Sharing the millennium development goals, Pakistan may finally be taking seriously the health of its future generations
The mothers and children of Pakistan have reasons to look to the future with hope. Their health and life is now receiving attention as never before. There is a commitment to their wellbeing at the highest level, a crucial factor in the reduction of maternal and child mortality and morbidity. This was the promise that the participants of the recently concluded National Health Forum on Maternal and Child Health, in Islamabad, walked out with.
During the conference, the National Maternal and Newborn Health Policy and Strategic Framework was presented. But above all, the Prime Minister of Pakistan, Shaukat Aziz assured of his government’s commitment to reducing maternal and child mortality. This forum culminated with the Islamabad Declaration which was endorsed by the federal and all the provincial health authorities. The Declaration has not only recognized the problem, but has also suggested doable actions and seek the commitment of the government.
A few days earlier, at the inaugural session of the International Conference on Gender Mainstreaming and the Millennium Development Goals (MDGs), also held in Islamabad, the Prime Minister had confirmed the government’s committed to achieving the targets agreed at the Millennium Summit in 2000. This envisaged, among other things, the development and implementation of programmes and interventions to ensure that the health needs of the people are being met. The PM said that achieving the eight MDGs (see box) requires effort, but for Goal 5 i.e., improving Maternal Health ‘extra effort’ was needed. This goal requires that by the year 2015 the Maternal Mortality Ratio (MMR) be reduced by three-fourths from the level in 1990. This means that in the next ten years the MMR is to be brought down to 140 from the estimated figure of over 500 in 1990.
In the concluding session, General Pervez Musharraf, the President of Pakistan, assured his support to the women’s gender issues. He said that looking after mothers is the root of the development.
This year the theme for the WHO Health Day i.e., April 7, is ‘Every Mother and Child Counts’. Measures will be taken to raise awareness of the fact that globally, each year, more than half a million women die during pregnancy and childbirth and 11 million children die before their fifth birthday. The World Health Report of 2005, which will be launched the same day, also addresses maternal and child health.
Awareness of women heath issues, including maternal health has increased considerably. This of course has been made possible following efforts over the past few years of the stakeholders. The media too has played a positive role in creating awareness among the masses.
In Pakistan, the key initiatives to help achieve the MDGs, include the National Program for Family Planning and Primary Health Care, Women’s Health Project, Reproductive Health Project, Maternal and Neonatal Special Immunization Activities, Enhanced HIV/AIDS Control Program, The National Nutrition Program, Community Midwifery Program (through the National Commission for Human Development), Population Welfare Program and The Women’s Right to Life and Health Project in Sindh. This project is being funded by the Bill and Melinda Gates Foundation.
The National Programme for Family Planning and Primary Health Care has been an effective and successful programme. It provides basic preventive and curative services at the doorstep through Lady Health Workers (LHW) who are selected from and deployed in their own communities. They provide antenatal, postnatal and newborn care, health education and also supply contraceptives. Referral to health centres where and when necessary is also part of their job. At present there are over 80,000 LHWs throughout the country and these will be increased to 100,000 by the end of 2005.
It is encouraging that a number of donor agencies, including WHO, UNICEF, UNFPA, ADB, DFID, USAID, JICA, CIDA are supporting the above programmes. Two of the recent projects on maternal and newborn health are supported by DFID and USAID. This will of course bring substantial amount of resources to undertake a number of initiatives towards achieving these goals.
The National Maternal and Newborn Health Strategy aims to improve access of high quality and effective services, especially for the poor and disadvantaged through development and implementation of provincial and district programmes that are sustainable and can be replicated.
At present the state of maternal and child health in Pakistan needs much to be desired. The health and survival indicators remain unacceptable. An estimated 25,000 to 30,000 women die each year from pregnancy related causes and an additional 300,000 to 400,000 are estimated to suffer from disability. Perinatal deaths, a reflection of maternal health nutrition and health care are also high. An estimated 565,000 children die each year, before their fifth birthday.
This poor state of mother and child health is a result of many diverse factors. It starts with the low social status of the women in Pakistani society, their poor education, their lack of economic power and lower priority in health seeking matters.
In a study done in the early eighties, at the Jinnah Postgraduate Medical Centre, Karachi, it was found that the factors causing delay in reaching the hospital in time by the mothers included unawareness of the seriousness of the problem, lack of transport, absence of husband from home, lack of finances in addition to inappropriate referral by the attending health care providers. As a result of these delays, many of these mothers died on their way to the hospital.
These factors need redress of which one needs to go beyond the health system. It requires collaboration with other sectors like education, social welfare, women’s development and population welfare.
In the health sector the priority interventions requiring attention are:
• Improving emergency obstetric and newborn care.
• Ensuring essential obstetric and newborn care including prompt recognition, management/referral of complications through skilled birth attendants (SBA).
• Expanding access to comprehensive family planning services.
• Increasing community awareness about nutrition and identifying dangerous signs during pregnancy and childbirth and the demand for family planning and SBA services.
• Addressing cross cutting issues of low family status, gender inequality, illiteracy and poverty.
• The reason for being optimistic is that one of the major constraints — lack of funds — is being removed by the donor agencies. However, the task ahead is tough. There are many other constraints and challenges to achieve the MDGs. One of the major challenges for the government is, and will be to ensure sustainability of these initiatives when the external financial assistance comes to an end.
• Moreover there is growing consensus that in developing countries including Pakistan the major constraint is a weak health system. Unless the health system is strengthened all the above mentioned initiatives are likely to fail. It is up to the implementers including the health professionals to ensure that this does not happen.
• The future for mothers and children appears to be promising. It is for us to change our thinking and work together concertedly, honestly and with commitment as a team to ensure that the promise is kept.
Sharing the millennium development goals, Pakistan may finally be taking seriously the health of its future generations 
