Around 600,000 children under the age of five die each year, mostly due to preventable diseases such as diarrhea, measles, low birth weight, malnutrition, and from curable diseases such as pneumonia and malaria. Pakistan’s under-five mortality rate of 109 per thousand live births and infant mortality rate of 84 per 1,000 live births is higher than both India (67) and Bangladesh (51). The Pakistan Integrated Household Survey 2001-2002, in fact, reports that the infant mortality rate has declined from 89 per 1,000 births in 1998-99. The improvement, however, does not correspond with any marked improvement in the primary health care system as a whole and must be treated with caution.

Full immunization rates showed a slight improvement in the survey at 53%, up from 49% in 1998-99. Though there was a slight decrease in the incidence of diarrhea and an increase in the use of ORS, most people continue to consult a private practitioner over a government facility, primarily because one does not exist in their area or is located too far away.

Prenatal consultation rate has increased slightly from 31% in 1998-99 to 35% in 2001-02. In rural areas, only 26% of pregnant women went for a pre-natal consultation. Most births, 78%, take place at home. In rural areas, 86% of deliveries take place at home, assisted by either a trained dai or a traditional birth attendant while family members attend 21% of births.

Twenty-one percent of children are born with low birth weights, meaning their health and well being is jeopardized even before birth. Compounding the problem is poor feeding practices in infancy and early childhood. According to UNICEF, only 16% of babies in Pakistan are exclusively breastfed (given no other food or drink, not even water) for about six months. Among children under five years of age, 38% are moderately to severely underweight.

Unclean drinking water and unhygienic sanitation account for the deaths of around 250,000 children each year, raising questions about government claims that 90% of the population has access to improved water sources and 62% has access to better sanitation.

Pakistan continues to be one of the ten polio endemic countries. In end of December 2002, 83 polio cases had been confirmed in 33 districts. By July 2002, only 2 cases had been confirmed in Afghanistan, meaning it is likely to be polio-free before Pakistan.

The public healthcare system comprises an elaborate infrastructure at the primary, secondary and tertiary levels. There has been a significant increase in the past decades in the provision of health services such as doctors, nurses, health centers, number of hospitals and hospital beds. These facilities provide subsidized health services. Despite this widespread reach, gaps and weaknesses in the system affect optimum utilization of these services. Public sector expenditure on health is low; 0.7% of the GNP against the WHO recommended 4% to 5% and per capita expenditure on health has shown little change in the past 25 years. In addition to the low budgetary allocations, the health sector also suffers due to mismanagement and lack of planning. Gender imbalance in government health services, insufficient focus on preventive aspect of health care, poor personnel management and the resulting high rates of absenteeism, and poor performance, among others, have led to lack of confidence in the public sector.

The private health sector now meets 70-80% of the health needs of the population, providing services ranging from high quality to the very basic. However, lack of regulatory legislation in the private sector has encouraged widespread “quackery” (practice of medicine by people with little or no formal training). According to rough estimates, there are more than 350,000 quacks operating in Pakistan, outnumbering qualified doctors by ratio of three to one. These non- formal medical practitioners usually operate in the rural and poor urban areas where health care consumers fail to distinguish between qualified and unqualified doctors, and often consult them for minor surgeries, dentistry, sexual and reproductive health services. With their extensive reach and little knowledge of safe medicine, and given the pattern of disease in the country which includes hepatitis, tuberculosis and the potential threat of HIV/AIDS, these practitioners have the potential to wreak havoc on the country’s health situation.

Global Movement for Children