It strives for being the MNCH information resource centre in Pakistan where all can have a facilitated access to different information on the subject of MNCH in Pakistan. The Knowledge Management function will inter alia also equip the Program Management with the information necessary for effectively and efficiently performing the management functions. The use of information for behavior change communication and advocacy also falls in the ambit of Knowledge Management cell. Through various methods of communication the relevant information will be processed and spread to intended audience. To this end a National MNCH Communication Strategy Framework has been developed. This is a guiding document endorsed by all key stakeholders in Pakistan developed with a purpose to provide guidance to those who are working on MNCH Communication in Pakistan. Following figure explains the Knowledge Management function of National MNCH Programme. 

Knowledge Management Flow Chart

Challenges to Strategic Communication for MNCH

Strategic Communication for MNCH faces the following challenges in Pakistan:

• There is a low level of awareness of the birth preparedness among women, families, and providers. Pregnancy is seen as a normal occurrence that does not require special preparations. The concept of birth preparedness is not well known in Pakistan, hence when there is an obstetric emergency; people do not know how to respond.
• Pregnancy and birth are typically seen as woman’s domain and men traditionally do not get involved in decisions involving pregnancy or birth. Household decisions, especially decisions involving finances, are made by men, and birth preparedness often requires financial and other resources. Most of the communication campaigns, however focus females who may have little decision making powers. It is therefore important to designs campaigns with husbands as primary audience along with mother in laws and other family members.
• Too much emphasis is laid on mass media without making an effort to know the right channels to reach the target audiences.
• There is a lack of credible large scale KAP studies on MNCH.
• Most communication activities lack the evidence base and are limited to developing posters, leaflets etc., instead of using research on health seeking behavior to design strategic communication activities.
• Communication campaigns are mostly based on the strategy briefs submitted by advertising agencies. These agencies themselves suffer from a lack of understanding of social and health issues and require capacity building efforts to improve their skills.
• Despite recent attention to MNCH, there is a need to bring in more players to support MNCH programs and policies through district, provincial and national advocacy campaigns.

Advocacy and Demand Creation

• The salient features of this strategy will be increasing community awareness for maternal and child care, women’s empowerment and their increasing involvement in the decision making process for seeking medical care, the activities will be incorporated into each of the above components.
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• Maternal, newborn and child health consists of a continuum of healthcare interventions, beginning before pregnancy and covering the prenatal, delivery and post-partum periods, and addressing the individual health of the women and children. The importance of correct knowledge, attitudes and behaviors at the household and community levels besides essential health services is therefore of immense importance.
• Studies have shown that women, families, and providers typically do not focus their attention on how to prepare and plan for the delivery of a baby, or for potential pregnancy and birth related health emergencies. In addition, few women, families or birth attendants are even aware of potential newborn complications such as birth asphyxia, respiratory problems, prematurity and cord infection. Awareness of prenatal and post-partum complications is equally low and often misunderstood among those audiences.
• The communication component of MNCH program address the above cited issues through evidence based interventions to improve knowledge and promote positive MNCH behaviors through BCC campaigns, it will mobilize communities for taking responsibility for MNCH by arranging for emergency transportation and having community saving schemes and it will have district, provincial and national level advocacy programs to improve MNCH facilities and to rope in more players for supporting MNCH policies and services.

Audience Analysis

Audience1: Communication Managers/officers
This strategy recognizes communication as a specialized discipline requiring specialists trained in the science and art of communication. MoH at present has very few people dealing with communication. Same is the case with provincial health departments. There is a need to increase the number of professional communication staff but more importantly, immediate attention has to be given to the capacity enhancement of the staff working at various communication assignments. Once trained and well versed in the objectives and strategies of the communication component of the program, they will be able to modify, develop and implement need based strategies for various levels.
Audience 2: Women in Reproductive Age
While women remain a primary audience for MNCH program, they are, by nature of the social context, secondary when it comes to making decisions about seeking care during an obstetric emergency. As a result, family, providers and community members must contribute to the decision making process. Leading MNCH programmers and researchers describe this paradigm shift as ‘shared responsibility’ for ensuring a safe delivery and a healthy baby, and that the woman herself is in a comprised position during and after delivery.
Audience 3: Husbands and Family Members
Shared responsibility for safe motherhood and child health is one hallmark of the paradigm change that has occurred over the past several years in the field of maternal and child health. Programs now stress the need for appropriate antenatal care, birth preparedness and complications readiness. Messages in these areas are directed to those people who can assist the mother and play a critical role in ensuring she gets the help she needs. Husbands and other family members, especially in-laws have been identified as two such audiences.
Audience 4 Community Leaders
Community leaders, including NGO, CBO and other locally designated leaders within each community, play a vital role in improving MNCH behaviors and practices in Pakistan. As respected bearers of advice, information and skills, community leaders by definition are role models for others. It is the goal of MNCH program through District Officers and collaborating NGOs to identify strong local leaders, to build lasting relationships with them, and empower them with the information, skills and resources they need to support MNCH.The program views these leaders as catalysts to improved maternal and newborn health outcomes in the country, and therefore will engage them through various activities and at multiple levels.
Audience 5: Ulema (Religious Leaders)
The traditional religious institutions of Mosques, and ulema have a strong influence in Pakistan. These institutions play an important role in the daily lives of a majority of people who refer to ulema and mosque for guidance on various issues including factors concerning their health and wellbeing. In far-flung and hard to reach areas, the mosque is sometimes the only medium of communication with the communities. Ulema and Mosques have played an appreciable role in the success of polio campaigns in Pakistan by supporting the immunization teams. The program will focus efforts to persuade ulema leadership on the need to highlight MNCH issues especially women’s right to health care during pregnancy and child bearing besides preaching the importance of having a birth preparedness plans through various initiatives at provincial and district levels.
Audience 6 Health Service Providers (LHW, LHV, WMO, MO, GP, Gynecologists)
All these health service providers have a consistent contact with the families. For the rural population, LHWs are the main source of health information and education while LHVs and Medical officers are the main service providers to families. The same roles are carried out by General Practitioners and Woman Medical Officers/ Gynecologists respectively in the urban areas. Communities are likely to go to these sources for verification of the information that reaches them through any media. Taking these Health service providers on board is thus extremely important.
Audience 7 Journalists
Print and electronic news -media may have a limited role in creating awareness about MNCH issues in rural Pakistan due to widespread illiteracy and limited TV/Radio usage. Its value, however, as important advocacy channel can not be over emphasized. The core of any media advocacy work must involve media managers, editors, etc. as well as the journalist who report on the issues. The program will work in partnership with media managers to equip journalists with required knowledge and skills to cover issues such as women’s right to life and quality MNCH services.
Audience 8 Parliamentarians and District Nazims
Under the present democratic system of Governance in Pakistan and the devolved system of local government, members to the National and Provincial Parliaments and those of the District Councils make the policy decisions including health. Emphasizing the importance of MNCH to these decision makers is crucial. This will result in allocation of funds for MNCH and will ensure continuity of the process. The program will inform and sensitize policymakers' issues about the MNH situation and the steps they can take for addressing it.
Audience 9 Federal, provincial and district bureaucrats