"In Pakistan, a lot of things are lacking, including quality healthcare. There is political instability and an even greater lack of awareness," Andro Shilakadze, chief field officer in Pakistan for the UN Children's Fund (UNICEF), told IRIN. "Even small steps like focusing on and promoting hygiene and sanitation, and stressing exclusive breast-feeding can lead to improved health but these are put on the backburner."
MDG four stipulates that Pakistan must reduce its under-five child mortality rate by two thirds between 1990 and 2015; from 130 deaths per 1,000 children in 1990 to 85 per 1,000 in 2015. According to the Pakistan Demographic Health Survey (PDHS) in 2006-2007, this rate was 94 per 1,000 in 2006/7.
"This seems reachable, especially in urban centres, but things are different in rural areas. Also, the ongoing strife in NWFP [North West Frontier Province] and Balochistan has put a large number of children at risk," said Amir Dawood, president of the Balochistan branch of the Pakistan Paediatrics Association (PPA).
MDG four also states that the country's infant mortality rate (IMR) should be reduced from 100 per 1,000 children in 1990 to 40 per 1,000 in 2015. In 2006/7, the rate was 78 per 1,000, according to the PDHS.
MDG five stipulates that Pakistan's maternal mortality ratio (MMR) be reduced by three-quarters during the same period; from 550 per 100,000 in 1990 to 140 per 100,000 in 2015. In 2006/7 the MMR was 276 per 1,000 births nationwide, with a much higher rate in rural areas.
"Given these figures, if anyone thinks that we can reach the MDGs by 2015, they are mistaken. By a long haul this is not a possibility," said Dawood.
Summing up the scenario in Balochistan, he said: "Balochistan is the most backward province in Pakistan and with regards to health care, the situation there is dismal. While the national [IMR] average is 77 per 1,000, according to a PPA survey conducted in 2005, out of a 1,000 live births, 102 did not survive. Ten percent of children in Balochistan have not had a single immunization."
He said the pending Child Protection Bill, which provides an institutional framework geared specifically towards prevention and protection of children from abuse, should be passed in parliament as soon as possible and newborn care should be prioritized.
He added that the Expanded Immunization Programme, which aims to provide free protection to every newborn child in Pakistan against eight deadly diseases, must be strengthened financially and administratively. "We have a lot of appointments on a political basis and this practice needs to end. It's human lives that we are dealing with."
Many health care professionals say the government needs to put its money where its mouth is and back up the commitments it has made.
"Over the time that I have spent conducting courses all over Pakistan I have often noticed that vaccinators have not been paid," said paediatrician D.S. Akram, founder of the Health, Education and Literacy Programme (HELP).
"There is no money for purchasing fuel. In many cases vehicles given to lady health visitor supervisors have been taken away by politicians, or in a tribal area the service provider was not allowed to work due to ongoing warfare. How and why would they work?"
Keeping track of performance
She said that although the government had introduced many positive initiatives, such as the lady health visitor programme, which has proven successful in rural areas, it needed to monitor and evaluate its efforts.
"The government and donor agencies must keep a tab on performance. I can tell you for a fact that of all the people we trained, hardly 10 percent follow the proper protocol. Not only is that a waste of training but also this increases the burden on the healthcare system," she said.
UNICEF's Shilakadze said the government could not be expected to achieve the MDGs alone. "The best way out is to strengthen the public-private partnership. Also, an increase in funding is important, along with monitoring that the funds are used adequately," he said.