KARACHI, Oct 16: A lack of focus by the government on reaching out to the poor and attending to their health and nutrition needs explain why Pakistan has, so far, failed to achieve the millennium development goals (MDGs) on maternal and child health, which were set by the United Nations 12 years ago and are required to be achieved by 2015, said health experts at a seminar on Tuesday.
While many other developing countries with meagre resources were set to achieve the MDGs on maternal and child health, a high population growth rate coupled with the absence of an effective government strategy to tackle these issues on a priority basis had put Pakistan into multiple crises, they said, while highlighting the need for a substantial increase in the health budget and taking the issue seriously.
These were some of the important points discussed by the health experts at the seminar, ‘Reproductive, maternal, newborn, child health and nutrition: status and priorities’, organised at a hotel by the Aga Khan University’s Division of Women and Child Health in collaboration with USAID.
The programme was part of a series of meetings being held in the provincial capitals to formulate a consolidated policy brief on maternal and child health for upcoming elections.
Pakistan is currently ‘off-track’ for progress on MDG-4 because of high rate of under-five deaths, which currently stood at 87 (per 1,000 live births) and infant mortality rate at 64. It also lags behind progress on MDG-5 with maternal deaths estimated at 276 (per 100,000) in 2006-07 and 260 in 2010.
Giving his presentation on the status of newborn and child health in Pakistan, Dr Zulfiqar A. Bhutta, professor and founding chair of the AKU division of women and child health, said that the maternal and child health statistics were far worse in many countries of South Asia and South East Asia back in the 1990s. But there had been a significant improvement in their performance by the year 2000 and countries such as Bangladesh and Nepal were set to meet the MDGs on maternal and child health by 2015, he added.
“The 2006-07 data shows that Pakistan has made little progress on under-five mortality rate, whereas neonatal mortality rate has remained unchanged since 1991. Evidence also shows that newborn death is strongly linked with maternal death,” he explained.
The maternal mortality rate in Sindh was 314, which, according to Dr Bhutta, was much higher than the national average of 276. “Sindh has shown no reduction in infant mortality rate of 81 deaths per 1,000 live births over the last decade while neonatal mortality rate, the major cause of infant deaths, has actually increased from 44 to 53 over the last decade,” he said.
There were variations in urban and rural data of the province as well as of the country. Giving an example, he said that the maternal and child health situation in Karachi slums was as bad as in rural Sindh whereas conditions in certain areas of Balochistan were as poor as in sub-Saharan Africa.
Speaking about childhood malnutrition trends in Pakistan, Dr Bhutta said it was fundamentally related to maternal anaemia and Sindh appeared as the poorest and food deprived province with only 28pc households found to be food secure in a recent national nutrition survey.
“Malnutrition among women was found to be highest in Sindh. Exclusive breastfeeding for six months is only 10pc in the province.Evidence shows that a relationship between birth interval and birth stunting also exists,” he said and called for an integrated approach to deal with the maternal and child health issues.
Immunisation is critical
The districts in Sindh with a high prevalence of pneumonia also had a high burden of diarrhoea, he said, adding that such facts should be taken into consideration while devising intervention strategies.
Similarly, he said, as immunisation reduced inequity it could have a strong impact in reducing death rate in newborns and under-five children if its 100pc coverage was ensured.
Dr Bhutta appreciated the government for making Pakistan the first country in the South Asian region to introduce Haemophilus Influenza B-type (Hib) and Pneumococcal vaccines. However, he said, this would not benefit unless the vaccines reached deserving children. He also called for integrating polio programme with rest of the EPI programme.
Simple, cost-efficient interventions were available to reduce maternal and child mortalities but what was required was a strong political will, he added.
National Council for Maternal and Neonatal Health President Dr Sadiqua Jafarey said the health survey of 2006-07 showed that the poor and rural population was the hardest hit and most mothers were dying within 24 hours of labour/delivery.
“It is imperative to look into the psycho-social, cultural and economic causes of maternal deaths in order to get to the root of this issue. There is a dire need for having an efficient system of recording maternal deaths,” she said.
Dr Farid Midhet of the College of Medicine, Qassim University, the Kingdom of Saudi Arabia, spoke in detail about increasing population and reproductive health. Pakistan had a youth bulge which, he said, was uneducated and unemployed that was bound to increase country’s challenges if efficient family planning measures were not put in place.
“Pakistan is all set to cross the 200 million mark in 2020. The contraceptive prevalence ratio is only 30pc, which is the lowest in the region.It is 74pc in Iran and 58pc in Bangladesh,” he said.
Sindh Health Director General Dr Feroz Memon said that the health department would consider the meeting’s recommendations in the policy-making process. “The government has set up a health sector reforms unit, which is in the process of making operational strategies,” he said.
Dr Nabeela Ali representing the USAID, Dr Sahib Jan Badar, manager of the maternal, newborn and child health programme, additional secretary for health Dr Suresh Kumar and additional secretary (development) Kiran Nauman also spoke.