Intervention to Improve Social Policy for Maternal and Child Health

The priority area of national relevance that the project falls under mainly is "Innovative Governance and Reforms", as the target is to improve healthcare governance at primary level and the attempt is to integrate social workers in primary communities, as an integral part of social policy development. Social workers will provide social protection services related to: (i) robust electronic data collection for index development and policy mapping, (ii) assessment of community needs for advocacy for policy development and holding the government to account, and (iii) pre-post test analysis for mediation in literacy, awareness and counseling for local capacity of vulnerable populations (mother and child in underdeveloped communities who are dependent on primary level services for health and social protection). In this way, the project will contribute to innovative solutions for primary health governance strengthening, improvement in preventive health and saving of national health costs in the future, and mobilization for policy reforms for community development. This study will be applied research using direct interventions and thus will contribute to use of open-access data and empirical evidence-based policy design.

In addition the project addresses three other national priority areas as work for social and health policy development is overlapping and cross-cutting, thus benefiting multiple sectors and sub-structures of national relevance. Firstly, the project will include development of an electronic health database through smartphone and digital app, and this will contribute to the priority area of national relevance under "Information Technology and Telecom". The proposed project will contribute to building a robust electronic database using technology, smartphone and 4G Wifi, which will improve Big Data, Index development for assessment and policy design, and scalable models for health and social protection.

Secondly, the project will also include building and integration of social work skills and profession by integrating them in the existing interdisciplinary primary healthcare team and thus contribute to priority area of national relevance under "Development Economics". To be noted is that the existing primary healthcare team (doctors, nurse, and LHW) are overburdened and inefficient. The proposed project will build a case for not just service efficiency in primary health, but add to labor market innovations and demand-side employment for Pakistan.

Lastly, the project through the community assessment of needs will contribute to recommendations for improvement in housing and sanitation, water and food security, waste disposal and sewerage system, transport services, schooling and education services, safety and security, and availability of loan, entrepreneurial and poverty schemes. Recommendations in the report will include suggestions for social protection schemes for improved wellbeing in communities and better planning of underdeveloped or badly managed cities, towns, and villages.

This proposed research is not just important for addressing priority area of national relevance, but also to meet the following five Sustainable Development Goals outlined for developing economies like Pakistan:

(I) SDG 3- Establish Good Health and Well-Being: The project proposes to strengthen primary level services and promote preventive health by delivering interventions 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. It must also be noted that interventions for mothers has direct benefits on self, child and family health and practices. This is timely especially in consideration to the multiple health crises Pakistan faces in communicable and non-communicable diseases and rising health costs.

(II) SDG 5- Enforce Gender Equality: The project proposes to provide efficient and equitable services to target improvement in maternal and child health. The project will directly intervene for improvement in basic clinical health indicators and health awareness and literacy (for Reproductive and Child Health, Hygiene and Sanitation \& Nutrition and Immunity Building , and Health-Risk Behavior Modification). It must be noted that newborn and child health is the responsibility of mother, and thus literacy and awareness in women directly children, especially girl children in areas of nutrition and education. It is also known to prevent regressive cultural practices like female feticide and child marriage.

This is timely especially in consideration that Pakistan is facing critical shortfalls in Millennium Development Goal targets for reducing maternal and child mortality.

(III) SDG 10- Reduce Inequality: One component of SDG 10 is reducing inequality between the genders. The study will focus on developing literacy and awareness for women of reproductive years as vulnerable populations. Women in underdeveloped areas that are dependent on primary healthcare services are from the population strata that face inequality issues related to illiteracy or semi-literacy, poverty and unemployment or informal sector employment. Targeting gender equality in health and social service protection for vulnerable populations is timely especially in consideration that the COVID-19 pandemic has directed policy and budget to infection control and health costs as opposed to gender equality.

(IV) SDG 11- Mobilize Sustainable Cities and Communities: The project proposes to provide develop a community needs assessment reports. The benefit of this report will be that it is prepared by the social workers and PIs of the study and as third parties they will provide an objective assessment for policy development and political advocacy. This is timely especially in consideration to the multiple challenges and policy pressures facing the government of Pakistan. Independent research universities must support the government in recommending policy implementation based on empirical evidence and pilot studies.

(V) SDG 17- Build Partnerships for the Goals: The project proposes to build interprofessional health workforce partnership by supplementing existing primary healthcare providers (doctor, nurse an LHW) with social workers (community social worker + health social worker). This will benefit interprofessional collaboration and teamwork for better patient management and development of care plans for patient safety and preventive health. It will also benefit collective policy advocacy to the center by a united primary health workforce. This is timely especially in consideration of the critical challenges facing the existing health workforce at primary level which is overworked, understaffed, inefficient, and unable to collaborate for optimal services and care plans or policy advocacy.

The proposed project is critical because there is very little funding and attention for developing social policy in partnership with health policy. In addition, there is neglect in consideration that research and budget must target preventive health. Currently the Sehat Sahulat Programme is covering mainly hospitalization and has not yet considered service improvement and strengthening of the primary health sector. The project will also aid socio-economic development of the country by improving primary healthcare services, improving maternal and child health outcomes, and 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 of an electronic database and an index for maternal health and wellbeing which includes social indicators can with the planning of 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.