December 04, 2008	Thursday	Zilhaj 5, 1429

KARACHI, Dec 3: A very marginal flow of funds for a maternal and child health improvement project from the federal government is causing concerns among the government health managers and field-workers of Sindh, which has high mortality in pregnancy-related cases, infants and children under five years of age.

Sources in the health department said that the release of federal funds out of the allocation as mentioned in the project paper had been so meagre that the high-ups and the programme executers could not even think about meeting the targets set under the Millennium Development Goals (MDGs), which expected a reduction in child mortality by two thirds and maternal mortality by three quarters.

As against an allocation of about Rs1,400 million, the funds released so far are only around Rs160 million though the project has entered its third year.

Pakistan’s maternal and child health indicators remained extremely poor as 25,000 to 30,000 women die from complications of pregnancy and child birth and the mortality figures of children under five years of age is put at 400,000 to 500,000, including 160,000 newborn babies who die in their first year of life.

The government of Pakistan which is committed to the MDG Declaration 2000, had announced some three years back that it would take special initiatives to reduce the infant mortality rate to 40 per 1,000 live births and maternal mortality ratio to 140 or less, in addition to ensure an increase in the universal immunisation rate to 90 per cent and the skilled birth attendance to 90 per cent by 2015 under its National Maternal, Neonatal and Child Health (NMNCH) programme.

However, owing to the policy-makers apathy, coupled with flawed vision of the bureaucracy, the NMNCH project (2006-2012) could be effected purposefully only last year through the provincial governments.

Under the programme, Sindh was promised release of Rs3,246.47 million funds over a period of six years.

It is learnt that against an allocation of Rs460 million for 2007-08, Sindh had received only Rs19 million, while another Rs128 million had been released against the allocation of Rs970 million for 2008-09.

The implementation strategies included provision of comprehensive 24-hours emergency obstetric neonatal care service through district and taluka headquarters hospitals, upgrading of rural health centres and basic health units and training and development of community midwives, meeting the international definition of “skilled birth attendants”.

Sindh was supposed to prepare 1960 community midwives trained in the home-based deliveries.

An official requesting anonymity said the first batch of about 350 matriculate girls had already been put to a two-year training against an stipend of Rs3,000 per months whereas a second such batch would be inducted in the next two months or so. Beside, training was also being ensured for the government health care providers and paramedical staff, lady health workers and lady health visitors.

The inadequate fund release has ultimately disheartened the executers of the programme. “The officials concerned are also unable to pay the stipends to the trainee students on a monthly basis,” said a source, adding that the civil works pertaining to upgrading and renovation of a good number of health units already mapped for the project was also not in sight.

There are a lot of things to be streamlined and decisions taken for making the programme viable. The officials and high-ups in the provincial health department are of the view that the federal government must ensure prompt and smooth flow of fund to achieve the MDGs targets within the stipulated period, the source said.

About the community midwives being trained under the programme, an official said: “Our purpose is to make them capable of performing deliveries independently and earn their livelihoods like other professionals.” Another official of the department said that there had been talk about micro-financing facility through banks for the trained women at some later stage but the nothing was certain because of the manner in which the entire project was being implemented.