Dawn Editorial 21 September 2019

Maternal and child health

A MOTHER or her newborn child dies every 11 seconds in some part of the world, according to a new report published by affiliated agencies of the United Nations. Most of these deaths occur in regions where access to healthcare remains a challenge, even though globally since 2000 the rate of neonatal morbidity has halved and the number of maternal deaths has reduced by a third. Housing about a quarter of the world’s population, South Asia remains one of the most problematic regions with regard to maternal and child health. According to a Lancet report, stillbirth and neonatal mortality rates are about twice as high in South Asia as in sub-Saharan Africa. When it comes to Pakistan, unfortunately, the country has the highest rate of newborn deaths in the world and one of the highest maternal mortality rates in the region. A 2018 report by Unicef stated that one in every 22 babies born in Pakistan dies within a month. The report further said that more than 80pc of newborn deaths would be preventable, given good nutrition, hygiene and access to well-trained midwives.
Adequate sanitation and the provision of adequate healthcare in Pakistan has always remained a challenge. However, in the past couple of decades, the problem has been compounded by a rapidly increasing population (Pakistan is the sixth-most populous country in the world), making the distribution of resources and doctors even more difficult than it was before. Unfortunately, it is characteristic of politics in Pakistan to pay little heed to the people’s actual needs — health, education and security. Successive governments introduce health schemes, usually towards the end of their tenures to gain popularity, but the overall approach towards subjects like health and education remains nonchalant. The PTI leadership has succeeded in making headlines by announcing the Sehat Insaf card early in its tenure, but that seems to be the extent of work put into improving the provision of healthcare. If the PTI-led government intends to bring some real change at all, it must shift its focus from ‘accountability for all’ to ‘healthcare for all’.


IMF impressions

FOR a number of days, a senior delegation from the International Monetary Fund, consisting of a director and the mission chief, made the rounds in Islamabad and Karachi, gathering impressions of how the implementation of the IMF programme has been going thus far. They met government leaders and opposition politicians, as well as the State Bank leadership, business stakeholders and the media. After their round of meetings, Mr Jihad Azour, the director of the Middle East department of the IMF, told media persons that the programme is “off to a good start”. This assurance alone is important because it should lay to rest all speculation that the visit was some sort of an emergency event due to slippages in meeting the targets. The team was clear that a formal review is scheduled for the end of October or early November, with the exact dates yet to be finalised, and that it is far too soon to start evaluating the programme’s success or failure. The most fundamental message of the team was for the authorities in Pakistan to stay the course; meanwhile, it was conveyed to the business elite and larger populace that without going through a difficult process of adjustment, the economy would not improve.
This much is fine. But the team also made some observations that merit further comment. In their assessment, there is a strong commitment to the programme and the reform targets envisaged in it at the topmost levels of the government. Mr Azour even said that the prime minister himself, whom he has met three times already, is very committed to the programme. We hope this is true, since sticking to a path of reform and not making further about-turns is important. Besides, Pakistan has little choice at this point in time but to continue and earn the Fund’s seal of approval after the first review, because meeting the Fund’s targets depend — crucially — on unlocking a large quantity of other financial assistance.
Ownership of the programme is critical to its success — there is no doubt about this. But if it is too soon to evaluate the programme’s success, it is also too soon to assess the quality of the ownership that the programme enjoys. Many of the more critical steps in the reform agenda have yet to be rolled out. All we have seen at the moment is a large macroeconomic adjustment, in the form of currency depreciation, high interest rates and a fierce tax effort launched since July. Many other steps, the real ones as a matter of fact, have yet to come. But those steps will require ownership beyond just the federal government level. The opposition parties, the provincial governments, and indeed the citizenry itself, have yet to be called upon to play their role. It is when that time comes that we will know how much ownership the programme actually enjoys.


Torkham crossing

THE launch of round-the-clock operations at Torkham — one of the two key trade and travel routes between Pakistan and Afghanistan, the other being Chaman in Balochistan — is one of the rare confidence-building measures taken by either side in recent years. The availability of day and night customs and immigration facilities at Torkham is expected to rapidly boost bilateral trade and make it easier for people travelling to and from Pakistan. The new data shows that the trade volume across Torkham has increased by about 55pc since upgradation of the border post early this month; hopefully, it should continue to surge in the months ahead. Similarly, the cross-border traffic of Afghans for medical treatment in Pakistan and for other reasons is also expected to jump once the government here upgrades its visa-processing section at its embassy in Kabul and reconstructs its Jalalabad consulate, which is in very poor shape because of being subjected to repeated militant attacks. Encouraged by early results from Torkham, a federal minister has hinted at the provision of round-the-clock immigration and customs services at Chaman too, if and when required.
Although the initiative was undertaken on the instructions of the prime minister, KP Chief Minister Mahmood Khan’s active interest in it expedited work on the project. Indeed, closer business ties with Afghanistan are an important aspect of the provincial economy. Brisk bilateral trade will help create new jobs in the region, improve public services and attract investment in transport and other infrastructure. China has already expressed its desire to set up cold chain facilities and a hospital at the border, and its foreign minister has spoken about Beijing’s plan to build a motorway connecting Peshawar with Kabul. This initiative could be a first step towards enhancement of regional connectivity. Peshawar as a regional trade hub could help Pakistan access the Central Asian markets for its export cargo once differences over road transit facilities through Pak-Afghan territory are resolved. Also, the goal of regional connectivity and improved trade ties cannot be achieved without concerted efforts from both sides to bridge their political differences. There has been a visible improvement in bilateral ties at the political level in recent months due to Islamabad’s efforts to convince the Afghan Taliban to sit across the table with the elected government in Kabul. Both countries should use this to build trust and an enduring relationship for the future of their people.

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