News
Tuesday, July 17, 2012
Current status of Pakistan in achieving millennium development goals 4 and 5By Nosheen Munir
Health status of people of Pakistan is in a poor state due to various issues such as the poor performance of programmes related to mother and child health – Maternal Neonate and Child Health (MNCH) programme, Expanded Programme on Immunisation (EPI) and Lady Health Workers (LHW) programme. Their poor performance has affected the progress in achieving the Millennium Development Goals (MDGs), especially the goal 4 to reduce child mortality, and 5 to improve maternal health. United Nations established the MDGs in 2000, to give a roadmap on what needs to be done by 2015; as 2015 is the target year for achievement of these goals.
This article only focuses on the health related goals – goals 4 and 5. So to measure the progress of MDG 4, 6 indicators have been set, such as Under-Five Mortality Rate, which hasdeclined to 86.5 from 117 since last 15 years. Although the Medium Term Development Framework (MTDF) target for 2010 was 77, there is a little chance that Pakistan will be able to achieve the 2015 MDG target of 52. The current infant mortality rate is 70, here again Pakistan has missed the MTDF target of 65 for 2010 and it is very unlikely that Pakistan will be able to achieve the target of 40 by 2015. Proportion of fully immunised children, 12-23 months, is also unlikely to be achieved due to poor performance of the EPI.
Proportion of under-1 year children immunised against measles is also unlikely to be achieved due to difference in the targeted and achieved percentage as targeted percentage is more than 90%, but the current achieved percentage is 86%.
But the indicator of proportion of children under five who suffered from diarrhoea in the last 30 days is likely to be achieved due to good progress in the last couple of years, and the last indictor, Lady Health Workers’ coverage of target population, and its progress shows that it is likely to be achieved by 2015.
The MDG 5 has 5 indicators which have been set to measure the progress. Maternal Mortality Ratio (MMR) is likely to be missed due to bad health care facilities as the target is 140 per 100,000 live births but Pakistan’s MMR ratio is 260 per 100,000 live births, which is the biggest challenge to achieve the target by 2015. Proportion of births attended by skilled birth attendants is not able to meet the target by 2015, contraceptive Prevalence Rate seems less in Pakistan, so target is likely to be missed, Total Fertility Rate remains hard to achieve, and proportion of women, 15-49 years, who have given birth during last three years and made at least one antenatal care is likely to be achieved because awareness has been created among the women of the country, especially among rural women.
Maternal Newborn and Child Health (MNCH) programme was launched in Pakistan, especially for mother and child health, but due to many reasons this programme fails to achieve the MDGs 4 and 5. The main hurdles for MNCH are financial control, human resource limitations and absence of proper organisational system. Lack of proper resources allocation, security issues have affected the social, physical and human capital outcomes.
Devastating floods of August and September 2010 in Pakistan have affected the overall economy and the progress in achieving MDGs 4 and 5. Similarly, the progress of expanded programme on immunisation (EPI) fails to achieve MDGs 4 and 5. Mainly, the staff is not satisfied with the remuneration system and they rarely get motivation. Another reason is absence of vaccinators and inopportune places of immunisation is the core issue behind the depressing consequence. No proper guidelines for immunisation have been provided, hence people of poor communities refuse to immunise their children during sickness, and tetanus. Toxoid coverage for pregnant women is very low. EPI should increase the number of human resource and awareness campaign should be improved. The progress of Lady Health Workers (LHW) programme seems to be bit improved. They are being trained to educate women of rural communities for antenatal care and referral, immunisation services, support to community mobilisation, provision of family planning, and basic curative care.
They are responsible for encouraging families and communities to timely access referral emergency obstetric and neonatal care services. A lady health worker visits on average 23 households per week and their role is to create awareness among the poor communities to avoid unnecessary pregnancies. This programme has positive effects on childhood vaccination, but still the programme has shown some unenthusiastic results in the performance of LHWs, such as irregular supply of drugs, due mainly to smaller number of trained LHWs. Pakistan is lagging behind in achieving the goals of maternal mortality ratio due to lack of proper supervision. Lady health workers are under-supplied with drugs and contraceptives.
Courtesy www.dailytimes.com.pk