Maternal, Neonatal and Child Health in Pakistan: Towards MDGs by moving from desire to reality

1. Maternal, Neonatal and Child Health in Pakistan: Towards MDGs by moving from desire to reality Dr. Farooq Akhtar National Program Manager National MNCH Program

2. Background 10 million deaths of children below 5 years 4 million are neonates Pakistan�s neonatal mortality rate is 54/1000 live births- 57 % of under-five mortality Contraceptive Prevalence Rate is 30% Deliveries Assisted by SBA 39% Constraints to achieve MDG 4 and 5 Government launched National MNCH Program To promote access to evidence based cost effective interventions

3. Objectives This paper reviews Implementation of program Likelihood of attaining the MDG4 and 5 targets & Provides Strategic Directions for scaling-up program implementation

4. Methodology Review of more than 25 documents and national surveys PDHS 2006-2007 MNCH PC-1 National Health Policy 2001 and draft 2010 Pakistan MDG reports Pakistan Social and Living Standards Measurement Survey 2005-6 Documents addressing MNCH policies, strategies WHO/UNICEF/UNFPA/World Bank

5. STATUS OF NEONATAL & CHILD HEALTH

6. Status of Maternal Health

7. SUMMARY: STATUS OF MATERNAL AND CHILD HEALTH Improvement in ANC Deliveries attended by SBA remained low CPR stagnated at 30 percent IMR , under 5 mortally- still high Only 47 percent children fully immunized Exclusive breast feeding- 37 percent

8. Reduction in mortality in 16 years, attained gains and required improvements to achieve Millennium Development Goals (MDGs) 4 and 5 by 2015

9. Neonatal, infant & child mortalities

10. Main Findings- Mortality Pace of reduction in IMR, NNMR and U5MR over the past 16 years was relatively slow Lowest gain was associated with neonatal mortality MMR was on track Reduction in U5- due to decrease in post neonatal (1-11 month) & Child deaths (1-4 years) NNMR (<1month) showed insignificant changes >57% of U5MR on average

11. Disparity in MNCH Services MNCH Services offered at First-level care facilities (FLCFs) managed by health sector, were not comprehensive in terms of RH and FP FLCFs managed by MoPW were less comprehensive in providing EmONC & essential newborn care services

12. Challenges and Solutions MDG 4 & 5 Vaccination Coverage of >90 percent Scaling-up IMNCI, essential newborn care & PNC >90% Accelerate reduction in neonatal mortality Increase SBA assisted deliveries Operational Pre-requisites: Training & deployment of 30,000 CMWs within 5 years Equipping and manning 1200 referral facilities for 24/7 EmONC services

13. Conclusions Despite tangible progress, Pakistan is lagging behind other countries to reach set MDG targets by 2015 We can timely achieve MDG if the reported reduction in MMR is sustained and accelerated (CPR, SBA, EmONC) Prevention of unplanned pregnancies can avert one quarter of maternal deaths Major focus needs to be directed to health system strengthening The U5MR and IMR will make a real breakthrough when stagnating NNMR is addressed effectively

14. Way Forward To scale-up prospected range of maternal and child survival interventions Strong focus on the production & deployment of CMWs linked to health system Major improvement of RH and FP Services Support of strong partnership & active community participation

15. Thanks !