers to accessing health services e.g. gender relations, social exclusion and related factors.
- Physical/geographical barriers to access.
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The further extension and consolidation of health services and infrastructure in Pakistan must be accompanied by a continuous improvement in the quality of those services and systems. This is in line with the GoP MNCH Programme strategies to strengthen the technical and management capacity of district services, to streamline the provision of EmONC services, and to introduce a cadre of community-based skilled birth attendants. The improved quality of MNH service provision -especially EmONC and family planning - should contribute to a significant reduction in maternal and newborn mortality/morbidity rates. Areas for research and advocacy with potential for policy reform and practice change include:
- Management of health service provision e.g. leadership development, workforce recruitment, deployment, training and retention.
- Bringing services such as skilled birth attendants and contraceptive services closer to the community.
- Motivation of health service providers e.g. attitudes and incentives, to engage with diverse groups.
- Understanding of “quality services” for different groups of poor women and girls.
- Role of the private sector in MNH service provision.
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Inadequate planning and coordination in the sector e.g. between public, private and civil society organisations, undermines the effective delivery of quality MNH services to the poor and vulnerable. One of the GoP MNCH Programme strategies, therefore, is specifically focussed on integrating at district level all services related with MNCH. Increased coordination between relevant agencies and greater accountability to those who use the services should contribute to improved MNH services. Possible areas for research and advocacy in this regard are:
- The influence of the legislative framework, governance and regulation on service delivery and practice in the sector.
- The role and effectiveness of interdisciplinary, inter-ministerial or cross-sectoral partnerships in improving service delivery.
- The role of monitoring and evaluation systems e.g. health information systems and health outcome measurements, in driving health service improvements.
- The role of planning and distribution of resources e.g. workforce planning at national, regional and district levels.
- The role of local communities in the planning and monitoring of MNH services and the accountability of these services to poor rural women and children.
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RAF’s purpose is to influence and improve MNH policy and practice through its support for quality research and/or effective advocacy. However, there is considerable scope for learning in the public sector and civil society in Pakistan as to how policy-related research and effective advocacy can contribute positively to policy reform and practice change. This could be a fruitful area for research:
- Role and effectiveness of research dissemination and advocacy as a means of translating or harnessing knowledge to effect policy change.
- Barriers to the translation of research evidence into policy and practice.
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Innovative approaches and practices will be necessary to improve the quality and delivery of MNH services. RAF encourages research and/or advocacy proposals that seek to contribute to innovation in MNH services. Potentially interesting areas to explore might include, for example:
- Piloted innovation in MNH services with potential for scaling-up.
- Sustaining and developing MNH services in hard-to-reach and conflict-affected areas.
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