Child Health Consultations

It is indeed a pleasure for me to be here this morning as we focus on one of the most important elements that affect the social and economic welfare of any nation: healthcare; and maternal and child health in particular. I am glad to see distinguished policy-makers from all levels of government, academicians, health administrators, the private-sector, civil society organizations, international organizations and donors all assembled here for this discussion. Everyone has an important and unique contribution to make and we are pleased to be part of this Consultation as we create a vision, design a strategy and define concrete actions to improve maternal, child and family health care for all.

Pakistan has made great strides in improving access to health services. People have more opportunities to receive health care services than ever before and the private sector is playing an increasingly important role in expanding the availability and quality of these services. This is evident in these and other statistics. For example, in 1961, the infant mortality rate was 139 per 1,000 live births. Today that rate is 91. The life expectancy has increased by 9 years for women and 7 years for men. Pakistan has made progress in reducing population growth, and the contraceptive prevalence rate has increased from 5.5 percent in 1968 to 23.9 percent in 1998. The total fertility rate, or the average number of children born per woman, has also declined from 6.4 percent at the beginning of the decade to around 4.8 percent by the year 2000. And, the national immunization rate has increased to 52 percent.

Although Pakistan has made notable progress in some key health indicators, preventable and treatable diseases -- that primarily affect young children and women of reproductive age -- still account for a predominant share of the country’s high mortality and morbidity rates. Health status and quality of life are not only affected by the presence and availability of health services, but also by social, cultural, economic and political factors as well.

Pakistan faces a daunting set of challenges at the start of the new millennium: a rapidly growing population, the need to compete in a global economy, and the necessity to steer a political course that will ensure peace and prosperity for its citizenry. A healthy population is key in addressing these challenges. Yet, Pakistan’s social and health indicators rank among the worst in the world. Pakistan ranks 129th out of 174 nations on the Human Development Index. About a third of the population lives below the poverty line, despite an economic growth rate of 5-6 percent on average between 1960-1990. Pakistan ranks 82nd out of 94 countries on the Mother’s Index, and is ranked 118 out of 140 countries on the Girl’s Investment Index.

The Social Action Program (SAP), which started in 1992, focused on increasing government expenditures on basic social services (education, health population, rural water and sanitation), institutional reforms, and improved governance and accountability. Social spending has unfortunately declined and now rests at pre-SAP levels; thus, there is a need to put more resources in social services and institutionalize the reform process.

The Government has recently taken a number of important steps to stabilize the economy, correct the fiscal deficit, re-establish confidence in public institutions, and create new public/private-sector partnerships which often tap the substantial capabilities and resources of the NGO community. These measures have helped improve the quality and availability of health care services. In parallel with its macroeconomic stabilization program, the Government has also developed a comprehensive program for structural reforms as part of the Poverty Reduction Strategy. Addressing social sector issues is becoming increasingly important in this context and we are pleased to see new strategies in health and education that reflect the Government’s commitment.

While progress has been made in a number of areas and programs, however, there still exists a critical need for increased access to and improved quality of health services especially for women and children – reproductive health, family planning and maternal and child health services. The maternal mortality rate, high percentages of deaths due to induced abortion and low-levels of female literacy indicate that we need to re-energize our efforts to address women’s health needs. Until women are more empowered to make their own choices, and until both women and men can participate in a dialogue about their reproductive health and family planning needs, little will change in the social and health indicators. Needs exist in every aspect of reproductive health and in empowering family and communities to enable them to access services and make informed choices. Therefore, the challenge ahead is to respond to the health needs of the women and children through a holistic and integrated approach, and link them to the social interventions – literacy, economic empowerment and gender programs.

This Consultation, over the next three days, will hopefully focus and reinvigorate public and private-sector efforts to improve the health of Pakistani women and children throughout the country. Several challenges must be successfully addressed if we are to achieve that goal. First, public sector expenditures on health care must increase. Currently, this figure has been reported to be only between 2 to 3 percent of the national budget, which is low by any measure in any country of the world. We cannot expect to make measurable and continuous progress in any of the key health indicators without a substantial increase in public expenditures. A more rationalized national budget allocation process that provides provincial and district government greater authority to plan and program resources will also make government health expenditures more effective in delivery health care services.

Second, we need to pursue innovative public-private sector partnerships – which include NGO service providers -- to improve the quality of health care services and ensure they reach the poorest segments of society. Third, we need to view health in the context of the broader social issues, such as women’s empowerment and the status of women. We should pursue opportunities to link to other programs -- such as income generation, education especially for women and girls – to improve the women’s status in society and empower her to make informed decisions about her health and that of her family. Finally, we should continue pursuing the current health care reform agenda to improve the health system structure so that there will be better delivery of quality health care services.

For over three decades, the United States has supported development efforts in Pakistan through USAID. Though our office closed in 1994, USAID continued to support Pakistan’s efforts to improve social sector services through the Pakistan NGO Initiative. In July of last year, USAID returned to Pakistan and I am pleased to announce we will work together with those in this room and many others to help meet the country’s goals and objectives in the health sector, especially as it relates to women and children.

This consultation provides USAID an excellent opportunity to hear first-hand -- from stakeholders to development partners -- what are the issues and challenges and what would be the best way to approach them in the medium and long-term. Your input over the next three days will play a critical role in shaping USAID’s health. We are here to listen to you and seek your input as to how best support your endeavors in improving the health status of the families and communities, reducing maternal and child mortality. Your participation in the meeting reflects your commitment to Pakistani women and children, and a commitment to work towards improving women’s status and services for women and children. Investments in maternal and child health will have an impact beyond improving women’s health, that of their children. It will also empower and strengthen families and communities. It’s the first step that lays the foundation for all others. And, we look forward to working with you all in this endeavor.