Pakistan missed the short term child health goals in its UN Sustainable Development Goals commitments. Can it catch up over the next decade?
While considerable progress has been made in the Punjab towards universal healthcare, there is still a long way to go to achieve the targets for children’s health under the Sustainable Development Goals (SDGs-2030).
Pakistan is a signatory to a global commitment to attaining certain landmarks on various indicators of child health as part of its resolve to meet the overall Goal-3 targets of Good Health and Well-being under SDGs by 2030. The statistics for the Punjab show a dismal picture. It has missed several short-term targets (set for 2020) including those for maternal mortality rate (MMR), infant mortality rate (IMR), under-5 mortality, availability of skilled birth attendant and immunisation, which are directly related to the status of child health in the province.
By 2030, Pakistan is committed to ending preventable deaths of newborns and children under five years of age. It is also aiming to reduce neonatal mortality to no more than 12 per 1,000 live births and under-5 mortality to no more than 25 per 1,000 live births.
According to Pakistan Demographic and Health Survey (PDHS-2017-18), the overall under-5 mortality rate was 74 deaths per 1,000 live births. In 2020, it stands at 67.2 per 1,000 live births. A whopping 84 percent of deaths under age 5 in Pakistan take place before a child’s first birthday, with 57 percent occurring during the first month of life i.e. 42 deaths per 1,000 live births. The major reason for high infant mortality, according to the latest survey, is the 31 percent births being handled by unskilled attendants.
According to PDHS 2017-18, the status of malnutrition, assessed by anthropometric measurements (weight and height), in children aged under 5 is very high in Pakistan. 44 percent of the children under five years of age are stunted, over 15 percent are wasted and 31.5 percent are underweight. Only 48 percent of the infants under age 6 months receive exclusive breastfeeding recommended by the World Health Organisation.
Despite making substantial progress in improving child health indicators under the Millennium Development Goals (MDGs 2000-2015) and SDGs 2015-2030 so far, Pakistan remains off-track. The inadequate improvement in child health indicators also impedes progress in achieving universal health coverage including access to quality essential healthcare services and access to safe, effective and affordable essential medicines and vaccines for all.
The Pakistan Tehreek-i-Insaf (PTI) government, after taking over reins in the Punjab in 2018, had reassessed the priorities in health sector and devised its strategies accordingly. Health Minister Prof Dr Yasmin Rashid says the government is set to establish seven Mother and Child Hospitals the worst performing districts of Bahawalnagar, Mianwali, Attock, Rajanpur, Layyah and Muzaffargarh and a Centre of Excellence at Sir Ganga Ram Hospital in Lahore.
“No amount of health infrastructure can meet the curative healthcare needs of children unless it is complemented by a primary focus on preventive healthcare,” said Prof Dr Masood Sadiq, the dean at the Children’s Hospital and Institute of Child Health, Lahore.
Considering three mega hospitals in Lahore, Multan and Faisalabad are already providing healthcare services to child patients, he says, the government’s decision to set up seven Mother and Child Hospitals of 200-beds each with 120 beds dedicated for mothers and 80 for children will make a real difference in ensuring quality healthcare to the children. “Two mega hospitals are also planned for Bahawalpur and Rawalpindi,” he says.
Prof Sadiq says the University of Child Health, for which a draft bill has reached the provincial cabinet, will provide services for treatment of child illnesses as well as research and development human resource. “A College of Pediatrics and a Nursing College of Pediatrics will also be established as constituent institutions under the varsity,” he added.
Prof Masood Sadiq says the current situation with regard to child health is not very encouraging. “We are still struggling to achieve full coverage of preventive vaccination, nutrition, sanitation and water supply. “More than 40 percent of all children are suffering from stunted growth,” he says. He adds that the ratio of stunted children is more or less the same in all provinces.
Prof Sadiq also stresses the need to control the population. He warns that infrastructure and facilities will eventually fall short if the population keeps growing and a preventive approach is not adopted simultaneously.
According to official statistics, as of 2020 children aged up to 14 years form 34.8 percent of the 220.9 million population.
While population growth rate declined from 1.92 in 2015 to 1.86 in 2017, Pakistan still has the highest population growth rate in South Asia after Afghanistan.
The Expanded Programme on Immunisation (EPI) to vaccinate all children under two years of age against eight vaccine-preventable diseases i.e. poliomyelitis, tuberculosis, diphtheria, pertussis, measles, neo-natal tetanus, hepatitis B and Hib meningitis ad pneumonia is crucial to reducing infant and child mortality.
Pakistan and Afghanistan are the only countries now endemic with polio. The progress made in recent years was reversed by a halt in vaccination due to Covid-19 pandemic. There have been 80 confirmed wild poliovirus cases so far this year in addition to 83 circulating vaccine-derived poliovirus type 2 (cVDPV2) cases. The anti-polio campaigns, however, have resumed after a break of eight months.
Dr Salman Kazmi, the Young Doctors’ Association (YDA), Pakistan, general secretary, stresses the need to promote health education in schools with a view to reducing child mortality and improving child health indicators. He says the doctors at Mayo Hospital, Lahore, in collaboration with the Punjab government have prepared a book, Health by Education, to create awareness regarding infectious diseases. “The book is available on Punjab Information Technology Board’s (PITB) e-learn, and Punjab Curriculum and Textbook Board’s (PC&TB) websites. “A revised draft of the book will be launched soon after addition of material on Covid-19 and other infectious diseases,” he says.
Minister Rashid says that Pakistan has to catch up with its UN Sustainable Development Goals commitments for the next decade. “We missed our targets for 2020. It is high time we plan to achieve the targets for the next decade,” she says. She says the provincial government has developed Punjab Health Sector Strategy 2019-29 to identify areas for interventions. “We are moving systematically towards improving the health indicators,” she says.
“We have identified districts that have been performing poorly on the indicators of mother and child health and devised special plans to meet those challenges, which include the establishment of Mother and Child Hospitals. The Insaf Health Card initiative is another intervention to achieve universal healthcare,” she says.
As health, economy and development are integrated, she says, “the emerging concept of One Health is the pivot around which we need to develop our development edifice. A modest beginning will be to devise work plans with definite targets to achieve the Sustainable Developments Goals.”
Universal Children’s Day will be observed on November 20; this year’s theme is: Children, Family, Health.
The author is a staff reporter for The News International.