CHILD HEALTH IN PAKISTAN

Achieving MDG 4
CHALLENGES & PROSPECTS

Community Health nursing 4th year

OBJECTIVES
Current status of child health in

Pakistan
Goals and progress related to MDG 4
Gaps
and
priority
areas
for
interventions.

Background
10 million children die per year*
Half of deaths in only six countries
Pakistan ranks number 4 *

Ref Ahmed & Lopez, WHO bulletin 2004

Hill & Pande, UNICEF report 2002

10 million children die in the world every year

Pakistan among top 5 in the world for no of child deaths

565,000 under 5 deaths every year

IMR comparison
Pakistan

78

India

63

Sri Lanka

13

Bangladesh

46

Malaysia

Angola

198

Singapore

2.28

Pakistan ranking is 175 out of 208

143 countries have IMR<50
Ref: State of the world children, 2005, UNICEF

 Population 160 million

45% children
5 million births

I M R 78
<5 MR 98

Millennium Development Goals

UN Millennium Summit in 2000

147 heads (the largest ever gathering of heads of

the states in the world), 189 states adopted UN
Millennium Declaration
to address health and development in many
dimensions income, hunger, disease, lack of
adequate shelter, and exclusion while promoting
education, gender equality, and environmental
sustainability
with quantitative targets set for 2015
review of progress in 2005

MDGs 1 8
Goal 1: Eradicate extreme poverty and hunger
Goal 2: Achieve universal primary education
Goal 3: Promote gender equality and empower
women
Goal 4: Reduce child mortality
Goal 5: Improve maternal health
Goal 6: Combat HIV/AIDS, malaria and other
diseases
Goal 7: Ensure environmental sustainability
Goal 8: Develop a Global Partnership for
development

Health related MDGs

Baseline, targets & current status
MDG
indicator

Baseline
1990

Current
status

Target
2015

Immunization
cover

50%

47%

>90%

Under 5 mortality

140

103

52

IMR

110

78

40

MMR

550

278

140

Births SBAs

18%

24%

90%

HIV prevalence

<0.1

<0.1

<0.1

25%

85%

TB cases detected
& cured

PROGRESS IN IMR
110
78

55

40

1990

2006

2015

Current rate of change= 2.10/yr

Required rate of change=3.40/yr

Ref: MDG Report Pakistan

GAPS
Universal first level care
Backup cover
Human resource development
Facility development

Financial input
Health delivery systems

Ref: Inventory of health & population investment Pakistan 2004.

Factors leading to Mortality

Poverty
Illiteracy and lack of awareness
High population growth rate
Inadequate resource allocations
Poor coordination
Quality of health care services
Ineffective referral systems
Lack of essential health research

Causes of Mortality
33%
22%

21%
12%
9%

Diarrhea

Pneumonia

Malaria

Ref: Robert & Black 2003, Lancet

Neonatal
causes

Others

Priority interventions
Neonatal health
Financial resources
Primary health care strengthening
Population

Neonatal Care
2/3 of all under five deaths are during
the first year of life
2/3 of all deaths in first year are during
first 28 days of life ( neonatal/newborn
period)
2/3 of all newborn deaths are in first
week of birth

Infant mortality rate has declined in last decades but

neonatal mortality rate in Pakistan has stayed constant

200

178

Infant m or tality r ate

Neonatal m or tality r ate

157
141

150

145

136

125

100

94

85

120

114
95

81

78

84

84
63

57

50
0

1950-4

1960-4
1955-9

1970-4
1965-9

1980-6
1975-9

59

55

50

1992-98
1987-91
1999-2003

Determinants of Neonatal
mortality in Pakistan
Less

Moderate

Most

Lack of Education
Lack of maternal empowerment

High fertility rate and short birth interval

Poverty

Gender inequality
Poor quality of PHC

Poor quality of secondary care

Poor quality of tertiary care

Poor referral systems

Fatalism

Ref: Bhutta et al, MCH in Pakistan 2004

20

Current Approach to
Reduction of Maternal
and neonatal
Mortality

Public Sector Expenditure on Health

(Federal and Provincial)
Year

Recurring

Developmen
t

Total

% of GDP

1996-97

11,857

6,485

18,342

0.8

1997-98

13,587

6,077

19,664

0.7

1998-99

15,316

5,492

20,808

0.7

1999-00

16,190

5,887

22,077

0.7

2000-01

18,337

5,944

24,281

0.7

2002-03

22,205

6,609

28,814

0.8

2003-04

24,305

8,500

32,805

0.8

2004-05

33,000

8,500

41,500

0.6

THE 18 US $
GHE 6.4 US $
OPE 11.6 US $

recommendation US $ 34

24

Current Approach to
Reduction of Maternal
and neonatal
Mortality

RESEARCH PRIORITIES
Burden of Disease & descriptive
epidemiology
Mortality in hospital & community
Regional data
Role of malnutrition in childhood mortality
Burden of disabling diseases

CONCLUSIONS
Indicators of child health status in Pakistan

are poor and Pakistan is lagging behind in

achieving MDG 4
Prioritizing neonatal care can result in
tangible improvement
Enhancing Primary Health Care system can
bridge the gap
Increased financial allocations will be required
to reach the targets

CONCLUSIONS
Rapid growth in population has a negative
impact on achieving MDG 4
Appropriate research and evidence based
interventions are needed to achieve the
required pace.