Improving maternal and child health in Pakistan: a programme evaluation using a difference in difference analysis

Muhammad Ashar, Lara Riedige Rohm, Pieter van Baal, Eddy van Doorslaer van Doorslaer

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)
27 Downloads (Pure)


INTRODUCTION: Pakistan is a country with high maternal and infant mortality. Several large foreign funded projects were targeted at improving maternal, neonatal and child health. The Norway-Pakistan Partnership Initiative (NPPI) was one of these projects. This study aims to evaluate whether NPPI was successful in improving access and use of skilled maternal healthcare.

METHODS: We used data from three rounds (2009-2010, 2011-2012 and 2013-2014) of the Pakistan Social and Living Standards Measurement Survey (PSLM). A difference-in-difference regression framework was used to estimate the effectiveness of NPPI and its different programme components with respect to maternal healthcare seeking behaviour of pregnant women. Various parts of the PSLM were combined to examine the healthcare seeking behaviour response of pregnant women to exposure to NPPI.

RESULTS: Trends in maternal care seeking behaviour of pregnant women were similar in districts exposed to NPPI and control districts. Consequently, only a weak and insignificant impact of NPPI on maternal care seeking behaviour was found. However, women in districts which used vouchers or which implemented contracting were more likely to seek skilled assistance with their delivery.

CONCLUSION: We conclude that the objective to improve access to and use of skilled care was not achieved by NPPI. The small effects identified for vouchers and contracts on skilled birth attendance hold some promise for further experimentation.

Original languageEnglish
Article numbere006453
JournalBMJ Global Health
Issue number12
Publication statusPublished - 30 Dec 2021

Bibliographical note

Funding Information:
Acknowledgements We are grateful to the staff of UNICEF, Sindh provincial office for their support and would like to thank Ellen Van de Poel for her contribution in the early stage of this research. Thank are also due to Rabia Awan, Director of the Pakistan Bureau of Statistics for providing access to the Pakistan Social and Living Standard Measurement Survey (PSLMS) and the Household Integrated Economics Survey (HIES) data sets as well as valuable insight into sampling methodology and coding scheme of these surveys. Contributors MAM and EvDvD developed the hypothesis. PvB and EvDvD helped in carrying out the analysis and data cleaning. LRR was involved in data cleaning and analysis. All authors contributed to the manuscript. MAM is guarantor of this research. Funding MAM is funded by Aga Khan University, Karachi through Faculty Development Award 2015. Map disclaimer The inclusion of any map (including the depiction of any boundaries therein), or of any geographic or locational reference, does not imply the expression of any opinion whatsoever on the part of BMJ concerning the legal status of any country, territory, jurisdiction or area or of its authorities. Any such expression remains solely that of the relevant source and is not endorsed by BMJ. Maps are provided without any warranty of any kind, either express or implied.

Publisher Copyright:


Dive into the research topics of 'Improving maternal and child health in Pakistan: a programme evaluation using a difference in difference analysis'. Together they form a unique fingerprint.

Cite this