Evidence Based Intervention to Improve Social Policy for Maternal and Child Health Using a Pre-Post Test Design

Some of the challenges Pakistan faces in priority areas of national relevance include absence of social policy to improve innovative governance and reform of the primary healthcare system, especially for maternal and child health. One integral tool for development of social policy in a country is the integration of the social work profession at primary level. Developed countries have progressed by strengthening the primary workforce with social workers, who have contributed by developing a social policy protection floor for mother and child in primary level communities through: (i) assessment of community needs (e.g. for housing, health, education, and employment), (ii) robust data collection, (iii) political advocacy, and (iv) supporting literacy and counseling . In this way, there is potential to fill a gap by adding Social Workers to the primary health force team in Pakistan to investigate the following research questions:

1. Can a robust, objective, third-party Community Needs Assessment Report (by Social Workers) help to mobilize governments and policy-makers for improve planning and protective policies for disadvantaged communities?
2. Can a more comprehensive health electronic database be developed with both health and social variables to better plan policy development and develop a much-needed regional Index for Maternal Health and Wellbeing?
3. Can maternal and health outcomes be impacted positively by the following intervention this project plans to deliver: (i) Reproductive and Child Health; (ii) Hygiene and Sanitation & Nutrition and Immunity Building; (iii) Health-Risk Behavior Modification; and (iv) Psychosocial Needs Assessment and Mental Health Awareness?
4. Can primary healthcare services become more efficient and effective (in teamwork and improved care plans for client) through interprofessional health workforce collaboration and supplementation of social workers to the team? The proposed project, lasting 24 months, will aid socio-economic development of the country by improving primary healthcare services, improving maternal and child health outcomes, improving preventive behavior overall in families, and strengthening the health workforce team. Improving preventive health also reduces national health costs in the long-run at an estimated USD 45 billion. Building an electronic database with both health and social indicators is integral for the planning of a more effective social and health policy in the future. Integrating social workers at primary level will create thousands of jobs per year for Pakistan and help develop the educations sector as well and provide opportunities for more health workforce development, like public health officers.

The activities that will be undertaken to achieve the project goals include:

1. Development of a digital app and finalization of an Index for Maternal Health and Wellbeing
2. Preparation of a Community Assessment Needs Report for mobilization of social protection floor
3. A Pre-Post Test Survey to measure changes caused by intervention for: (i) Basic Clinical Health Indicators, (ii) Reproductive and Child Health, (iii) Hygiene and Sanitation & Nutrition and Immunity Building, (iv) Health-Risk Behavior Modification; and (v) Psychosocial Assessment and Therapy needs.
4. Dissemination of findings to government bodies, policy-makers, scholars, and researchers to mobilize social policy support and improved governance at primary level through the project pilot model.

An interdisciplinary team of social policy analyst, economist, physician, comprise the main investigators who have developed the proposal and will oversee the study.

They will be supported by a clinical psychologist, biostatistician, and a social statistician for assistance in technical psychosocial assessment and advance data analysis for Pre-Post Test design. Officers from Forman Christian College University will support the project in areas of senior consultancy, IT support and digital app development, and budgeting and audit. Senior consultancy and support for recruitment and training for social workers as data collectors and intervention facilitators will be provided by the University of the Punjab.

The sectoral collaborators and technical consultations, including gaining necessary permissions for data collection in primary settings, will be provided by The Primary & Secondary Healthcare Department, Punjab, Office of the Director General Health Services, Policy & strategic Planning unit (PSPU), development partners (UNICEF, WHO, BMGF), Academia (KEMU) and planning & development department Punjab.