Background: High maternal and neonatal mortality in Pakistan, especially in the geographically challenging and underserved region of Gilgit-Baltistan, underscores the urgent need to strengthen Basic and Comprehensive Emergency Obstetric and Newborn Care (BEmONC and CEmONC) services. With limited progress toward SDGs 3.1 and 3.2, this study aims to assess the health system issues that lead to poor maternal and neonatal health outcomes. Methods: This mixed-methods study evaluated the maternal and neonatal healthcare services across six high-mortality districts in Baltistan and Diamer, Northern Pakistan. Using the Health Facility Assessment tools, we evaluated infrastructure, delivery volume, signal functions, and workforce capacity. Geospatial analysis examined facility accessibility, while surveys captured provider confidence in managing emergencies and patient satisfaction via exit interviews. Focus groups with healthcare providers and pregnant women provided valuable insights into community experiences. Results: Out of 60 assessed healthcare facilities, only 25 (41.7%) were found to be functional. They included four high-volume CEmONC sites and 21 low-volume BEmONC centers. Only one facility met all nine signal functions. NICUs were available in just two facilities, while only four facilities had operating rooms. Staff were critically inadequate, and the existing staff lacked confidence in managing obstetric complications. Patient satisfaction was mixed, with concerns over delays, hygiene, and staff shortages. Although 76.2% of BEmONC facilities were within two hours of a CEmONC facility, access to advanced care remains limited. Focus groups revealed barriers to access and community-led potential solutions. Conclusion: The study identifies critical gaps in maternal and neonatal health services across Baltistan and Diamer, revealing significant disparities in facility functionality, human resources, and service availability. An evidence-based package with a health system approach is vital to ensure adequate resource allocation and improved maternal and neonatal outcomes.
Ariff et al. (Wed,) studied this question.