Controlling newborn deaths: Despite higher funding, Pakistan doing worse

ISLAMABAD:

Despite considerable policy change, there has been slow progress in reducing neonatal mortality in the country. At less than 0.9% decline per year between 2000 and 2010, the neonatal mortality rate is less than the global average, which is 2.1%. There has been no improvement in the rate of decline since 1990.

However, full coverage of interventions in place would prevent 84% of newborn deaths and 59% of still births by 2015, reveals Save the Children’s Health Policy and Planning journal, “A decade of change for newborn”, launched at a hotel here on Monday.

The journal states that at 194,000 Pakistan had the world’s highest number of newborn deaths in 2010, despite donor funding that increased more for Pakistan than for other countries from 2005. Pakistan also ranks among top the three countries globally with the highest percentage (32%) of babies born with low birth weight.

According to the journal, neonatal mortality for live births in Pakistan was 45 in 2000, which decreased to 41 in 2010. Newborn deaths in 2000 were 203,000 which fell to 194,000 in 2010.

With just 5 doctors and 8 nurses and midwives in the country for every 10,000 persons, human resources constrain newborn care, causing large disparities among various geographical locations. Only 6,000 community midwives have been deployed, while their numbers need to be increased 30 times.

The three leading causes of neonatal deaths reported between 2000 to 2010 was preterm birth, 37%, severe infections, 28%, and complications during labour and childbirth, 25%, which collectively account for 90% of deaths.

The journal says the national programmes for maternal, newborn and child health have been integrated in Pakistan but a systematic evaluation of these programmes with specific focus on newborns has not been conducted and lacks in-depth analysis.

Changes in some socio-economic factors between the year 2000 and 2010 were significant, as gross national income increased from $470 to $1,050, literacy rate rose from 29% to 40% and there was a drop in the total fertility rate from 4.5 to 3.5 births per woman.

Total health expenditure has more than doubled from $2,223 million to $4,203 million. Donors contribute about 20% of public health sector expenditure. Per capita health expenditure increased from $15 to $23, but is still less than the actual requirement of $35 set by the Commission on Macroeconomics and Health Recommendations.

Current health challenges include societal norms that discourage care-seeking. Many women are unable to access care for themselves or for their child.

Several humanitarian disasters, destabilising political insurgency, high level of poverty and inaccessibility to rural population over the past decade have also affected health and development.

“The perception of government effectiveness and political stability worsened over the decade,” states the journal. Newborn survival for the first time appeared in national health policies and strategies in 2001.

The journal credits national partnership and activists for keeping newborn health on the agenda despite competing challenges to development, including earthquakes and floods.

However, it will take more than advocacy and committed partnerships to improve newborn survival in the country along with provincial leadership and innovative models of financing and effective action, states the journal.

Published in The Express Tribune, October 17^th, 2012.