Healthcare Workers' Perspectives on Barriers to Maternal, Newborn, and Child Health (MNCH) Services in Pakistan: A Narrative Review
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Background: Pakistan continues to experience substantial maternal, neonatal, and child-health challenges despite longstanding investment in community- and facility-based MNCH programmes. Although barriers encountered by women and families have been widely examined, the experiences of healthcare workers responsible for delivering these services remain dispersed across programmes, professional cadres, and geographical settings. Objective: To synthesise healthcare workers' perspectives on barriers to MNCH service delivery in Pakistan and examine how these barriers operate across community, facility, and programme-management levels. Methods: A narrative review informed by structured literature-identification and thematic-synthesis principles was conducted using literature published between 2010 and 2025. PubMed/MEDLINE, PubMed Central, Google Scholar, relevant institutional and technical sources, and reference-list searching were used to identify eligible qualitative, mixed-methods, programme-related, and contextual evidence. Sixteen sources contributed to the workforce-centred synthesis. Provider-derived findings were distinguished from community-only evidence and synthesised using an inductive thematic approach. Results: Six interconnected themes emerged: health-system and infrastructural constraints; human-resource shortages and workload; training, skills, and supervision gaps; managerial, governance, and financing limitations; sociocultural and community-interface challenges; and additional barriers affecting underserved, remote, displaced, and refugee populations. Barriers operated across levels of the health system, with frontline workers frequently dependent on facility functionality, supply chains, referral systems, supervision, and managerial capacity beyond their direct control. Conclusion: Strengthening MNCH delivery in Pakistan requires coordinated improvement of workforce capacity, facility functionality, supplies and referrals, training and supervision, managerial support, and community engagement rather than isolated demand- or workforce-focused interventions.
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