RAWALPINDI, March 11: Maternal and newborn mortality and morbidity rates in the country are high despite an extensive health service network due to poor outreach of health care facilities to the people, states a USAID-funded project study on maternal newborn health.

The outreach and coverage of this health facilities network has been poor. Pointing out to the weakness in the health care delivery system, the study says the extensive public sector facilities reach only one-third of the population, while the rest are served by the private practitioners.

Besides, the public sector health facilities are under- utilized due to a number of factors ranging from logistical reasons to improper infrastructure, shortage of equipment and staff.

But still the public sector is the most important health provider for the isolated rural communities. The study suggests that the health sector needs improvement in areas like physical facilities, safe water supply, privacy for women patients, supply of drugs, logistics and equipment and providers capabilities especially in counselling and clinical management.

It also called for addressing the issue of non-availability of health providers, particularly women staff at the public health facilities. Besides, these public health centres need to improve their linkages with the communities they serve.

One of the main objectives of devolution of health department to the district level in the provinces was to improve its working. However, as the study mentions that although the government has delegated health services planning and management responsibilities to the districts, management systems at the district level are weak. The management systems include referral systems, supervisory systems, health information systems and coordination between private and public sectors.

As for the private sector which caters for a large section of the population, the study states: “The private sector services in the country are unregulated, leading to questions of quality.”

The challenge of decreasing mother and newborn mortality rate can be met through ensuring that all women have access to skilled attendants throughout child birth — especially after delivery, the study recommends.

Most maternal and newborn deaths occur at home due to the absence of skilled health providers. The statistics show that over 80 per cent of women give births at home, and only five per cent of these deliveries are conducted by skilled health providers.

Institutional delivery is being adopted by several countries as a key strategy to check maternal mortality, but in Pakistan, the socio-cultural and geographical factors limit this option to urban areas.

Many traditional values discriminate against women, lowering their status and affecting their food intake and nutrition, education, decision making, mobility and health care. Husbands, in-laws, religious and community leaders all play an important role in these customs.

Women, families and health providers, the study says, pay little attention to preventive care and planning for potential maternal and newborn emergencies. The study believes that the answer to the situation lies in developing innovative strategies like provision of skilled attendance, particularly through training mid-wives, to serve the community directly.

The National Commission on Human Development had started a programme for training of mid-wives, but it has several grey areas seeking attention. The NCHD’s Community Mid-Wife project addresses issues like standard of mid-wifery schools, hands on training and deployment, and community birthing centres.