LAHORE: More than 41 per cent of births in Punjab are handled by ‘unskilled birth attendants’ as over 45 per cent of the posts of medical officers (MOs)/women medical officers (WMOs) are vacant at primarily healthcare facilities of Punjab.

According to ‘Integrated Reproductive Maternal Newborn and Child Health and Nutrition Program Emergency Obstetric and Newborn Care’, a report by the Punjab government, there is a limited supply of technology intensive services for urban conglomerates while in the rural areas there is a shortage of qualified practitioners.

Take a look: Children giving birth to children in Pakistan

It says skilled birth attendants play a crucial role in protecting lives of mothers and newborns through clean and medically-sound delivery practices, early identification and prompt management of complications.

Punjab being the largest province houses 56 per cent of the total population of the country and situation is being said to be much disturbing as government hospitals in rural areas lack delivery and labor room facilities.

As more than 45 percent of the sanctioned posts of the MOs and WMOs have yet to be filled, ‘paramedics’ largely attend the sick women and children at government healthcare facilities.

Filling the positions appears to be an unending problem for the health managers. One of the major factors behind the vacant positions is that the health department has failed to enforce a police under which every postgraduate is to work for three years at rural health centres (RHUs) or basic health centres (BHUs) shortly after completing training at teaching hospitals.

Resultantly, several RHCs and BHUs have been lying dysfunctional due to the shortage of doctors and basic infrastructure.

According to official statistics, the government had sanctioned 2,613 posts of MOs/WMOs for RHCs and BHUs of the province, of which 1,099 have been vacant for the last a decade or so.

The shortage of doctors has hit hard south Punjab districts as government’s major focus is on tertiary care hospitals of the provincial capital.

Take the example of Muzaffargarh. Of the 98 sanctioned positions of MOs and WMOs for BHUs and RHCs, 82 seats are vacant. Of the 98 sanctioned posts of BHUs and RHCs of Multan district, 88 have yet to be filled. The same is the situation of Layyah BHUs and RHCs where of the 48 seats, 37 have yet to be filled.

“Despite relative affluence, the analysis reveals a dismal picture of woman and child health in Punjab”, the report states reviewing the available health facilities for sick women, the frail segment of society.

Punjab is far behind the targets set for 2015 under the millennium development goals (MDGs) to reduce maternal and newborn deaths.

According to the Multiple Indicator Cluster Survey, 74 per cent of women in Punjab receive only one antenatal care visit from skilled birth attendants during pregnancy; this reflects missed opportunities for identifying and managing high risk pregnancies. Additionally, with more than 41 per cent of births attended by unskilled attendants, the risk of delivery-related complications among mother and child are compounded.

The report says the maternal mortality rate (MMR) for Punjab (227 per 100,000 live births) is still high when compared with neighboring countries of South Asia.

“The high total fertility rate and MMR in the province are also indicative of the fact that the experience of pregnancy and other reproductive health related aspects among women in Punjab predispose them to a high risk of morbidity and mortality”, it said.

The report also highlights nutrition influence on the health status of women and children.

Globally, 26 per cent of children under the age of five years are moderately or severely malnourished. In Pakistan, 37 percent of children under the age of five years are underweight for age, among which 12 percent suffer from severe malnutrition, 37 percent are stunted and 13 percent suffer from wasting.

“In Punjab every third child below the age of five is estimated (34 per cent) to be underweight”, the report said. It said the women and children in Punjab also suffer from high rates of deficiencies in essential vitamins and minerals.

“To understand the health status of children (those less than 5 years of age), the infant mortality rate and under 5 mortality rate (U5MR) are considered to be the key indicators for assessing the health in this age group in a population”, the report states.

It says the infant mortality rate is 82 per 1,000 live births for Pakistan and 77 for Punjab as compared to 41 in Indonesia and 15 in Sri Lanka.

The U5MR for the Punjab is estimated to be 94 per 1,000 live births. These translate as one in every 13 children born in the province does not survive till the first birthday.

According to the report, direct obstetric causes such as postpartum hemorrhage, sepsis and complications of abortion are responsible for close to 50 per cent of maternal deaths. A majority of these maternal and early newborn deaths can be avoided by provision of prenatal, delivery, postnatal and newborn care services within reasonable travel distance and travel time.

For an immediate relief to the pregnant women, the Punjab government has planned to make functional 550 BHUs under 24/7 programme by providing 24 hours delivery/labor room facilities.

“This snapshot of health status indicates that Punjab is far from achieving the health related MDG targets”, the report states.

Published in Dawn, May 16th, 2015

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