EDITORIAL: The federal minister for planning, development and special initiatives, Asad Umar in his message on the International Day of Family Planning has said that one of the key challenges for Pakistan is its high population growth as the need for schools, healthcare, electricity and gas supply is directly related to growth in population. This in fact has been Pakistan’s story for over half a century. Successive governments have recognised this malaise but have not succeeded in making a dent in the population explosion except for a very brief period when we launched the “Lady Health Care Workers programme”, it appeared that we may be able to come to grips with the high rate of population growth. Furthermore, heath indicators in Pakistan, particularly those relating to mother and child healthcare, continue to show poor performance compared to regional and other Muslim countries as noted in the 2020-21 Economic Survey: (i) life expectancy at birth in 2019 was 67.3 years in Pakistan against India’s 69.7 years, Bangladesh’s 72.6 years, Sri Lanka’s 77 years, Indonesia’s 71.7 years, Malaysia’s 76.2 years with only Afghanistan statistics worse than Pakistan’s at 64.8 years; (ii) infant mortality rate was 55.7 per 1000 live births in Pakistan, India’s 28.3, Bangladesh’s 25.6, Sri Lanka 6.4, Indonesia 20.2, Malaysia 7.3 with even Afghanistan performing better than Pakistan with 46.5 deaths per 1000 live births; and (iii) under five mortality at 67.23 per 1000 in 2019, India 34.3, Bangladesh 30.8, Sri Lanka 7.1, Indonesia 23.9, Malaysia 8.6 and Afghanistan at 60.3.
Pakistan performed better in maternal mortality at 140 per 1000 live births against Afghanistan’s 638, India’s 150, Bangladesh’s 173, Indonesia’s 177 though Sri Lanka and Malaysia performed significantly better at 36 and 29, respectively. This the Survey attributes to “percentage of births attended by skilled health personnel increased from 58 percent in 2015 to 68 percent in 2020…maternal mortality ratio fell from 276 maternal deaths per 100,000 births in 2006 to 189 in 2019.”
The lower maternal mortality rates and higher infant mortality and under five mortality rates in Pakistan compared to other countries, if data integrity is not challenged, indicates a disturbing factor: the focus is on percentage attended by skilled health personnel but not on educating the mother on child care including birth spacing to optimize the health of the mother and the child.
A study carried out by Harvard School of Health, Department of Global Health and Population, Maternal Health Task Force and Integrero dated 2014 concluded that Pakistan’s experience with Lady Health Workers Programme (LHWP) offers “insight into successful implementation strategies, contextual enabling factors, and programme challenges to guide similar initiatives in other countries. Since its inception in 1994 strong unwavering political support has enabled the programme’s financial and administrative needs to continue to be met in the midst of government turnovers. Additionally, Pakistan identified its most critical health problems to appropriately guide the programme’s core objectives. Over two decades, a phased scale-up strategy has been used to gradually expand the LHWP to its current level, enabling the improvement strategies to be regularly developed and modified. Other strengths include string recruitment policies, well-designed management and supervisory structures, and development of an information management system specific to LHWP.”
To put this study in perspective health workers have been subjected to intimidation/terror attacks during the polio eradication campaign, which remains suspended, and lady health workers have come out in protest in Islamabad and provincial capitals against their “meagre” pay scales in 2020 and 2021. The Khan administration’s focus so far has been on issuing cards (cash disbursement, subsidy including interest-free loans, health cards, subsidy to the poor farmers’ cards) and on stunted growth of our children but there is a need to strengthen the lady health workers’ reach by building on their past successes.
Copyright Business Recorder, 2021