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’.
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.