The public sector has run multiple integrated and specialised maternal and neonatal health (MNH) programmes to reduce high mortality rates.

“There are three cadres of female community-based providers, all trained in women’s, adolescent and child health,” says Dr Mariyam Sarfraz, dean of the School of Nursing and Midwifery at the Islamabad-based Health Services Academy (HSA). She adds that Lady Health Visitors (LHVs) and Female Welfare Workers (FWWs) receive similar two-year post-matric training in maternal and child health, primary care and family planning, and both are licensed in midwifery.

Community Midwives (CMWs), introduced in 2007 under the Pakistan National Maternal and Child Health Programme, with support from UNFPA and UNICEF, were meant to replace or upskill traditional birth attendants in rural and emergency settings, with training in safe delivery and village-based birthing stations as a source of income.

A similar, five-year programme (later extended to another year) was piloted earlier through the USAID-funded PAIMAN programme (2004-2010), which expanded from 10 to 23 districts, worked through existing public systems and community providers, partnered with the private sector, strengthened 24/7 services, and later added child health and spacing.

However, the programme faced repeated shocks — from the 2005 earthquake and 2007 political crisis to the 2008 elections, the Swat operation displacing over two million people, and the 2010 floods — with the biggest setback coming in 2010, when healthcare was devolved to provinces, triggering administrative disruption, staff reshuffles and medicine shortages.

According to Dr Sarfraz, “The 2007 CMW programme could not be sustained with the same vigour provincially, due to a lack of funds for stipends and training capacity. It has since been discontinued in Punjab, where the focus has shifted to facility-based care through upgraded basic health units and rural health centres, 24/7 labour rooms, financial incentives for antenatal and facility deliveries, ambulance services, and LHW incentives for referrals. However, these facilities remain obstetrician-led rather than midwife-led.”

Reforms are now underway, with a four-year Bachelor of Science in Midwifery (BScM) being introduced alongside the two-year diploma. Three universities: Fatima Jinnah Medical University in Lahore, the HSA in Islamabad and the Mohiuddin Institute of Nursing and Allied Sciences in Mirpur, are offering the programme, which began at HSA in 2024 (for which Dr Sarfraz led curriculum development), with the first cohort of 30 graduating in 2028. Approved by the Higher Education Commission (HEC), the programme emphasises hands-on clinical training and allows diploma holders to enter in the fifth semester via a bridging exam, completing the degree in two years.

Published in Dawn, EOS, May 3rd, 2026