The President's Task Force on Human
Development has proposed two
programs in health:
A majority of Pakistan's population extagen depends heavily upon government programs to meet its health care needs. Poor health care indicators such as maternal and infant mortality demonstrate that these needs are not often met. Preventable and communicable diseases are the major causes of high mortality rates and contribute heavily to the burden of illness in Pakistan.
The Basic Health Unit (BHU) is the institutional mechanism for the delivery of Primary Health Care in rural Pakistan. BHUs are presently ineffective in providing large scale primary health care. Most BHUs are mismanaged and only meet the needs of less than 40% of the population of Pakistan.
The Task Force conducted an analysis through workshops and individual interviews, of the current delivery capacity and coverage of primary health care. The Task Force's analysis highlights limited access as one of the major shortcomings of the primary health care system. The Task Force suggests policy interventions and recommends a Primary Health Care Program (PHCP) to improve access to care.
Community based preventive health programs that leverage indigenous resources provide the model for the Primary Health Care Program (PHCP). This program will eventually reduce the government's burden for the provision of primary health care services. Communities will completely sustain the PHCP within two to four years.
The PHCP will be affiliated with the proposed Human Development Incubators for implementation. It will drastically reduce mortality and morbidity rates, especially Maternal and Infant Mortality.
Pakistan's health indicators lag behind those of most countries in the developing world. Maternal and infant mortality rates are uncharacteristically high - 350/100,000 live births and 85/1,000 live births respectively (NIPS: July 2001). Analysis reveals that limited access as well as low quality of care levels have hindered human development.
The Task Force evaluated many approaches targeted at the improvement of basic health in Pakistan. Our objective is to strengthen the Government of Pakistan's plans to reduce the maternal mortality rate to 70/100,000 live births and the infant mortality rate to 45/1,000 live births by 2010. Achieving these goals within the next decade will require increased resources in primary health care and reproductive health as well as enhanced training.
Presently, untrained or improperly trained traditional birth attendants/dais assist with the majority of births in Pakistan. One study reported that untrained personnel attend 83% of all births nationally (Human Development Report, 2001, UNDP). While dais are valuable and culturally entrenched service providers, their failure to adhere to modern and safe birth practices is commonly viewed as a contributing factor to the high infant and maternal mortality rates.
The Task Force is proposing a National Community Midwives Program (NCMP) to address Maternal and Infant Mortality within the larger context of Primary Health Care (Primary Health Care Program, President's Task Force on Human Development, Pakistan, 2002). The program will recruit and train women to become midwives in their own communities. These trained midwives will be based in the village and will be able to provide safer reproductive health care to rural women. By promoting community-based midwives, the program builds on the indigenous tradition of domiciliary deliveries rather than replacing it. This will address the skills deficiencies of traditional birth attendants and increase the number of individuals trained in safe and modern birth practices.