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Health system failing children in Pakistan

Over 420,000 under-fives die each year in Pakistan and many of these deaths could be prevented by improvements to health services.

With its population of around 180 million, Pakistan has more child deaths than all but two of the world’s nations. This high death toll is in part a result of poor health services across the country. Results of a new study into the health sector of Pakistan have just been published in The Lancet, summarised in a recent IRIN article. The report’s authors conclude that the poor survival rate of young children is “the most devastating and large-scale public health and humanitarian crisis Pakistan faces”.

The country has made some progress towards reducing child death rates. In 2000, for every 1,000 live births, 95 children were likely to die by the age of five ; by 2011, this figure had dropped to 72 (according to data from the World Health Organisation). The report singles out the rising number of community-based female health workers as one of the successes of the past two decades for improving the rates of child deaths, and also of maternal mortality.

However, as the report outlines, health care services across the country remain poor. And with no national health insurance system, the majority of Pakistanis (78%) have to pay for their own health care. Since families must pay out of their own pockets, this can mean that children are not taken to clinics and hospitals for medical attention until it’s too late to help them.

Though the growth in community health workers has helped reduce child deaths, the country still faces a huge shortage of trained nurses and midwives (who are currently outnumbered by doctors 2 to 1). Almost half of the young children who die each year in Pakistan are newborns and experts believe that a greater number of skilled birth attendants could save the lives of more than 200,000 women and children by 2015.

The report acknowledges that it isn’t only poor health care which contributes to the high number of child deaths. Around two-fifths of under-fives in Pakistan are underweight and more than half are stunted. This lack of adequate nutrition among the young weakens their ability to fight off infection and illnesses.

Public health spending has declined to less than 1% of the country’s GDP and with many Pakistanis unable to pay for the medical care they need, the situation with regards to state healthcare doesn’t look likely to improve any time soon. As one teacher explained, his mother was recently unable to “get the treatment she needed and in March, she died” because the family “could not afford to pay”.
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