{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T15:15:52Z","timestamp":1789139752348,"version":"build-2803163510"},"reference-count":39,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int. J. Neonatal Screen.","IJNS"],"abstract":"<jats:p>Newborn screening (NBS) in Pakistan remains limited by fragmented service delivery, uneven provincial capacity, and the absence of an implementation pathway that links policy intent to operational planning. This study aimed to co-design a provincial NBS implementation framework for Punjab. To do so, we used a sequential blended workshop model supported by visual planning methods. We conducted a qualitative, three-phase co-design process with 19 participants from laboratory medicine, pediatrics, obstetrics, public health, academia, and policy. Phase I consisted of pre-work and an online workshop to establish a shared knowledge base and identify implementation barriers and enablers. Phase II used an in-person, visually facilitated planning workshop to translate these findings into a provincial NBS implementation framework. Phase III involved a asynchronous email-based review to refine the framework and reach consensus. Content analysis from Phase I identified five implementation domains: physical and technical infrastructure, operational systems, clinical integration, workforce and engagement, and governance and policy. In Phase II, these domains were translated into a visual implementation framework that specified priorities, stakeholders, risks, enablers, and action areas for phased rollout. Congenital hypothyroidism was identified as the most feasible entry-point condition. The final framework positioned NBS not as a stand-alone pilot, but as a coordinated provincial system requiring governance, financing, referral pathways, quality assurance, and workforce development. This study contributes an implementation-oriented model for moving from fragmented NBS initiatives to a provincial implementation framework in a low- and middle-income setting. It also offers a practical foundation for broader national scale-up.<\/jats:p>","DOI":"10.3390\/ijns12030074","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T14:39:24Z","timestamp":1789137564000},"page":"74","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Co-Designing a Provincial Newborn Screening Implementation Framework in Pakistan Using a Sequential Blended Workshop Model"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7693-5740","authenticated-orcid":false,"given":"Aysha H.","family":"Khan","sequence":"first","affiliation":[{"name":"Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, The Aga Khan University, P.O. Box 3500, Karachi 74800, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6807-5429","authenticated-orcid":false,"given":"Lena","family":"Jafri","sequence":"additional","affiliation":[{"name":"Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, The Aga Khan University, P.O. Box 3500, Karachi 74800, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Dianne","family":"Webster","sequence":"additional","affiliation":[{"name":"Newborn Metabolic Screening Programme, Lab Plus, Auckland City Hospital, Auckland 1140, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Farkhanda","family":"Ghafoor","sequence":"additional","affiliation":[{"name":"Roshni Association, P.O. Box 11073, Lahore 54792, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"given":"Tariq","family":"Zafar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics & Neonatology, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore 54000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Afzal","family":"Saeed","sequence":"additional","affiliation":[{"name":"Laboratory Services, Sindh Institute of Child Health and Neonatology, Karachi 74800, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"given":"Jaida","family":"Manzoor","sequence":"additional","affiliation":[{"name":"Department of Pediatric Endocrinology and Diabetes, The Children\u2019s Hospital University of Child Health Sciences, Lahore 54600, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Fouzia","family":"Ishaq","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Fatima Jinnah Medical University, Sir Ganga Ram Hospital, Lahore 54000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"given":"Tayyaba K.","family":"Butt","sequence":"additional","affiliation":[{"name":"Department of Pediatrics & Neonatology, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore 54000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8325-4513","authenticated-orcid":false,"given":"Saima","family":"Zaki","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Allama Iqbal Medical College, Lahore 54550, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Azeema","family":"Jamil","sequence":"additional","affiliation":[{"name":"Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, The Aga Khan University, P.O. Box 3500, Karachi 74800, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Hafsa","family":"Majid","sequence":"additional","affiliation":[{"name":"Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, The Aga Khan University, P.O. Box 3500, Karachi 74800, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Ojodu, J., Singh, S., Kellar-Guenther, Y., Yusuf, C., Jones, E., Wood, T., Baker, M., and Sontag, M.K. (2017). 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