Upstream Policy Recommendations for Pakistan’s Child Mortality Problem
Policymakers in Pakistan continue to face challenges in reducing mortality in children under the age of five. Leading causes of death in this age category—(1) neonatal tetanus and severe infection, (2) pneumonia, (3) diarrheal disease, (4) measles, (5) injury, and (6) malaria—have been generally attributed to social, economic, and environmental factors. These include poverty, malnutrition/undernutrition, poor hygiene, unsafe water and sanitation. The nation has a legacy of commitments to achieving public health goals and demonstrated their desire to improve conditions by working towards the 2015 Millennium Development Goals (MDG) reducing the child mortality rate by approximately 42% by 2015. However, the dismal progress towards addressing child mortality and morbidity in Pakistan can be attributed to the current downstream approach. Therefore, an upstream preventive approach, considering the root causes of child injuries and death, is recommended. This chapter provides a snapshot of the nation’s current health policy, recent history and encounters with natural disasters, current healthcare funding, and health profile with an emphasis on children under the age of five. The chapter puts forth policy recommendations grounded in the concept of upstream approaches in health policy that encompass social, economic, environmental, and structural factors that must be addressed to achieve a sustainable solution to child mortality in the country.
KeywordsChild mortality National health policy Pakistan
Animal or plant based material such as wood and coal used as fuel
The first 4 weeks of life after birth
Conditions in which people are born, grow, live, and work; examples include economic status, environmental quality, access to healthy food and clean water, and access to green spaces.
Pakistan’s health system is three-tiered with management of responsibilities divided between federal, provincial, and district governments.
- Bilal Z. Understand the federal budget 2017-18 [Online]. The Daily Times. 2017. http://dailytimes.com.pk/pakistan/07-Jun-17/understand-the-federal-budget-2017-18. Accessed 19 June 2017.
- Ebrahim Z. Pakistan: smoke-free stoves a godsend for village women [Online]. Inter Press Service News Agency. 2010. http://www.ipsnews.net/2010/02/pakistan-smoke-free-stoves-a-godsend-for-village-women/. Accessed 18 June 2017.
- Galpin R. Fighting Pakistan’s measles epidemic [Online]. BBC News. 2013. http://www.bbc.com/news/world-latin-america-22724080. Accessed 18 June 2017.
- Hussain K, et al. Seroprevalence of pediatric malaria in Quetta, Balochistan, Pakistan. Iranian J Parasitol. 2013;8(2):342–7.Google Scholar
- IRIN. The top 10 natural disasters since 1935 [Online]. 2010. http://www.irinnews.org/news/2010/08/10. Accessed 18 June 2017.
- Khan KS. Social determinants of health in Pakistan: the glass is more than half empty. 2006. https://assets.publishing.service.gov.uk/media/57a08c29ed915d622c00117d/Khan_Socialdeterminants.pdf. Accessed 18 June 2017.
- Mahmood MA. Determinants of neonatal and post-neonatal mortality in Pakistan. Pak Dev Rev. 2002;41(4 Part II):723–44.Google Scholar
- Meili R. Upstream: talking differently about health. 2013. http://www.thinkupstream.net/upstream_talking_differently_about_health. Accessed 19 June 2017.
- Mohiuddin YN. Pakistan: a global studies handbook. Santa Barbara, CA: ABC CLIO, Inc.; 2006.Google Scholar
- Riley JC. Low income, social growth, and good health: a history of twelve countries. (California/Milbank Books on Health and the Public.). Berkeley/Los Angeles: University of California Press, with Milbank Memorial Fund; 2008.Google Scholar
- Styles R. Why thousands of Pakistani children are falling prey to paedophiles [Online]. Daily Mail. 2014. http://www.dailymail.co.uk/femail/article-2739799/Why-millions-Pakistani-children-falling-prey-vicious-paedophiles.html#ixzz4kSol75nL. Accessed 19 June 2017.
- The Express Tribune. 92,000 children die of pneumonia in Pakistan every year [Online]. 2015. https://tribune.com.pk/story/988945/92000-children-die-of-pneumonia-in-pakistan-every-year/. Accessed 19 June 2017.
- The World Bank. What a waste: a global review of solid waste management. 2012. http://documents.worldbank.org/curated/en/302341468126264791/pdf/68135-REVISED-What-a-Waste-2012-Final-updated.pdf. Accessed 19 June 2017.
- The World Bank Group. Mortality rate, under-5 (per 1,000 live births). 2017. http://data.worldbank.org/indicator/SH.DYN.MORT?locations=PK. Accessed 18 June 2017.
- United Nations Children’s Fund (UNICEF). Diarrhoea remains a leading killer of young children, despite the availability of a simple treatment solution. 2017. https://data.unicef.org/topic/child-health/diarrhoeal-disease. Accessed 19 June 2017.
- United Nations Children’s Fund (UNICEF) and World Health Organization (WHO). Integrated global action plan for the prevention and control of pneumonia and diarrhoea. 2013. https://www.defeatdd.org/global-action-plan-pneumonia-diarrhea. Accessed 14 Aug 2017.
- World Health Organization (WHO). Declaration of Alma-Ata international conference on primary health care, Alma-Ata, USSR, 6–12 September 1978. 1978. http://www.who.int/publications/almaata_declaration_en.pdf. Accessed 18 Jun 2017.
- World Health Organization (WHO). Global Health Observatory country views, Pakistan statistics summary (2002 - present). [Last updated 19 Jul 2017]. 2016. http://apps.who.int/gho/data/node.country.country-PAK. Accessed 14 Aug 2017.
- World Health Organization (WHO). Global health observatory (GHO) data: child health. 2017a. http://www.who.int/maternal_child_adolescent/epidemiology/child/en/index.html. Accessed 18 June 2017.
- World Health Organization (WHO). Total expenditure on health as a percentage of gross domestic product (US$). 2017b. http://www.who.int/gho/health_financing/total_expenditure/en/. Accessed 18 June 2017.
- World Health Organization (WHO). What are social determinants of health? 2017c. http://www.who.int/social_determinants/sdh_definition/en/. Accessed 18 June 2017.
- Zahid W. Pakistan’s GDP growth rate is even higher than that of China: Harvard study [Online]. The Express Tribune. 2017. https://tribune.com.pk/story/1452332/pakistans-gdp-growth-rate-even-higher-china-harvard-study/. Accessed 14 Sept 2017.
- Zahidi F. Worries pile up as waste grows in Pakistan [Online]. Alzazerra. 2014. http://www.aljazeera.com/indepth/features/2014/08/solid-waste-pakistan-karachi-2014867512833362.html. Accessed 19 June 2017.
- United Nations Children’s Fund (UNICEF). Levels and trends in child mortality. Report 2015. Estimates developed by the UN inter-agency group for child mortality estimation, New York. 2014. http://www.childmortality.org/files_v20/download/IGME%20Report%202015_9_3%20LR%20Web.pdf. Accessed 14 Aug 2017.
- World Life Expectancy. Health profile: Pakistan. 2017. http://www.worldlifeexpectancy.com/country-health-profile/pakistan. Accessed 14 Aug 2017.
- Beyond health care: the role of social determinants in promoting health and health equity. 2015. http://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/. Accessed 10 Sept 2017.