Pakistan’s maternal and child health policy: analysis, lessons and the way forward
Section snippets
Setting and surrounding
An estimated 400,000 infant and 16,500 maternal deaths occur annually in Pakistan. These translate into an infant mortality rate (IMR) and maternal mortality ratio (MMR) that should be unacceptable to any state. The numbers reflect only the years of life lost due to premature mortality. Should the years lived with disability, such as due to malnutrition in children and reproductive morbidity in women be included, the burden of disease (BOD) would be even greater. It is no surprise that in 1996,
Approach and methodology
This review broadly covers the period 1990–2002 and analyzes the last three health policies. In addition, it includes a critique of the major national programs on MCH/FP during this period. It also utilizes evidence from health and demographic surveys conducted by independent agencies to assess the status of MCH/FP.
The review has generally preferred the traditional terms maternal and child health and family planning over the broader reproductive health (RH) as it covers the period before as
Health situation
Pakistan has lagged its neighbors and other low-income countries in terms of health and population outcomes, despite the fact that Pakistan’s GNP of US$ 440 is higher than the average (US$ 410) for low-income countries [4]. Despite improvements in the 1990s, IMR of 83 per 1000 live births [5], [6] is higher than the averages for low-income countries and south Asia by 10 and 16%, respectively (Table 1) [4]. Neonatal mortality accounts for 40–60% of all infant deaths and 60% of neonatal mortality
Macroeconomic scenario and its influence on MCH/FP policy
The economic growth in Pakistan has followed a downward trend with the real GDP growth falling from over 6% per annum in the 1980s to around 4% during the 1990s [17]. A sharp rise in interest payment on public debt and a commensurate fall in expenditures over this period are responsible for the sluggish performance. These macro economic imbalances, coupled with governance failures and government’s inability to channel limited resources effectively towards pro-poor activities, have resulted in a
Lessons learnt
Several lessons can be learnt from the foregoing review, which have been substantiated by relevant experiences from countries of the region. The major ones being as follows.
- (i)
Any MCH/FP policy is as good as the planning and implementation capacity of its stewards, the Ministries of Health and their MCH/FP units. Unless polices are translated into appropriate programs, put into operation and evaluated, they only retain academic value. Institutional capacity and good governance is vital in
The way forward
While acknowledging that the direction of the national policy as being appropriate, MCH/FP remains high on the list of unfinished agenda in Pakistan. The shortcomings alluded to need be addressed by developing a longer-term vision and delineating effective implementation and good governance modalities if the government aims at achieving the RH related Millennium Development Goals. Without creating false impressions about the scope of the challenge Pakistan faces, we strongly believe that there
Acknowledgements
The authors gratefully acknowledge the assistance of Dr. Zulfiqar Ali, Adviser, and Dr. Zahid Larik, Program Manager, National Program for Primary Health Care and Family Planning, Ministry of Health, Government of Pakistan, for their assistance in making available public sector documents on MCH/FP.
This paper was presented at the “National Consultation on Maternal and Child Health and Family Planning in Pakistan: Planning for the Future”, held under the auspices of the Ministry of Health,
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