FIGURES from the Human Development Report 2014 show that where Sri Lanka loses eight infants per 1,000 live births, Pakistan loses 69. Doing back-of-the-envelope calculations, if we assume our population growth rate to be 2pc per annum, on a base of 180 million people this implies 3.6m births a year. Some 240,000-odd babies become part Pakistan’s infant mortality statistics each year.

In a nutshell, Pakistan loses 61 more children per 1,000 live births than Sri Lanka. It is true that the latter, with its gross national income per capita at 9,250, does have a much higher income level than we do (4,652). But, it is not just an issue of higher incomes. Vietnam with an income that is quite close to us has only 18 infant deaths per 1,000 live births, and Bangladesh (2,713), with a much lower income (2,713) level has only 33. Clearly, there is more to it than just national income.

Though higher income has an impact on human development indicators, the relationship is not a simple, direct one and certainly not linear. Bangladesh has better human development indicators than Pakistan, though its income level is much lower. Vietnam’s achievements on the human development side are impressive even though its income levels are only a little higher than ours.

Do the poor matter or not? The answer in Pakistan seems to be that they do not.

In almost all countries that are roughly at Pakistan’s level of income, the progress on reducing infant mortality has been more impressive than in Pakistan.

I am not comparing Pakistan to any developed, high-income country as that contrast would have been too stark and given the income differentials, people would have felt that developed countries are not really a good comparator for us. But, clearly, even in comparison to developing countries, our performance is not good.

Sri Lanka loses 35 and Vietnam 59 mothers per 100,000 live births — figures that come under the maternal mortality rate. We lose 260 mothers. Again, the same arguments apply. Given the number of pregnancies in Pakistan, this will be close to 10,000 mothers or so per annum.

These numbers of infant and maternal deaths dwarf the number of people we lose to terrorist and other incidents and accidents. But we focus a lot more on the latter than on infant and maternal mortality. Every year, when the human development indicators for Pakistan are launched and we see a dismal picture, we comment and move on. But these numbers require attention.

Given that we know that even at our income levels we can do a lot to reduce these numbers, not doing so seems to be criminal on the part of policymakers, policy implementers as well as the citizens of the country.

Though we can save the bulk of 200,000-odd infants and 10,000-odd mothers dying every year, we choose not to do so.

There is significant evidence that access to clean drinking water and sanitation facilities and access to pre- and post-natal care, nutritional supplements for mother and child, vaccinations for children and facilities for oral hydration in cases of diarrhoea can have a significant impact on reducing infant and maternal mortality.

Though these facilities do cost money (hence the connection with income), higher incomes do not guarantee the provision of these facilities. Even at relatively low incomes, it is possible for countries to provide many of these services. Vietnam is an example of this.

The real question then seems to be about policies and policymaking. Does the state have these priorities or not? Do the poor matter or not? And clearly the answer in Pakistan seems to be that they do not. It seems there are countries that have been more responsive to the needs of people than others.

Countries that have focused on education, social welfare, water and sanitation, basic health facilities, and public health; whether or not they have been high-growth countries, have been able to make significant progress on human development indicators. All high-growth countries have not been able to make rapid progress, and the explaining factor is the lack of people-centred policies. Do the majority, who happen to be the poor in most countries, matter or not? That is the question.

Our drinking water infrastructure is crumbling even in our biggest cities. In many places, the mixing of drinking water with liquid waste, the fecal-oral connection, has been reported repeatedly.

Waste management, whether of solids or liquids, is in its infancy even in the bigger cities. One of the more expensive housing colonies right in the middle of the city of Lahore still uses empty plots for dumping liquid waste. They are, even today, not connected to the main drains that have been laid by the Lahore Development Authority.

Many villages have started to look like dumps where plastic and other non-biodegradable solid waste has been accumulating for decades now. And most villages, of course, do not have any sewerage systems for the proper disposal of waste.

We have only mentioned a couple of variables. We could also have talked about the health costs of lack of proper services for adults, or the cost of being sick, of morbidity and birth defects. The story is going to be the same for each of these issues.

True, the focus on these areas may be politically motivated. Regardless, the issues of motorways versus water and sanitation, underpasses versus healthcare for the poor, schools versus metro systems are not trivial and should be thought through clearly by the authorities.

The cost of not investing in water and sanitation or basic health facilities is, among others, dead children and mothers. Most of these children and mothers happened to have been from poor families but does this make it more acceptable? When we are in a position to address this, by not doing so we all become killers of these children and mothers.

The writer is senior adviser, Pakistan, at Open Society Foundations, associate professor of economics, LUMS, and a visiting fellow at IDEAS, Lahore.

Published in Dawn, September 26th, 2014