Upstream Policy Recommendations for Pakistan’s Child Mortality Problem

  • Samina Panwhar
  • Beth Ann Fiedler


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.


Child 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

Social determinants of health

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.

Three-tier health system of Pakistan

Pakistan’s health system is three-tiered with management of responsibilities divided between federal, provincial, and district governments.


  1. Bilal Z. Understand the federal budget 2017-18 [Online]. The Daily Times. 2017. Accessed 19 June 2017.
  2. Ebrahim Z. Pakistan: smoke-free stoves a godsend for village women [Online]. Inter Press Service News Agency. 2010. Accessed 18 June 2017.
  3. Fatmi Z, et al. Situational analysis of household energy and biomass use and associated health burden of indoor air pollution and mitigation efforts in Pakistan. Int J Environ Res Public Health. 2010;7:2940–52. Scholar
  4. Galpin R. Fighting Pakistan’s measles epidemic [Online]. BBC News. 2013. Accessed 18 June 2017.
  5. Hazir T. Pneumonia: no. 1 killer of Pakistan’s children. Bull World Health Organ. 2008;86(5):330–1. Scholar
  6. Hussain K, et al. Seroprevalence of pediatric malaria in Quetta, Balochistan, Pakistan. Iranian J Parasitol. 2013;8(2):342–7.Google Scholar
  7. IRIN. The top 10 natural disasters since 1935 [Online]. 2010. Accessed 18 June 2017.
  8. Kakar Q, et al. Malaria control in Pakistan: new tools at hand but challenging epidemiological realities. East Mediterr Health J. 2010;16:S54–60.CrossRefGoogle Scholar
  9. Khan KS. Social determinants of health in Pakistan: the glass is more than half empty. 2006. Accessed 18 June 2017.
  10. Khattak AA, et al. Prevalence and distribution of human Plasmodium infection in Pakistan. Malar J. 2013;2:297. Scholar
  11. Mahmood MA. Determinants of neonatal and post-neonatal mortality in Pakistan. Pak Dev Rev. 2002;41(4 Part II):723–44.Google Scholar
  12. Meili R. Upstream: talking differently about health. 2013. Accessed 19 June 2017.
  13. Mohiuddin YN. Pakistan: a global studies handbook. Santa Barbara, CA: ABC CLIO, Inc.; 2006.Google Scholar
  14. Niazi AK, Sadaf R. Measles epidemic in Pakistan: in search of solutions. Ann Med Health Sci Res. 2014;4(1):1–2. Scholar
  15. Nisar YB, Dibley MJ. Determinants of neonatal mortality in Pakistan: secondary analysis of Pakistan Demographic and Health Survey 2006–07. BMC Public Health. 2014;14:663. Scholar
  16. Razzak JA, et al. A child an hour: burden of injury deaths among children under 5 in Pakistan. Arch Dis Child. 2013;98(11):867–71. Scholar
  17. 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
  18. Savedoff WD. What should a country spend on healthcare? Health Aff. 2007;26(4):962–70. Scholar
  19. Styles R. Why thousands of Pakistani children are falling prey to paedophiles [Online]. Daily Mail. 2014. Accessed 19 June 2017.
  20. The World Bank. What a waste: a global review of solid waste management. 2012. Accessed 19 June 2017.
  21. The World Bank Group. Mortality rate, under-5 (per 1,000 live births). 2017. Accessed 18 June 2017.
  22. United Nations Children’s Fund (UNICEF). Diarrhoea remains a leading killer of young children, despite the availability of a simple treatment solution. 2017. Accessed 19 June 2017.
  23. 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. Accessed 14 Aug 2017.
  24. World Health Organization (WHO). Declaration of Alma-Ata international conference on primary health care, Alma-Ata, USSR, 6–12 September 1978. 1978. Accessed 18 Jun 2017.
  25. World Health Organization (WHO). Global Health Observatory country views, Pakistan statistics summary (2002 - present). [Last updated 19 Jul 2017]. 2016. Accessed 14 Aug 2017.
  26. World Health Organization (WHO). Global health observatory (GHO) data: child health. 2017a. Accessed 18 June 2017.
  27. World Health Organization (WHO). Total expenditure on health as a percentage of gross domestic product (US$). 2017b. Accessed 18 June 2017.
  28. World Health Organization (WHO). What are social determinants of health? 2017c. Accessed 18 June 2017.
  29. Zahidi F. Worries pile up as waste grows in Pakistan [Online]. Alzazerra. 2014. Accessed 19 June 2017.

Further Reading

  1. 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. Accessed 14 Aug 2017.
  2. World Life Expectancy. Health profile: Pakistan. 2017. Accessed 14 Aug 2017.
  3. Beyond health care: the role of social determinants in promoting health and health equity. 2015. Accessed 10 Sept 2017.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Samina Panwhar
    • 1
  • Beth Ann Fiedler
    • 2
  1. 1.Oregon Health AuthoritySalemUSA
  2. 2.Independent Research AnalystJacksonvilleUSA

Personalised recommendations