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Exploring knowledge translation practices in a global health program: case study on the establishment of the Pakistan National Maternal, Neonatal, and Child Health Program

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Abstract

Aim

To describe the major knowledge translation processes, decisions, and organizations involved in the landmark decision to institute a national, federal program in one of the most populous countries of the world. The Maternal, Newborn and Child Health (MNCH) program was a vertical program that was established in 2006 in Pakistan.

Subject and method

Using the case study methodology, we conducted a peer and grey literature review, with key informant in-depth interviews for meeting the study objectives. We used Wilson et al’s Knowledge to Action (K2A) Framework to explore the knowledge translation processes, the major decisions, and the national and international organizations involved during the 7-year period preceding the decision. The time period was selected based on the change in government in late 1998, which continued till the establishment of the national program.

Results

Using the framework, we categorized knowledge translation practices and major decisions into phases of research, translation, and institutionalization. We were able to identify 20 organizations that had played a part in the institution of the program, of which six national and international were considered significant towards effecting decisions. While organizations such as the World Bank and Pakistan Ministry of Health played important roles, we highlight the pivotal role of the Health Secretary’s office, as an unusual ‘knowledge broker’ situated within the Government.

Conclusion

While effective program planning in low middle-income countries can greatly benefit from knowledge translation practices, explaining processes from evidence generation to the final step of key decisions is valuable in understanding the complexities involved in such settings. The study begins to fill a critical gap in literature in illustrating real-world program planning in resource-constrained countries, lagging in maternal and child health indicators.

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Abbreviations

ADB:

Asian Development Bank

AusAid:

Australian Department for International Aid

CMW:

Community Midwife

DFID:

Department for International Development, UK

ESP:

Economic Survey of Pakistan

JICA:

Japanese International Cooperation Agency

K2A:

Knowledge to Action

KT:

knowledge translation

MCH:

Maternal and Child Health

MICS:

Multiple Indicator Cluster Survey

MMR:

Maternal Mortality Ratio

MNCH:

Maternal, Neonatal and Child Health

MOH:

Ministry of Health

NCMNH:

National Commission for Maternal, Neonatal and Child Health NGO

NGO:

Non-government organization

NNS:

National Nutrition Survey

NSF:

National MNCH Strategic Framework

P&D:

Ministry of Planning and Development

PC-1:

Planning Commission Document/Proforma-One

PDHS:

Pakistan Demographic Health Survey

PIHS:

Pakistan Integrated Household Survey

PLSMS:

Pakistan Living Standard Measurement Survey

SBA:

Skilled Birth Attendant/Attendance

TAMA:

Technical Agency for Management Assistance

UNFPA:

United Nations Population Fund

USAID:

United States Aid for International Development

WB:

The World Bank

WHO:

World Health Organization

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Acknowledgements

We wish to acknowledge support and assistance of Mr. Arsalan Bashir and Mr. Muhammad Imran, both Research Associates at the Subh-e-Nau: and Environment and Public Health Concern Pakistan, in the literature review, ethical review, setting up the interviews and their transcription. We also thank Janna MacLachlan, MSc OT, Dalla Lana School of Public Health, University of Toronto, for reviewing the transcript and providing critical feedback. Finally, we especially thank the study participants for their valuable time, input and cooperation throughout the course of the study. This study would not have been possible without the support and able guidance of Dr Boika Rechel and Dr Sue Lawrence, both research supervisors at the London School of Hygiene and Tropical Medicine, University of London UK. 

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Authors and Affiliations

  1. Rehabilitation Sciences Institute, University of Toronto, 851-500 University Ave, Toronto, ON, M5G 1V7, Canada

    Jawad Chishtie

  2. Science and Data Lead, SERVIR-Mekong, Asian Disaster Preparedness Center, Bangkok, Thailand

    Farrukh Chishtie

  3. Department of Physical Therapy, University of Toronto, Toronto, ON, Canada

    Susan Jaglal

Authors
  1. Jawad Chishtie
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  2. Farrukh Chishtie
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  3. Susan Jaglal
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Corresponding author

Correspondence to Jawad Chishtie.

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Ethical statement

The study was not funded, and the authors received no compensation for any related activity. The study was undertaken as part of the requirement of the first author’s MSc Public Health degree at the London School of Hygiene and Tropical Medicine. Informed consent was obtained from all individual participants included in the study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

The study protocol was approved by both international and national ethical review boards that included the London School of Hygiene and Tropical Medicine’s Ethical Review Board (LSHTM MSc Ethics Ref: 7462) and the National Bioethics Committee, Pakistan Medical Research Council. There were no risks or benefits to the participants. We took special care to maintain anonymity and confidentiality. Transcripts were anonymized by assigning an alias, while we do not refer to individual respondents or their organizations in presenting our findings.

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The authors have no conflicts of interest to declare.

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Chishtie, J., Chishtie, F. & Jaglal, S. Exploring knowledge translation practices in a global health program: case study on the establishment of the Pakistan National Maternal, Neonatal, and Child Health Program. J Public Health (Berl.) 29, 215–228 (2021). https://doi.org/10.1007/s10389-019-01115-y

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