THE 18th Amendment which has been held responsible for much of the confusion and lack of meaningful, coherent action in the country’s health sector has been invoked yet again to justify lack of initiative.

A senior official in Islamabad now cites it as a major reason for Pakistan’s slide down a couple of ranks on the MMR or the maternal mortality ratio list.

We were listed at 147th on the MMR radar last year. This year we are at number 149, and without nearby Afghanistan for company we would have been quite unique on this count in the region. At the very least, the repositioning reflects stagnation if not further deterioration.

Also read: Pakistan’s ranking in mother mortality rate falls further

Mortality rates of mothers and newborns are somehow still unable to get the attention they deserve. The figures generally illustrate how certain sections of society — in particular women and children — already at a disadvantage are even more likely to suffer apathy in the ‘remoter’ areas where the incidence of maternal mortality is greater.

These areas comprise those at a distance from the official planners. This is how it is in the case of Balochistan where the MMR is said to be 700 against a national average of 276 per 100,000 live births. Quite tragically for the times, the under-five mortality rate nationally is 89 deaths per 1,000 live births.

These daunting figures obviously have their origins in conservative outlooks and general apathy that long predate the tangles introduced by the 18th Amendment under which health is to be treated as a provincial subject. It is unfortunate if the amendment has made a national drive for improvement in basic-level health services more complicated.

Devolution sought to bring the tackling of the issues to a level where both the people and the officials working in their name had a strong understanding of their problems and a keen desire to take part in the search for solutions.

It is about time the country started benefiting from the system by fully acting on it instead of using its non-implementation to justify inaction.

Published in Dawn, May 7th, 2015

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