Barriers to implementation of emergency obstetric and neonatal care in rural Pakistan

Autoři: Sajid Haider aff001;  Rana Farhan Ali aff002;  Munir Ahmed aff001;  Asad Afzal Humayon aff001;  Muhammad Sajjad aff001;  Jamil Ahmad aff001
Působiště autorů: Department of Management Sciences, COMSATS University Islamabad, Vehari, Pakistan aff001;  Health and Nutrition Supervisor, Chishtian, District Health Office, Bahawalnagar, Pakistan aff002
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224161



Recognizing the need for improving maternal and newborn care, the Punjab public health department (Pakistan) launched emergency obstetric neonatal care (EmONC) services under WHO guideline. Unfortunately, the program implementation is facing some serious problems. The purpose of this study was to identify barriers to implementation of EmONC in district Bahawalnagar (Pakistan).


This study used sequential exploratory design. Specifically, a qualitative study was conducted to identify barriers to EmONC. Subsequently, the relative importance of these barriers was determined in a quantitative study. Participants were health service providers involved in 24-hours basic EmONC services in the basic health units of district Bahawalnagar (Pakistan). Qualitative data were gathered by interviewing the participants using key informant guide. Quantitative data were collected in a rank order survey of the same participants. The methodological quality was assessed using mixed methods appraisal tool (MMAT) version 2011.


The results indicate that lack of teamwork, conflict management, communication, and improper power distribution are important interpersonal barriers. The significant organizational-level barriers include job insecurity, lack of organizational culture, human resource deployment issues, and lack of role clarity. Lack of target management, lack of resource availability, house job requirement, and dual practice issues were identified as major system-level barriers.


Barriers to EmONC implementation must be addressed for improving maternal and neonatal care in district Bahawalnagar.

Klíčová slova:

Death rates – Employment – Jobs – Labor and delivery – Neonatal care – Pakistan – Public and occupational health – Social communication


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2019 Číslo 11