SPEAKING at the launch of an ambitious five-year family planning initiative officially titled the Costed Implementation Plan (CIP), Sindh Chief Minister Qaim Ali Shah stressed that family planning and reproductive health were at the top of the government’s agenda.
If this were true, it would be terrific news indeed for the women of Sindh. An unacceptably high number of women in Pakistan die due to pregnancy and childbirth. While up-to-date and accurate data regarding maternal health is difficult to obtain, WHO estimates that the maternal mortality rate in Pakistan is 170 deaths per 100,000 live births. The figure in Sindh is even higher than the national average. According to the UN Millennium Development Goals Report of 2012, the maternal mortality ratio in Sindh is between 345 and 350 deaths per 100,000 births.
Improving access to contraception is one of the most important means to improve maternal health. With a generous budget of Rs51.2 billion, the new CIP seeks to increase access and use of family planning measures across Sindh to stem the rate of population growth and improve reproductive health.
However, before we congratulate the Sindh government on taking on this new, costly initiative, we must remind the government of existing reproductive health policies and programmes that it is failing to implement.
Maternal healthcare in Sindh continues to be abysmal.
As far back as 2006, the government adopted the National Framework on Maternal and Newborn Child Health, which promised to establish maternal and newborn child health cells in every province of Pakistan. The framework set forth detailed targets for government-run obstetric care centres in all provinces, including Sindh. The policy envisaged that Rural Health Centres will provide basic obstetric care, including skilled attendants for normal childbirth, provision of essential medicines and contraceptives, and transportation to district hospitals in case of complications during pregnancy and childbirth. District hospitals are required to provide comprehensive obstetric services, including provision of caesarian sections and blood transfusions. These hospitals are to be staffed with a gynecologist/obstetrician, an anesthetist and equipped with a functional operating theatre. But a visit to RHCs and district hospitals today, almost 10 years later, reveals that these targets are woefully far from being met.
An RHC in the Rehri Goth area of Karachi lies vacant and locked in the early afternoon. The chowkidar inside says a doctor had come by in the morning, but left and shut the facility a while ago. If a woman in labour arrives, even the requisite skilled birth attendant will not be available to look after her, nor would she be provided transport facilities to take her to a hospital if complications arise.
The RHC in Murad Memon Goth Karachi is also eerily quiet. Although it is a large building located on a vast compound, there are no patients inside the wards. The medical officer in charge is absent. There is no electricity and the facility has no medicines.
Government-run maternity homes in other parts of Karachi, including Liaquat Market and Model Colony, which are also required to provide basic obstetric care, are similarly understaffed and ill-equipped.
District hospitals in Hyderabad appear to be incapable of handling complicated deliveries. For example, District Hospital Kohsar in Hyderabad did not have a functioning maternity ward until a month and a half ago, because its facilities were being used to house IDPs. Although the hospital is now equipped to handle normal deliveries, it cannot deal with pregnancy-related complications since the posts of gynecologist and anesthetist are lying vacant.
Liaquat University Hospital in Hyderabad is one of the largest hospitals in Sindh. On a Saturday evening, a fairly large crowd is lined up outside the labour ward. But a majority of the beds inside are unoccupied because of the apparent shortage of staff available to attend to the large numbers of people. There is no gynecologist present in the hospital at the time of our visit. Patients huddled outside the ward say that there are no medicines available at the hospital: the doctors hand them prescriptions and the patients have to purchase the medicines at a pharmacy.
The government’s promise to provide quality, accessible and affordable obstetric services remains unfulfilled in these facilities in Hyderabad and Karachi, suggesting worse conditions in the province’s interior. There seems to be little to no check on endemic staff absenteeism and the unavailability of medicines.
In light of the failure to implement extensive maternal health policies, it is crucial to remind the government that framing policies and allocating budgets is not enough. The government’s commitment must be demonstrated through the actual implementation of policies and programmes. It would be a shame if the Sindh government’s new family planning initiative becomes yet another broken promise and the billions devoted to it go to waste.
Sara Malkani is a lawyer and Ayesha Khan is with the Collective for Social Science Research.
Published in Dawn, December 22nd, 2015