By Fenton Whelan & Will Anderson
On 20 March 2018
How granular data helped improve skilled birth attendance in Punjab, Pakistan
Leveraging existing monitoring systems to rapidly collect useful data for governments.

Risks of childbirth

Childbirth is inherently a risky moment. A complication that can lead to the death of the child or mother develops in around 15% of deliveries. These complications are well understood, and there are clear treatment protocols. In a good hospital, the risk of maternal death is close to zero. But at home in a village, far from the nearest road, the chances of obtaining care in time to ensure the survival of both mother and child are severely compromised.




Data systems need to record to right data

Prior to 2014, Punjab lacked the data to identify shortcomings in the system. The government knew, for instance, that people in rural areas were less likely to be able to access healthcare, but they did not know exactly which people and in which areas. For the Government to rapidly and improve skilled birth attendance (SBA) coverage, they required a system capable of delivering detailed information on coverage across Punjab.

In 2014, vaccinators in Punjab were already using a mobile reporting system which captured their location every time they vaccinate a child. Rather than creating an entirely new system, Punjab was able to leverage the power of the vaccinator app to collect useful information for SBA coverage purposes. A simple adjustment to the app meant vaccinators began collecting an additional data point; whilst performing routine vaccinations, the vaccinator would ask the mother whether or not the child was born in the presence of a skilled birth attendant. This data was recorded along with the location data.

Data systems need to present the data in meaningful ways

This information provided the Government with an up to date picture of SBA coverage across Punjab. In turn, this helped officials to make better decisions. For example, officials use the information to determine the most beneficial location to:

  • Build new health facilities which are ready and able to safely deliver babies

  • Operate existing health facilities which are ready and able to safely deliver babies 24/7

  • Station dedicated maternal and child health ambulances   




Using this data system to make better decisions contributed to the rapid improvements in SBA coverage across Punjab, especially in rural and remote communities. Now in 2018, 360,000 additional children are being born each year with medical care in the first moments of life. Rapid improvements in Punjab’s health system have convinced many that the system needs to aim even higher and in early 2018 work began to further increase SBA coverage across Punjab.


About the Authors

Fenton Whelan founded Acasus, he has more than a decade of experience in public health and education development. Fenton leads the Acasus support in Pakistan. Will Anderson is the lead researcher for public-sector projects at Acasus. 

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