HYDERABAD: Unabated deaths of newborns and children under five years of age continue to remain a disturbing phenomenon in Tharparkar despite federally-funded health programmes worth billions of rupees launched to address issues involving maternal and neonatal healthcare.

While the Sindh government is trying its best to avoid embarrassment as results of reports on deaths, it has yet to see if these programmes deliver or are marred by issues that hamper achievement of healthcare goals in Thar which is making the headlines again.

Pakistan has already missed Millennium Development Goals-4 and 5 that respectively deal with child healthcare and maternal mortality ratio (MMR) despite having programmes like Maternal & Neonatal Child Healthcare (MNCH), Community Based Management of Acute Malnourished (CMAM) or Nutrition Support Programme and National Programme for Family Planning & Primary Healthcare. All these are federally or donor-funded, continuing in Sindh, too, but health indicators do not show significant improvement.

The Nutrition Support Programme is run by donors like the World Health Organisation (WHO) and Unicef in collaboration with NGOs in nine districts, including Tharparkar, for infants, expecting and lactating mothers. The federally-funded MNCH aimed at producing 6,000 community midwives in the past six to even years in Sindh. Regardless of programme managers’ claims of efficient working, their performance demands independent evaluation amidst deaths of newborns/infants.

The nutrition programme has components, including severe acute malnourished (SAM), moderate acute malnourished (MAM) and Nutrition Stabilisation Center (NSC). Once enrolled newborn/infant falls in SAM category for ready to use therapeutic food (RUTF) if his/her mid-upper arm circumference (Muac) is less than 11.5cm, a benchmark. After RUTF support for two months, baby is covered in the MAM for two months for ‘ready to use supplementary food (RUSF).

An official, who remained associated with the programme, said: “Infants’ enrolment follows check-ups. It is important to see if scanning of newborns/infants is done as NGOs are allotted separate areas taluka-wise in Thar.”

Mazhar Khamisani — transferred a couple of months ago as project director of the Expanded Programme on Immunization (EPI) for questionable performance in federally supported EPI and in the wake of close to 300 measles-related deaths in upper Sindh in 2012 – is surprisingly tasked with the Sindh government’s nutrition programme to be run with soft loan for three years. A finance department officer confided to Dawn that donors expressed reservations before Sindh’s planning & development officers over his posting. Sindh in terms of food insecurity, as per National Nutrition Survey 2011s, appeared as Pakistan’s poorest and food deprived province. Only 28 per cent households were food secure and the rest (72 per cent) households were found to be food insecure and of the 72 per cent, 21.1 per cent were food insecure without hunger, 33.8 per cent with moderate hunger and 16.8 per cent with severe hunger. Vaccination, statistically, is pathetically low in Sindh if Pakistan Demographic Health Survey (PDHS) 2012-13 is anything to go by. It puts fully vaccinated children’s percentage at 29 in 2012-13 against 37 per cent in 2006-07.

Prof Salma Sheikh, dean faculty of allied sciences in Liaquat University of Medical & Health Sciences (LUMHS), stressed the need for strengthening nutrition programme to prevent deaths, attributed to malnutrition in Tharparkar. She said deaths after newborn period among children of five years of age were caused by diarrhea and pneumonia. “Malnutrition is the underlying cause of death in 54 per cent children under five years of age. Malnourished child always has four to ten times more risk of dying from these diseases than a normal child,” she remarked and agreed that malnutrition in Thar (28 per cent) was more common than other districts (18 per cent). She said child health policies needed serious attention to reduce mortality among children.

The MNCH revolves around production of community skilled birth attendants /midwives to handle healthcare services of expecting mothers and neonatal (newborns) before delivery, during and post delivery periods.

Prof Dr Aneela Rehman, LUMHS’s dean faculty of community medicine & public health sciences, stated that “performance of MNCH needs third party evaluation for which the government should take measures. Their [MNCH] evaluation reports are manipulated,” she claimed.

Despite such programmes, Sindh’s health indicators are not improving and if Pakistan’s IMR (infant mortality ratio) is 74/1000 per live births then Thar’s must have even higher IMR. The LUMHS is ready to train health professionals under MNCH to reduce mortality in newborns of Thar.

But Project Director Dr Sahib Jan Badar defends programme’s performance, claiming that third party evaluation would be conducted after five years of appointment of 6,000 skilled birth attendants/community midwives.

“We are working perfectly,” he said.

Published in Dawn, January 22nd, 2016