National MNCH Program
National MNCH Program
Maternal, Neonatal & Child Health Program
Ministry of Health, Government of Pakistan
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The health status indicators of Pakistan are poorer than most low-income countries, even when compared with countries having a lower Gross National Product per capita. The percentage of total government health expenditure in relation to Gross Domestic Product in Pakistan is also much lower than many developing countries.  While the health of the population in Pakistan has improved over the past decades, the rate and level of improvement has been unsatisfactory.




Contributing factors include poverty, low levels of literacy and lack of civic facilities such as proper sanitation and water. More importantly, however, there are weaknesses in the healthcare delivery system including insufficient focus on preventive interventions, gender imbalances, weak human resource development and insufficient funds.

Since the country became independent, there have been considerable improvements in the health indicators. One example is that the infant mortality rate (IMR) has decreased from over 150 in 1950s to 82 in 2002. Unfortunately, a corresponding decrease in newborn mortality rate (deaths under one month of age) has not been achieved. The newborn mortality rate now constitutes more than half of all infant deaths. Likewise, maternal mortality ratio (MMR) is believed to have declined considerably since independence and is estimated to range between 350-400 maternal deaths per 100,000 live births. Contraceptive prevalence rate has shown a slow and steady increase over the most recent time period (1980 and later), although the increase in the use of traditional methods and condoms is higher than that of other temporary methods. Surgical sterilization still seems to be the method of choice for women having five or more births already. Total fertility rate (TFR) has shown a steady decline over the last two decades, which some scholars consider to be as remarkable as that in the East Asian countries where the demographic transition is near completion. Nonetheless, overall progress in maternal, newborn and child health (MNCH) has remained unsatisfactory when compared with neighboring countries, whereby our IMR, MMR and newborn mortality rates are higher than those in India, Bangladesh and Sri Lanka.

In Pakistan infants and newborn babies die mainly due to birth asphyxia, intra-uterine growth retardation, acute respiratory infections and diarrhea. All of these causes are both preventable and treatable. A majority of births occur at home and are attended by untrained traditional birth attendants. The major causes of maternal deaths are hemorrhage, puerperal sepsis, toxemia of pregnancy and obstructed labor. Several studies on maternal mortality have identified the need for addressing the three delays in accessing emergency obstetric care and for integrated efforts for saving mothers’ lives both at the community and hospital level.

The Constitution of Pakistan guarantees basic human rights to all citizens, which includes equitable access to health and social services. Government of Pakistan (GOP) is aware of the huge burden of preventable deaths and morbidity among women and children and is committed to improving their health status. Unfortunately, concerted efforts to improve the health of mothers and children have been lacking. Short-term and localized programs and projects have failed to achieve significant and sustainable improvements in MNCH indicators. Such improvements can only be achieved through a national level, comprehensive, focused and effective program that is owned and managed by the districts, and is customized to meet the district’s specific needs.

Health Policy of Pakistan over the years

In 1990, Pakistan adopted its first National Health Policy to provide vision and guidance to the development of national healthcare delivery system. Its goal was to provide universal coverage through enhancement of trained health manpower. The Policy put emphasis on maternal and child health and primary health care. The National Health Policy was revised in 1997 to introduce a “vision” of the health sector development by the year 2010.

In June 2001, Federal Cabinet approved the current National Health Policy, which envisages health sector reforms as a pre-requisite for poverty alleviation, gives particular attention to strengthening the primary and secondary tiers of health services, and calls for establishment of good governance practices in order to achieve high quality of health services.

The 10 Year Development Plan (2001-2011)

The Ten Year Perspective Development Plan 2001-2011 also places emphasis on improving the service delivery mechanisms for reducing preventable diseases.  The policy focus is on continuous shift from curative to promotive and preventive services through primary health care. 

Responding to the need for a coherent, innovative, sustainable, reliable and cost-effective strategy in MNCH, the Ministry of Health commissioned its National MNCH Strategic Framework in April 2005. The vision of the strategic framework is “of a society where no family suffers the loss of a mother or newborn due to preventable or treatable causes”. The Framework pledges to ensure availability of high quality MNCH services to all, especially for the poor and the disadvantaged. The Framework aims to improve the accessibility of high quality and effective MNCH services for all, particularly the poor and the disadvantaged, through development and implementation of sustainable provincial and district programs.

