Situation Analysis of Millennium Development Goals 4 & 5 : Pakistan’s Perspective

Millennium Development Goals [MDG] are being pursued since the year 2001, to scale up the critical health and development indicators for the world population. In this article we aimed to describe and explain the status of maternal and child health in Pakistan, in the light of MDGs 4 & 5 with their corresponding targets and indicators. Secondary data has been used to analyze the achievements or relative letdown in MCH sector in Pakistan. Though over the last two decades, maternal and child health indicators have been improved here, but still big challenges remain. At present, the under-5 mortality rate has fallen by 24% and maternal mortality ratio is halved since 1990. Pakistan is found to be 83% & 100% off track towards MDG 4 & 5 respectively. (ASH & KMDC 19(2):91;2014). Invited Review 91 ______________________________________________________________________________________________ Department of Community & Family Medicine, College of Medicine Taibah University Al Medinah Al Munawara, Kingdom of Saudi Arabia Correspondence: Prof. Farah Asad Mansuri Professor of Community & Family Medicine, College of Medicine Department of Community & Family Medicine, College of Medicine, Taibah University Al Medinah AlMunawara, Kingdom of Saudi Arabia Email:[email protected] Introduction Integrated global efforts have been successfully taking place over a half century to improve life on earth and human longevity worldwide. In the same wake, during September 2000, the world leaders at the United Nations committed to work together for a safer, prosperous and equitable world by deriving eight Millennium Development Goals through its 21 targets and 60 indicators, which are to be achieved by the year 2015. These goals were set in order to combat poverty and hunger, illiteracy and injustice, disease and deaths and environmental degradation. The Goals 4, 5 and 6 respectively address, reduction of child mortality, improving maternal health and control of HIV/AIDS & malaria. Some modification in the structure of Goal 5 was introduced later on, realizing the fact that the reduction in maternal mortality cannot be achieved unless universal access is ensured among reproductive health seekers. Therefore the specific target on reproductive health (known as target B), for universal access to reproductive health was included in the original structure of MDG 5 and that overarches the goal of improving maternal health. An explicit attention of the health policy makers and health technologists is more than ever required to monitor progress in these critical health areas. Under the health related goals of 4, 5 and 6, a total of 18 progress indicators in health sector have been identified to assess morbidity and mortality rates. These indicators are infant mortality rate, Under 5 Mortality Rate (U5MR), Maternal Mortality ratio (MMR), HIV prevalence in youth and deaths due to measles in less than 4 year old etc. To date 1.3 years remain for achieving MDGs targets which seem an unaccomplished task for many other countries. Globally, child and maternal mortality have been reduced to 50% since 1990. This significant improvement in health indicators Annals Abbasi Shaheed Hospital & Karachi Medical & Dental College 92 have been achieved unevenly for some countries but developing countries including Pakistan is way behind the target. It does not mean that developing countries are only to blame for this failure but the developed countries also lack an arching financial and technical support in meeting these targets. Out of a survey of Public health practitioners of 77 countries, 51% were found to be fully agreed on positive statement for MDGs achievement whereas 40% partially agreed. Pakistan has the third highest burden of maternal, fetal, and child mortality. It has made slow progress in achieving the MDGs 4 and 5 and in addressing common social determinants of health. The evidence shows that 52 (77%) out of total 68 countries with highest burden of child mortality, will not achieve MDG 4 by 2015 and regrettably, Pakistan is one of them. A very negligible change is marked in child mortality despite of recruiting huge force of LHS/LHW during last decade. Similarly, Pakistan is off track for all the five indicators of improved maternal health (Goal 5). One of the study mentioned that Maternal Neonatal Child Health (MNCH) has been functional only in 48% of the tertiary level care facilities in our country. The importance of introducing MNCH further endorsed by the fact that over 40% of global neonatal deaths take place in central south Asian sub-region and it presents a formidable challenge for near future with lack of political stability and security in such countries. Pakistan, like many other developing countries has been struggling hard to make improvements in maternal and neonatal health, through some interventions like community or lady health workers (CHW), lady health supervisors (LHS), Antenatal care, MNCH, Community Midwives (CMW) and Skilled birth attendance etc. Despite of adopting preventive approaches, the main constraints for lack of success of MDGs 4 & 5 found in Pakistan, are inequitable interventions and lower skilled birth attendants’ coverage. In a study on 68 priority (fast Track) countries for countdown towards 2015, it was found that only 19 countries were on track to meet MDG 4 whereas 47 showed acceleration in the yearly rate of reduction in mortality of children younger than 5 years, and in 12 countries progress had decelerated since 2000. This study concluded that progress towards reduction of neonatal deaths has been slow, and maternal mortality remains high in most Countdown countries because of existing disparities in the coverage of interventions between and within countries. Our country has to face an uphill task in meeting these set targets of MDG 4 & 5 now by 2020, probably by mitigating the fragmentation in implementation of MNCH/Reproductive Health (RH) and Family Planning (FP) services. It is highly imperative not only to attain these MDGs but also to sustain its pace in the post MDG period with recent changing responsibilities from Federal to the Provincial health systems. Progress towards MDG 4 The Goal 4 demands a reduction of child mortality to 2/3 rd of its global average, between the year 1990 & 2015. Five out of the total 6 indicators (83%) of child health are not met uptil now in Pakistan. The only achievement made is cutting down the proportion of diarrhea to 8% in 2013 from 26% during 1990-91, among less than 5 years old and stands promising to bring U5MR further down. The current Infant Mortality Rate (IMR) of 74 per 1,000 live births in Pakistan is lagging behind the MDG target of 40 per 1,000 live births. But it has reduced nearly to 27% in last couple of decades. The number of deaths decreased from 102 to 77 deaths per 1,000 during 1990/91 and 2001/ 02. However, in last decade, it has only reduced from 77 to 74 deaths per 1,000 live births. Whereas, under -5 mortality rate has been reduced by 24% during this period, and currently reported to be 89 per 1000 live birth. Both U5MR & IMR are thought to be relatively decelerated in last few years as compared to early years. Regarding immunization status, 80% of the children 12-23 months are fully immunized and 81% Volume No. 19 (2), December 2014 Farah Asad Mansuri