Conflict in Balochistan hampering access to women and child health services: study

The conflict-hit parts of Balochistan have much lower coverage levels for maternal and child health services than peaceful parts of the province, according to a case study on healthcare in Pakistan’s violence-affected areas published in BioMed Central’s Conflict and Health journal.

Researchers at the Aga Khan University and the Centre for Global Child Health at The Hospital for Sick Children in Toronto, Canada, conducted the case study in two areas of Pakistan: Balochistan – with a specific focus on the Makran belt that includes the districts of Gwadar, Keich and Panjgur – and Fata due to the chronic nature of conflict in these areas. The study consisted of a qualitative and quantitative analysis of the provision of reproductive, maternal, newborn, child and adolescent health and nutrition services (RMNCAH&N) comparing coverage in districts facing minimal, moderate and severe levels of conflict.

Researchers found significantly lower levels of contraceptive use, facility delivery, exclusive breastfeeding, BCG vaccinations, and care seeking for acute respiratory infections in severe conflict districts of Balochistan when compared to minimal conflict districts. There was no significant difference in coverage levels between moderate and severe conflict areas. A similar quantitative assessment of coverage levels in Fata was not possible due to a lack of reliable quantitative data.

The study found that many primary care healthcare facilities in Fata and a few in the Makran division of Balochistan were not functional due to insecurity, unavailability of staff and damage to healthcare facilities. Researchers added that roadblocks and curfews in conflict-hit areas further exacerbated supply chain challenges and compromised healthcare by restricting the availability of essential medicines and commodities.

The study also found incidents of harassment, target killings, security threats and kidnappings of the health workforce, specifically polio workers, in conflict-hit areas. Stringent government regulations on NGOs working in Fata and Balochistan were also impeding efforts to expand access to healthcare.

Another major bottleneck in delivering health services was the unavailability of health professionals of all cadres, especially female health workers. On a positive note, the study pointed to the success of a health workforce strategy adopted in District Keich in Balochistan. This involved sending senior staff on rotations between the district centre and far-flung areas for a week in a month, thereby helping expand access to healthcare in remote areas.

“Pakistan must develop customised strategies to promote women and child health services in conflict-hit areas,” said AKU’s Dr Jai Das, the lead author of the case study.AKU researchers Zahra Ali Padhani, Sultana Jabeen, Arjumand Rizvi, Uzair Ansari, Malika Fatima, Ghulam Akbar, Wardah Ahmed and Zulfiqar A. Bhutta are co-authors of the paper.