International Goals

Pakistan is signatory to several international agreements regarding improving MNCH. Most notably, the Government is committed to achieve the Millennium Development Goals (MDGs) in MNCH, which are:

  • Goal 4: Reduce child mortality by two-thirds, between 1990 and 2015: The indicators to measure progress toward this MDG include under-five mortality rate; infant mortality rate (IMR) and proportion of one-year-old children immunized against measles. (Pakistan’s target is to reduce IMR to 40 per 1000 live births and to increase measles immunization rate to >90% by 2015).
  • Goal 5: Improve maternal health by reducing the maternal mortality ratio (MMR) by three-quarters, between 1990 and 2015: The indicator to measure progress toward this MDG include maternal mortality ratio and the proportion of births attended by skilled health personnel. (Pakistan’s target is to reduce MMR to 140 or less, and to increase skilled birth attendance to 90%, by 2015).

In addition to the above, Pakistan envisages increasing, by the year 2015, the contraceptive prevalence rate (CPR) to 55%; proportion of pregnant women receiving prenatal care from the current 31% to 100%; and reducing the total fertility rate (TFR) from the current 3.9 to 2.1.

The Healthcare Delivery System of Pakistan

Pakistan has a three-tiered health system in its public sector, comprising the primary health facilities, secondary care hospitals and the tertiary level teaching hospitals. The private sector is primarily a fee for service highly fragmented profit driven entity. The Federal Ministry of Health (MoH) and provincial Departments of Health (DoH) are implementing a number of special initiatives, which focus on addressing the challenges of maternal health. The MoH’s role is policy development, standard setting, regulatory frameworks for drugs & services, development of national plans, inter province coordination, monitoring, evaluation and research, resource mobilization, collaboration with international agencies and provision of services through federal health institutions. After devolution, provincial DoH role is more in policy, intra-provincial coordination, monitoring and evaluation, medical and nursing education and tertiary care service delivery. District DoH role is of implementation, monitoring and supervision, management of healthcare delivery at and below District Head Quarter Hospitals and implementation of National Priority Programs at the district level.

Pakistan has 946 Hospitals, 552 Rural Health Centers, 5,290 Basic Health Units and 4,554 Dispensaries in the public sector. However, the public system has remained chronically under funded with the result that a lot of the heath infrastructure and equipment is in a state of disrepair. The health manpower in the country comprises 18,029 specialist doctors, 100,131 general physicians, 27,677 working nurses, 6,741 Lady Health Visitors and over 95,600 Lady Health Workers.

The Federal Ministry of Health (MoH) and Provincial Departments of Health (DoH) are implementing a number of initiatives, which focus on addressing the challenges of child health. Key present initiatives related to maternal and child health are the following:

  • National Program for Family Planning and Primary Health care
  • National EPI Programme
  • Nutrition Project
  • MNT-Special Immunization Activities.
  • National Program for Control of Diarrhoeal Diseases (CDD)
  • Acute Respiratory Infections Control Project
  • Polio Eradication
  • Integrated management of childhood illnesses (IMNCI) strategy (1998 – ongoing)
  • Women’s Health Project (in 20 districts)
  • Reproductive Health Project

Additionally, a number of donor-initiated projects are also being implemented while some are in the planning phase. 
Program Directions
Strategic directions for a nationally integrated MNCH program are provided in the Strategic Framework document. The proposed program is based upon the recommendations of the Framework, which was a result of extensive discussions at provincial and district levels, and which was endorsed by the Prime Minister of Pakistan and unanimously adopted by all provinces and AJK in the National Public Health Forum in April 2005. The Framework presents a number of innovative strategies to strengthen district health systems to prepare them for efficient delivery of MNCH care. The Framework presents a number of innovative strategies that may be adopted by provinces and districts according to their specific needs.

In addition to innovative strategies, the Framework provides guidelines for developing advocacy campaigns and community education to create a demand for high quality MNCH services. The National MNCH program is based upon the guidelines provided in the Strategic Framework document, including those related with strengthening of the management and organization mechanisms of the healthcare delivery system.