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The poor state of Pakistan’s healthcare system

Dawn's special coverage of the Sustainable Development Goals 2015-2030 continues.
Published Sep 22, 2016 11:14am
Goal 3: Good health and well-being


• Targets: end communicable diseases, achieve universal health coverage, and provide access to safe and effective medicines and vaccines by 2030

• Pakistan is ranked 149th out of 179 countries in 2015 on the Maternal Mortality Ratio Index

• New healthcare blueprint needs increased funding, efficient cross-sector linkages

By Shahnaz Wazir Ali

The writer is the provincial coordinator for primary healthcare and family planning programs in Sindh. She can be reached at shahnazwa.sapm@gmail.com

The eight United Nations Millennium Development Goals (MGDs) were time-bound and quantified global targets ranging from halving extreme poverty rates to providing universal primary education by 2015. Pakistan signed off on the MDGs in 2000, however, despite all the rhetoric around policy, budgetary and implementation commitments, and subsequent efforts, the country’s track record fell short of the targets, placing it next to those nations ranked the lowest in the Human Development Index. Then, last year, the Sustainable Development Goals (SDGs), an ambitious set of 17 goals with 169 indicators set to impact seven billion people, with a single deadline of 2030, were framed on the bedrock of human rights, inclusivity and justice. However, they are yet another articulation of aspirations reflected in development terminology crafted in the halls of the UN and subscribed to by governments without always comprehending the level of effort and resources required. As signatory, Pakistan is committed to aligning its development agenda towards low-carbon pathways over the next 15 years. But skeptics argue that evidence on the previous 40 MDG indicators precludes Pakistan’s ability to achieve the SDGs. That said, the therapy being proposed is that countries should identify goals based on their resources and try to achieve them rather than opt for a one-size fits all framework.


According to Unicef, despite significant improvements over the past two decades, Pakistan ranks towards the bottom among other countries when it comes to infant and neonatal mortality.


With Goal 3 – promoting good health and well-being – calling for an integrated approach crucial for progress across multiple goals, including alleviating poverty and hunger, the focus includes a commitment to end the epidemics of AIDS, tuberculosis, malaria and other communicable diseases by 2030. It also aims to achieve universal health coverage, and provide access to safe and effective medicines and vaccines for all.

Challenges to mother and child health are attributed to poverty, social exclusion and discrimination. – White Star
Challenges to mother and child health are attributed to poverty, social exclusion and discrimination. – White Star

Consider the challenges to mother and child health in Pakistan. Especially severe, they can be attributed to poverty, and compounded by social exclusion and discrimination. Behind every statistic, there is a child in distress calling for immediate attention of state and society. According to Unicef, despite significant improvements over the past two decades, Pakistan ranks towards the bottom among other countries when it comes to infant and neonatal mortality. This is why 44pc of all children are stunted and 9.6 million experience chronic nutrition deprivation. Compounding the nation’s state of poor health, for example, is the toll taken by pneumonia killing approximately 92,000 children annually. Pakistan’s ranking in the Maternal Mortality Ratio Index has slipped from 147 in 2014 to 149 in 2015, recording a staggering 276 deaths per 100,000 births. Excepting Afghanistan, all the other countries in this region have better health indicators than Pakistan.

To add, Pakistan has the third highest rate of infant mortality in the world. The mortality rates among children are often seen as a proxy for the level of social development. And for good reason, because they reflect the level of nutrition, parents’ education, and access to health services. Consider the impact of the Benazir Income Support Program – the largest social protection intervention – which targets women living in chronic poverty. Despite its flaws, the BISP must have had significant impact on maternal or child health indicators. Learning lessons from the past, the recent initiative to condition cash payments on primary school enrolment and in partnership with provincial governments will further encourage women to send their girls to school.


Pakistan’s ranking in the Maternal Mortality Ratio Index has slipped from 147 in 2014 to 149 in 2015, recording a staggering 276 deaths per 100,000 births.


If one examines the recently announced National Health Vision, it may present an alignment of socio-economic commitments, but is also reminds that without national consensus the state-owned health sector will continue to suffer. With no universal medical care, overhauling the health sector not only requires that health be put at the top of the political priority list, but increased funding, efficient cross-sector linkages and medical training are also imperative if the NHV is to be implemented.

With the government’s development blueprint premised on an enabling environment essential for socio-economic development, Vision 2025 is to be implemented in sync with the SDGs. For now, all such plans look good on paper. However, sustainable development is achievable through the process of devolution. If implemented effectively, the SDGs will serve the needs of the people by bringing accountability and decision-making within provincial jurisdiction. Worth mention is that optimism amongst policymakers came to the fore when the minister for planning, development and reforms, Ahsan Iqbal, pledged ‘the highest priority to achieving the [SDG] goals’, which would imply that there is sufficient political interest.

The reality may be that poverty will not be eradicated by 2030, and the state may not be able to feed around 215m children, nor ensure healthy living for all, but what can be achieved is tailoring programs to the demographics of different geographical regions by looking at the evidence of success and deriving contextual formulas for efficient delivery.


This story is part of a series on the SDGs, continue reading the previous stories.


Dawn's special coverage of the SDGs continues tomorrow.
Coming next: Right to education: Where do we stand?