Maternal, neonatal and child health in Pakistan: towards the MDGs by moving from desire to reality

Of the 10 million annual deaths of children below five years of age, four million are neonates. Pakistan's neonatal mortality rate of 54/1000 live births, which accounts for 57% of the under-five mortality, the contraceptive prevalence rate stagnating at 30%, the meagre number of deliveries assisted by skilled birth attendants [39%] and the low coverage of cost-effective child survival interventions hamper the achievement of Millennium Development Goals [MDGs] 4 and 5. The Government launched the national maternal, neonatal and child health programme in 2007 to promote access to evidence-based cost-effective interventions; strengthen district health system capacities; empower communities; expand the community midwives' cadre; and promote utilization of essential services. This paper reviews the implementation of the programme and the likelihood of attaining the MDG4 and 5 targets by 2015, and provides strategic directions for scaling-up programme implementation

Learning through crisis: development and implementation of a health cluster strategy for internally displaced persons

Five major disasters in Pakistan affected close to 8 million people from 2005 to 2009. The 2008-09 humanitarian crisis in Khyber Pakhtunkhwa and the Federally Administered Tribal Areas [FATA] of Pakistan resulted in 2.76 million internally displaced persons [IDPs], of whom 88% were off-camp IDPs hosted by the local population. The service delivery challenges posed by the IDPs, their sparse geographical distribution and phased displacement were managed through a successful health response strategy, which focused on 13 major interventions supplemented by a set of standard guidelines for field implementation. This study evaluates the process and results attained by this coordinated health cluster strategy that has guided the mobilization and implementation of a colossal humanitarian response to an unprecedented crisis in Pakistan's history

[Delivering as one] UN reform process to improve health partnerships and coordination: old challenges and encouraging lessons from Pakistan

The UN Secretary-General constituted a high-level panel on system-wide coherence in 2005 within the areas of development, humanitarian assistance and the environment. The panel adopted [Delivering as One] as a slogan for its coherence initiative. Pakistan was among eight pilot countries implementing this reform initiative. Five joint programmes were developed, on health and population; agriculture, rural development and poverty reduction; disaster risk management; education; arid environment. Fourteen UN agencies supported the health and population joint programme and participated in its implementation. Although confronted by many challenges, the positive results of the joint programmes confirmed the advantage of Delivering as One over the past scenarios of fragmentation, duplication and incoherent government and UN strategic operations. The paper shares the accomplishments of the health and population sector including its ability to harness the power of intersectoral collaboration and prospectively concentrate human and financial resources around the strategic national priorities