In the 2010, high maternal mortality draws attention of PPHI-B management to strengthen the Primary Healthcare (PHC) in country for this purpose Basic Emergency Obstetric and New Born Care (BEmONC) was planned. In response, BHU Plus 24/7 BEmONC was implemented in all provinces with financial support of Federal Ministry of Health Islamabad.

In its first maternal health project, PPHI had identified barriers to maternal health and the feasibility of interventions to reduce the risk and mortality associated with pregnancy and childbirth. Recognizing that the major causes of maternal deaths were common and largely preventable or treatable, PPHI promoted a set of essential obstetric care services for all women. These services included not only emergency care but also prevention and early treatment of complications before they become emergencies; they targeted anemia, infection, hemorrhage, prolonged labor, hypertension, and through voluntary family planning services and unwanted pregnancy. Main focused on capacity building of female health care providers to increase the skills of those attending births.

PPHI- B has established 39 BHU Plus 24/7 Basic Emergency Obstetric Born Care by the end of the 2023. New approaches emphasizing increased access to quality of care, positive practices by health providers for families and communities. Policies that should favor safe motherhood, proper referral system to higher facilities and effective community mobilization. Meanwhile UNFPA also shared his support since last five years:

• Basic EmONC.
• Antenatal & Postnatal Care.
• Family planning services.
• Immunization.
• Laboratory services.
• Women specific medicines.
• Ultrasound services.
• 24 Hours ambulance services.
• MNCH counselling.

Some of the important protocols that revolve around the concept of 24/7 BHUs include the essential obstetric care principles and labor management. These protocols are observed to address the main complications of the delivery such as ante-partum hemorrhage, eclampsia, prolonged labor, uterine rupture, post-partum hemorrhage, management of vaginal and cervical tears and retained placenta. The protocols include the following:

• Initial assessment, duration, use of a partograph.
• Assessment of fetal well-being.
• Episiotomy.
• Special care for women who have undergone genital mutilation.
• Use of vacuum extractor.
• Management of hemorrhage management of eclampsia.
• Issues related to multiple births.
• Breech deliveries.

Referral to next level of care, if necessary.

These 24/7 BHUs are equipped with essential drugs and women specific medicines required for MNCH services. These facilities also provide resuscitation and basic care of the newborn (e.g., management of hypothermia and hypoglycemia) and readily available prophylactic to prevent neonatal ophthalmic etc.