An assessment of facility readiness for comprehensive abortion care in 12 districts of Pakistan using the WHO Service Availability and Readiness Assessment tool
Although Pakistan’s Essential Package of Health Services was recently updated to include therapeutic and post-abortion care, little is known about current health facility readiness for these services. This study assessed the availability of comprehensive abortion care, and readiness of health facili...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2023-12-01
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| Series: | Sexual and Reproductive Health Matters |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/26410397.2023.2178265 |
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| author | Palitha Gunarathna Mahipala Sabeen Afzal Qudsia Uzma Atiya Aabroo Nilmini Hemachandra Katy Footman Heidi Bart Johnston Bela Ganatra Tahira Ezra Reza Ahsan Maqbool Ahmad Hasan Bin Hamza Maida Umar Kauser Hanif Sayema Awais Mariyam Sarfraz Ellen Thom |
| author_facet | Palitha Gunarathna Mahipala Sabeen Afzal Qudsia Uzma Atiya Aabroo Nilmini Hemachandra Katy Footman Heidi Bart Johnston Bela Ganatra Tahira Ezra Reza Ahsan Maqbool Ahmad Hasan Bin Hamza Maida Umar Kauser Hanif Sayema Awais Mariyam Sarfraz Ellen Thom |
| author_sort | Palitha Gunarathna Mahipala |
| collection | DOAJ |
| description | Although Pakistan’s Essential Package of Health Services was recently updated to include therapeutic and post-abortion care, little is known about current health facility readiness for these services. This study assessed the availability of comprehensive abortion care, and readiness of health facilities to deliver these services, within the public sector in 12 districts of Pakistan. A facility inventory was completed in 2020–2021 using the WHO Service Availability and Readiness Assessment, with a newly developed abortion module. A composite readiness indicator was developed based on national clinical guidelines and previous studies. Just 8.4% of facilities reported offering therapeutic abortion, while 14.3% offered post-abortion care. Misoprostol (75.2%) was the most common method provided by facilities that offer therapeutic abortion, followed by vacuum aspiration (60.7%) and dilatation and curettage (D&C) (59%). Few facilities had all the readiness components required to deliver pharmacological or surgical therapeutic abortion, or post-abortion care (<1%), but readiness was higher in tertiary (22.2%) facilities. Readiness scores were lowest for “guidelines and personnel” (4.1%), and slightly higher for medicines and products (14.3–17.1%), equipment (16.3%) and laboratory services (7.4%). This assessment highlights the potential to increase the availability of comprehensive abortion care in Pakistan, particularly in primary care and in rural areas, to improve the readiness of health facilities to deliver these services, and to phase out non-recommended methods of abortion (D&C). The study also demonstrates the feasibility and utility of adding an abortion module to routine health facility assessments, which can inform efforts to strengthen sexual and reproductive health and rights. |
| format | Article |
| id | doaj-art-7b3f5ffc17b044bcb240afe383db7abe |
| institution | Kabale University |
| issn | 2641-0397 |
| language | English |
| publishDate | 2023-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Sexual and Reproductive Health Matters |
| spelling | doaj-art-7b3f5ffc17b044bcb240afe383db7abe2025-08-20T03:31:46ZengTaylor & Francis GroupSexual and Reproductive Health Matters2641-03972023-12-0131110.1080/26410397.2023.2178265An assessment of facility readiness for comprehensive abortion care in 12 districts of Pakistan using the WHO Service Availability and Readiness Assessment toolPalitha Gunarathna Mahipala0Sabeen Afzal1Qudsia Uzma2Atiya Aabroo3Nilmini Hemachandra4Katy Footman5Heidi Bart Johnston6Bela Ganatra7Tahira Ezra Reza8Ahsan Maqbool Ahmad9Hasan Bin Hamza10Maida Umar11Kauser Hanif12Sayema Awais13Mariyam Sarfraz14Ellen Thom15WHO Representative & Head of Mission, World Health Organization Country Office, Islamabad, PakistanDeputy Director Programs, Ministry of National Health Services, Regulation and Coordination, Islamabad, PakistanTechnical Officer RMNCAH, World Health Organization Country Office, Islamabad, Pakistan. Correspondence:Deputy Director Programs, Ministry of National Health Services, Regulation and Coordination, Islamabad, PakistanTechnical Officer RMNCAH, World Health Organization Country Office for Myanmar, Yangon, MyanmarConsultant, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, SwitzerlandTechnical Officer, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, SwitzerlandUnit Head, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, SwitzerlandDirector, Centre for Global Public Health-Pakistan, collaborative centre for Institute of Global Public Health, University of