KARACHI, Nov 14: Only a well-trained and fully committed workforce provided with quality interventional tools and adequate incentives in addition to recognition of health initiatives by the government and community can ensure achievement of improved mother and child health status as required under the millennium development goals determined by the comity of nations.

This was summed up at a seminar by three different groups comprising health administrators and practitioners, politicians, members of civil society, representatives of non-governmental organizations and the media after detailed deliberations on issues related to health services for mothers and infants, their mortality rates, family planning initiatives and immunisation coverage, on Friday.

The exercise was a part of the Pakistan Demographic and Health Survey-2007 (PDHS) dissemination seminar, being held with the support of the United States Agency for International Development under the aegis of the National Institute of Population Studies (Nips), to involve decision-makers at the district level to help improve health status of children and mothers in Sindh and Balochistan.

Before the group discussion and formulation of final recommendations, Executive Director of Nips Mohammad Ali Afridi, Syed Mubashir Ali of the PDHS and Dr Zafarullah Gill apprised the participants of findings of the survey and the issues related to health, education and family planning.

They highlighted the importance of evidence-based decision-making for implementation of health and population programmes. It was said that the PDHS (2006-07) was the country’s largest household-based survey involving 95,441 households and 10,023 ever-married women of age ranging between 12 and 49 years. The survey sample provided estimates for Pakistan as a whole, for urban and rural areas, for each province excluding the federally-administered tribal areas and northern areas, as well as restricted military and protected areas.

According to the survey, an average household in the country consists of more than seven persons and 92 per cent of the households are headed by men. Almost all urban households (98 per cent) have electricity as compared to 84 per cent of the rural households.

Overall about 30 per cent households do not have toilet facilities with the highest proportion (43 per cent) in Balochistan. Two-thirds of urban households use piped water as compared to only 24 per cent of rural households. Hand pump, tube-well and borehole are the major sources of drinking water in rural areas.

‘Over 50pc women uneducated’

More than half of women and 30 per cent of men above five years in the country have never attended school. Seventy per cent women and 46 per cent men in Balochistan are uneducated.

Fertility has decreased steadily since 1984 from six children to 4.1 children on average. Women in the NWFP and Sindh have 4.3 children compared with 3.9 children in Punjab and 4.1 in Balochistan. Half of the surveyed women got married after reaching 19.

The rate of family planning has tripled over the last two decades but has been on a constant decline for the last few years. Now the contraceptive prevalence rate is 30 per cent slightly less than what was in 2003 (i.e. 32 per cent), according to the survey report. Twenty-two per cent married women use modern methods for family planning, lagging behind India and Bangladesh where 49 per cent 47 per cent married women use the modern methods. Under the millennium development goals the rate of contraceptive use needs to go up to 55 per cent by 2015.

There is a large gap between contraceptive knowledge and use, as 96 per cent married women know about it but the use is as low as 14 per cent in Balochistan, 25 per cent in the NWFP, 27 per cent in Sindh, and 33 per cent in Punjab.

Vaccination, mortality rates

The survey shows that 47 per cent of children between 12 months and 23 months when surveyed had received all recommended vaccines-one dose of BCG, three doses each of DPT and polio, and one dose of measles. However, there is a marked variation in its coverage in different provinces – ranging from 35 per cent in Balochistan to 53 per cent in Punjab. Since 1990 the coverage has reduced by only three per cent and the 90 vaccination target of MDGs by 2015 seems very difficult to achieve particularly when widespread diarrhoea and pneumonia still prevails.

About infant and child mortality rates, the participants of the seminar were briefed that children mortality had decreased in the past 20 years but it remained relatively stable since 2003. At present the rate for the five-year infant is 78 deaths per 1,000 births and the under-five mortality rate is 94 deaths per 1,000 births. The country needs to bring down the rate to 40 by 2015 under the millennium development goals.

The maternal mortality rate, which was 533 deaths per 10,000 live births in 1990, has been reduced to 276 deaths. However, it needs to be further slashed to 140 by 2015.

Later, one of the discussion groups noted that education of families and public opinion leaders’ support for family planning as well as improvement in the service delivery for women should be ensured on a priority basis to reduce mortality rate effectively.

Another group tasked with formulation of recommendations for improved polio immunisation observed that the coverage could be increased by ensuring posting of better skilled and dedicated teams of vaccinators, payment of better salaries, protection of field workers so that they could visit all areas without any fear.

Representing another group, the director-general of health services in Balochistan, Dr Amanullah Khan, said that lack of skilled manpower was a serious problem.

An official from Sindh said that engagement of routine government vaccinators in national and sub-national immunization activities against polio virus was also a matter of concern as the staff got relatively less time to discharge routine immunization duties. Besides, efforts should also be made to make aware health officials, media and community leaders of the latest updates on the subject of vaccines and their utilities.

Sindh MPA Humera Alwani, who was the chief guest, noted that coordination required between the health and the population welfare departments towards management of various issues pertaining to women and child health was missing. She said that all the stakeholders should realize the issues and own the related programmes and initiatives to work for a better future.