Situation of Maternal Health: Pakistan

1. Situation of Maternal Health: Pakistan Dr. Nabeela Ali Chief of Party PAIMAN

2. Demographic Profile • Population 164 Million • Population Rural 67% • Growth Rate 1.9% • Total fertility rate 4.1 births • Contraceptive use 30%

3. Public sector hospitals 906 • Basic Health Units 5,290 • Population/Bed • 1,536 • Doctors 122,798 • Nurses 57,646 • Midwives 25,000 • Lady health Workers 96,000

4. Issues in National Perspective • Every hour in Pakistan: • Three women die due to maternal causes • Thirty newborn babies die in first month of life • Interventions needed to reduce maternal and newborn mortality: • Skilled Birth Attendance • Referral and transportation systems • Health facilities providing emergency obstetric and newborn care (EmONC) • Awareness of community on key health messages and behaviors.

5. Maternal Health Indicators Source: PDHS 2007

6. Key Women’s Health Indicators • There are almost 29 million women of reproductive age • More than 5 million women become pregnant each year • Three delays (in decision making, in transportation, and in receiving care) contribute towards high MMR of about 350-500 per 100,000 live births

7. Women’s HealthTrends in Pregnancy & Delivery • A large proportion of deliveries are conducted by unqualified personnel (62%) • Contraceptive Prevalence Rate is 30%-34% • Unmet need for FP is 33%

8. Where do we stand ? Source: Pakistan Economic Survey 2004-05

9. MMR by District, 1993

10. Urban Rural Gap – “One” Antenatal Visits Recommended Four Antenatal Visits !! • There is wide Gap between urban-rural for one antenatal visit • Further, it is required to have at least 4 antenatal • From 40% we have to reach 100% rural women seeking at least one antenatal visit Source: PSLSM 2004-05

11. Health – Human Resource Development Status Quo in the number of LHV, Midwives and Nurses

12. Correlation between neonatal mortality rate and SBA

13. We Pledged in September 2000 • The Millennium Development Goals Goal 4 Reduce child mortality by two third between 1990-2015 Goal 5 Reducing maternal mortality by three quarters between 1990-2015

14. MMR – per 100,000 live births 120 500 5 100 80 350 GAP 230 60 40 140 20 0 1990 2003/4 2015 Status of MDG - Maternal Health (Goal 5) Target 2015: 140 per 100,000 live births Current rate: 350 per 100,000 live births At current pace MMR in 2015: 230 per 100,000 live births

15. Can Pakistan Achieve MDG Goal 4 & 5 ?? • Is our progress since 2000 on track ? Slow • Will business as usual work ? No • Are extraordinary measures warranted? Yes Opportunity Window 10 years 2015 2000 2005 15 years for achieving MDGs

16. The triangle of death…… Unskilled birth attendants Traditional culture of birthing Lack of awareness Poor access to EmONC

17. Continuum of Care Scenarios TBA Family Skilled Attendant Nursing Care Obstetrician Poorly developedIntermediate Well developed

18. Rationale: Linking High Priority to SBA • More than 75% of deliveries take place at home in rural communities • The postpartum period is one of the most vulnerable for both mother and newborn, yet neither health programs nor mothers and families recognize this vulnerability. • For mothers, death at delivery, immediately thereafter, and during the first week of the baby’s life account for more than 60% • For newborns 50% of deaths are within 72 hours after delivery (The World Health Report 2005). • Add to this mounting death toll the stillbirths that alone total nearly 3.3 million annually.

19. Government’s Response To Achieve MDGs • MNCH Cell created in the Ministry • National MNCH Policy and Strategic Framework developed • Prime Minister endorsed the National MNCH Program in April 2005 • Islamabad Declaration unanimously adopted by Federal, Provincial, District Governments and development partners • PC-1 implementation started as of June 2007 • 12,000 Community Midwives (CMWs) to be trained in next five years.

21. Priority Areas • Community Midwives trained and placed in rural communities • Provision of Basic and Comprehensive EmONC services • Comprehensive family planning services • Nutrition interventions • National Program for FP & PHC • Creating awareness and demand for services

22. From Home to Hospital 3 Training 1 IEEC 5 6 Upgrade, Train 4 Upgrade, Train Transport BEmOC CEmOc BHU/RHC DHQ/ THQ Training 2 TBA CMW LHW Village Obstetric Emergencies (bypass RHC)

23. A Shared Responsibility

24. Challenges at Hand

25. CBI……. The Rationale … Low & Inequitable Distribution of Health Resources Population Served Health Expenditure Tertiary Hospital 1% 40% Secondary Health Care 9% 45% 15% PHC 90% (Source: P&D Division 1994) PHC Wing ,Ministry of Health

26. Health–Human Resource Development Status Quo in the number of LHV, Midwives and Nurses

27. Confidence in Public Sector Facilities? Quality issue lead to lack of confidence in Public sector which is resulting in high out of pocket expenditure for the poor Source: PSLSM 2004-05

28. Communication Challenges • Information gaps regarding MNH behaviors • Wide spectrum of population • Cultural barriers • Mass media penetration • Reaching out to women behind walls

29. Media Support Increasing awareness and demand for MNH services through communication strategies that empower individuals and communities to seek and expect quality MNH services Advocacy for positioning Safe Motherhood as a key human and development issue.

30. Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it is the only thing that ever has. Margaret Mead