Present Perspective of Maternal and Neonatal Health in Pakistan and an Approach to the Problem through Primary Health Care

Abstract

The current status of maternal and neonatal health care in Pakistan is assessed and found to be grossly inadequate. Recommendations for improving the delivery of health care services are provided. In Pakistan most health care programs were initiated by voluntary groups. The public assistance health care system is underfinanced and provides inadequate coverage. Community participation in health care is minimal, and most Pakistanis take a fatalistic attitude toward illness. During the colonial era, little effort was made to provide health care for those unable to afford the services of private health care professionals. Since the colonial era some progress has been made in health care services but much still remains to be done. Most medical care is still provided by private clinics for a fee, and there is only a small network of social security health services. Health insurance is available for only a small segment of the population. Public expenditures on health, including medical education, amounts to only 1% of the gross national product. Studies indicate that total pregnancy wastage was 200.81/1000 fetuses in 1963-65, the infant mortality rate was 105/1000 live births in 1978, and the present maternal mortality rate is 6-8/1000 births. 99% of all deliveries occur at home, most of which are attended by traditional birth attendants. There are about 25,000-30,000 traditional birth attendants, but only about 3000 are trained. There are approximately 43,000 hakims and 13,000 homeopaths. At the present time, there are 858 maternal and child health centers, but 16,800 are needed. If minimal health needs are to be meet by the year 2000 a total of US$7630 million will have to be expended. The achievement of the projected health care services and facilities for the year 2000 is dependent on the development of a strong political will committed to the improvement of health conditions in the country. The type of health care system that will probably emerge in Pakistan will incorporate a public assistance health system, a private sector system, social services agencies, voluntary agencies, and limited comprehensive health insurance pplans. Pakistan still needs to develop an integrated health plan. International agencies, by staging appropriate workshops and conferences, may be able to stimulate the development of commitment to improve health conditions among Pakistan's health professionals and policy decision makers.