How program science can improve maternal and child health in Pakistan
Pakistan has made much progress in recent years to improve the health of its population. But improving maternal and child health continues to lag behind the country’s stated goals.
The reasons are many, says Marissa Becker, MD, FRCPC. One challenge is a lack of local opportunities for clinicians and public health officials to learn research methods that could ultimately strengthen their programs. With support from a 2022 International Development, Aid and Collaboration (IDAC) grant, Dr. Becker and her team will teach an approach called “program science” to help these individuals first identify data and then use it to create meaningful improvements.
Program science is an iterative process
“Rather than trying to put research into practice, program science aims to get research out of practice and use research and knowledge generation to inform programs,” says Dr. Becker.
Put another way, in a program science scenario, the program itself reveals gaps in population-level outcomes or service delivery and generates research questions to address the gaps. Using an iterative approach, program science cycles knowledge and evidence back into a program to optimize it and improve population-level outcomes.
“Let’s imagine providers have a goal for 90 per cent institutional delivery [babies delivered in hospital], but they’ve achieved only 50 per cent,” says Dr. Becker. Using program science, they will leverage existing program data or generate new data to understand why the gap exists. “Is the gap uniform across the country? Is it experienced disproportionately by women with low socio-economic status?” By answering these questions, providers can learn what interventions or approaches are required to address gaps and inequities.
The University of Manitoba’s Institute for Global Public Health (IGPH) has worked in Pakistan for more than 15 years. It is leading a three-year initiative in partnership with Pakistan’s Health Services Academy and Centre for Global Public Health to introduce a program science approach to improve maternal and child health in the country. Dr. Becker, who has considerable experience using program science, is leading this effort. She is an associate professor of Community Health Sciences, Medical Microbiology and Infectious Diseases at the university, and director of technical collaborations at the IGPH. Dr. Becker is working with Maryanne Crockett, MD, FRCPC, a pediatrician, and Lisa Avery, MD, FRCSC, an obstetrician, to deliver the program in Pakistan.
Three-year training program
Funding from the Royal College’s IDAC program will enable workshops for 30 clinicians and public health officials.
- In year one, participants will learn the principles of program science, data analysis and knowledge translation. They will also study best practices in maternal and child health.
- In year two, small groups will identify a challenge in maternal and child health, and work with a mentor to implement a research project using a program science approach.
- Year three will focus on using data for decision-making and knowledge translation, with the goal of optimizing population-level outcomes.
Dr. Becker will judge the initiative’s success by the extent to which teams use data to make program changes. “We want to see throughout the training that people are using program science effectively, and we want people to champion the approach.”