Two important world reports were released in the past month, with direct links to newborn and maternal survival in Pakistan. The first, released by the World Health Organisation on May 2nd, ranked Pakistan fourth in the world for preterm births, at 748,100 per year. The report, Born Too Soon, argued that shortages in qualified health workers and inadequate capacity for the care of premature babies are a major reason for the lack of progress in reducing neonatal deaths. It went on to explain how investment in health workers can considerably reduce maternal and child mortality ratio.
The lack of health workers directly impacts the quality of life for mothers. This was reflected in the second report, released by Save the Children on May 8th, where Pakistan was ranked 78 out of 80 countries under the less developed countries category on the annual Mothers’ Index. The State of the World’s Mothers, released for the thirteenth year, ranked 165 countries for being the worst and best places to be a mother. It echoed the views of Born Too Soon – that health workers are the key to success. Frontline health workers have a vital role to play in promoting good nutrition in the first 1,000 days in impoverished communities in the developing world where malnutrition is too common, doctors and hospitals are often unavailable, too far away, or too expensive.
Indeed, we need more frontline health workers who are skilled and confident in newborn care. We need health clinics equipped with life-saving commodities. We need community health workers and midwives to screen children for malnutrition, treat diarrhoea, promote breastfeeding, distribute vitamins and other micronutrients, and counsel mothers on good nutrition, hygiene and sanitation. The “lifesaving six” interventions highlighted in the State of the World’s Mothers report can be delivered in many remote and impoverished places through well-trained and well-equipped community health workers. In a number of countries – including Cambodia, Malawi and Nepal – these health workers have contributed to broad-scale success in fighting malnutrition and saving lives.
Save the Children says nearly 1.3 million children’s lives could be saved each year if six interventions are fully implemented at scale in the 12 countries, including 100,000 in Pakistan, most heavily burdened by child malnutrition and under-5 mortality. With the help of frontline health workers, all six of these interventions can be delivered fairly rapidly using health systems that are already in place.
What is lacking is the political will – the will to invest in inexpensive yet proven solutions that are essential to the women and children who need them most. Three of the six solutions – iron, vitamin A and zinc – are typically packaged as capsules costing pennies per dose, or about $1 to $2 per person per year. The other three solutions – breastfeeding, complementary feeding and good hygiene – are behavioural change solutions, which can be implemented through outreach, education and community support.
In Pakistan, about 100,000 Lady Health Workers (LHWs) and 4,000 Community Midwives (CMWs) exist at community level. While the government’s LHW Program is present in all districts, in reality only 60% to 65% of the whole population is covered, with many of the poorest and hardest to reach without any access at all. The Prime Minister announced an increase in the number of LHWs to 120,000 and CMWs to 16,000, although about 12,000 more CMWs need to be deployed in order to meet the World Health Organisation (WHO) criteria.
The Government of Pakistan should live up to its commitment to increase the number of LHWs and extends its commitment to increase the number of CMWs. These increases would help close the gap in health promotion and provision of services. Both the federal and provincial governments and donors should work together to fill this frontline health workers gap by recruiting, training and supporting new and existing health workers, and deploying them where they are needed most.
The provincial governments and donors are now playing a larger role in the post 18th constitutional amendment scenario as the LHW program has devolved to provinces. The appointment and training of CMWs have become provincial subjects as well and should now be prioritized by the provincial leaders.
The provincial governments now need their own frontline health workers policies and strategies in light of their respective Millennium Development Goal (MDG) targets. This needs to be done with great urgency, given high maternal mortality ratios like that of Balochistan, at 785 per 100,000 live births. All provincial governments and the Federally Administered Tribal Areas (FATA) secretariat will need to come up with policies and strategies about increasing frontline LHWs and CMWs quickly in order to put provinces and FATA on the right track towards achieving MDGs 4 and 5. Donor agencies are also required to align their support in the post 18th constitutional amendment scenario and extend technical assistance to provinces to respond to the demands in an effective manner.
The writer is an advocacy manager for Save the Children and tweets at @amahmood72