Manitoba, Islamabad, Pakistan; Technical Advisor, Health Services Academy, Islamabad, PakistanSenior Technical Advisor, Ministry of National Health Services, Regulation and Coordination, Islamabad, Pakistan; Senior Technical Advisor, Centre for Global Public Health-Pakistan, collaborative centre for Institute of Global Public Health, University of Manitoba, Islamabad, Pakistan; Technical Advisor, Health Services Academy, Islamabad, PakistanSRHR Advisor, Ministry of National Health Services, Regulation and Coordination, Islamabad, PakistanStatistician/ Data analyst, Health Services Academy, Islamabad, PakistanMNCH Specialist, Centre for Global Public Health-Pakistan, collaborative centre for Institute of Global Public Health, University of Manitoba, Islamabad, Pakistan; MNCH Specialist, Health Services Academy, Islamabad, PakistanSRHR Coordinator, Ministry of National Health Services, Regulation and Coordination, Islamabad, PakistanAssociate Professor, Health Services Academy, Islamabad, PakistanTeam Lead for Healthier Population Cluster, World Health Organization, Islamabad, PakistanAlthough Pakistan’s Essential Package of Health Services was recently updated to include therapeutic and post-abortion care, little is known about current health facility readiness for these services. This study assessed the availability of comprehensive abortion care, and readiness of health facilities to deliver these services, within the public sector in 12 districts of Pakistan. A facility inventory was completed in 2020–2021 using the WHO Service Availability and Readiness Assessment, with a newly developed abortion module. A composite readiness indicator was developed based on national clinical guidelines and previous studies. Just 8.4% of facilities reported offering therapeutic abortion, while 14.3% offered post-abortion care. Misoprostol (75.2%) was the most common method provided by facilities that offer therapeutic abortion, followed by vacuum aspiration (60.7%) and dilatation and curettage (D&C) (59%). Few facilities had all the readiness components required to deliver pharmacological or surgical therapeutic abortion, or post-abortion care (<1%), but readiness was higher in tertiary (22.2%) facilities. Readiness scores were lowest for “guidelines and personnel” (4.1%), and slightly higher for medicines and products (14.3–17.1%), equipment (16.3%) and laboratory services (7.4%). This assessment highlights the potential to increase the availability of comprehensive abortion care in Pakistan, particularly in primary care and in rural areas, to improve the readiness of health facilities to deliver these services, and to phase out non-recommended methods of abortion (D&C). The study also demonstrates the feasibility and utility of adding an abortion module to routine health facility assessments, which can inform efforts to strengthen sexual and reproductive health and rights.https://www.tandfonline.com/doi/10.1080/26410397.2023.2178265abortionpost-abortion carehealth facility assessmentservice readinessservice availabilityPakistan |
| spellingShingle | Palitha Gunarathna Mahipala Sabeen Afzal Qudsia Uzma Atiya Aabroo Nilmini Hemachandra Katy Footman Heidi Bart Johnston Bela Ganatra Tahira Ezra Reza Ahsan Maqbool Ahmad Hasan Bin Hamza Maida Umar Kauser Hanif Sayema Awais Mariyam Sarfraz Ellen Thom An assessment of facility readiness for comprehensive abortion care in 12 districts of Pakistan using the WHO Service Availability and Readiness Assessment tool Sexual and Reproductive Health Matters abortion post-abortion care health facility assessment service readiness service availability Pakistan |
| title | An assessment of facility readiness for comprehensive abortion care in 12 districts of Pakistan using the WHO Service Availability and Readiness Assessment tool |
| title_full | An assessment of facility readiness for comprehensive abortion care in 12 districts of Pakistan using the WHO Service Availability and Readiness Assessment tool |
| title_fullStr | An assessment of facility readiness for comprehensive abortion care in 12 districts of Pakistan using the WHO Service Availability and Readiness Assessment tool |
| title_full_unstemmed | An assessment of facility readiness for comprehensive abortion care in 12 districts of Pakistan using the WHO Service Availability and Readiness Assessment tool |
| title_short | An assessment of facility readiness for comprehensive abortion care in 12 districts of Pakistan using the WHO Service Availability and Readiness Assessment tool |
| title_sort | assessment of facility readiness for comprehensive abortion care in 12 districts of pakistan using the who service availability and readiness assessment tool |
| topic | abortion post-abortion care health facility assessment service readiness service availability Pakistan |
| url | https://www.tandfonline.com/doi/10.1080/26410397.2023.2178265 |
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