title: Countdown to 2015: a case study of maternal and child health service delivery challenges in five districts of Punjab.
abstract: OBJECTIVE
  To identify the challenges confronting the Pakistan province of Punjab in delivering maternal and child health services at the district level.
  
  
  METHODS
  The qualitative assessment was done from May 15 to June 15, 2010, comprising 5 focus group discussions, 5 in-depth interviews with district managers, 49 in-depth interviews with providers, and direct observation of 19 facilities providing comprehensive emergency obstetric care in the districts of Multan, Muzaffargarh, Bahawalpur, Khanewal and Jhelum. Using skilled birth attendance coverage as an indicator, Punjab districts were stratified into three socio-economic strata, and from these the five-districts were selected.
  
  
  RESULTS
  Distribution of basic emergency obstetric care facilities by population size was found to be inadequate in all districts. Quality of care was compromised by lack of staff and equipment. No anaesthetist was available in majority of the district hospitals and tehsil facilities. Half of the teshil headquarter hospitals were devoid of staff nurses. Vital medicines used in obstetric care were not available. Partograph was not being used in any of the tehsil-level facilities. Chlorine solution was not present in any of the facilities. Governance issues included multiplicity of command channels, delays in receipt of medicines and political interference.
  
  
  CONCLUSIONS
  If the province has to achieve the related Millennium Development Goals (MDGs), related to maternal and child health, the existing facilities are not adequate. To achieve progress, proven and innovative approaches will have to be put in place that may influence the continuum of care from the household to the health facility.
authors.affiliation: Population Council, House 7, Street 62, F-6/3 Islamabad. amir@popcouncil.org
authors.forename: Ali Mohammad
authors.initials: AM
authors.lastname: Mir
authors.forename: Sadaf
authors.initials: S
authors.lastname: Gull
mesh_terms: D002648:Child; D002662:Child Health Services / Q000592:standards*; D002675:Child, Preschool; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007407:Interviews as Topic; D008297:Male; D008427:Maternal Health Services / Q000592:standards*; D009774:Obstetrics / Q000592:standards*; D010154:Pakistan; D011247:Pregnancy; D011787:Quality of Health Care