Hospital and health administrator level barriers and priorities for National Neonatal Hearing Screening in Pakistan: A thematic analysis

OBJECTIVES: To investigate the Barriers and Priorities accorded by hospital and health administrators to neo-natal hearing screening. METHODS: This qualitative exploratory descriptive study employing purposive sampling technique was conducted in Islamabad, over a period of 18 months from 1st August 2015 to 31st January 2017. Sample included the stakeholders i.e., Heads of public sector hospitals of Islamabad including Pakistan Institute of Medical Sciences, Capital Hospital, and Federal Government Services Hospital, Islamabad. Study included in depth interviews using a self-structured interview guide and audio recording. Recorded data was transcribed followed by thematic analyses which was manually drawn and verified. RESULTS: The Outcomes from thematic analysis were drawn as Planning, Essential requirements for NNHS, High risk screening, education, Existence of skilled maternal & newborn health workers. Hearing screening equipment//facility instrumentation, Logistic support, Health ministry support and Financial cover are also significant outcomes. Lack of awareness in the public and professionals regarding the importance of early identification of HI, poor health infrastructure, burden on tertiary care and lack of referral top the list of barriers to initiation of NNHS program at hospital administrative level. CONCLUSION: The Barriers to NNHS identified at Hospital and Health care administrator level include lack of awareness, poor health infrastructure, burden on tertiary care and lack of referrals. Inherent barriers to NNHS cover the spectrum of lack of liaison/ linkages between obstetrics and other departments, deliveries at homes especially in rural areas, poor follow-up, scarcity of technical and adequately trained manpower. Intangible barriers to NNHS comprise lack of health care information system, attitudinal barriers, inadequate fiscal resources, and lack of integrated approach at intra departmental levels.