Speech of Minister for Health

Pakistan Development Forum Speech of Minister for Health It is my pleasure to be here in this important forum and report on developments in health sector, since it met last. I am happy that I speak as a m ember of a democratic government. Democracy is the recognition of rights. Considering health as the basic right of the common man, I believe that health is vital to democracy. I recognize Health as a key factor for development in the democratic context. Our vision is to work for Health-for-all. That requires access, equity, efficiency and effectiveness of essential health interventions- catering to the rights, needs and dignity of the majority of the population. 2. One of the first things I did, on assuming responsibilities of my office as Federal Health Minister, was to look at the vision, embodied in our National Health Policy. The priorities listed in the policy are indeed priority areas namely, reduction of widespread prevalence of communicable diseases, es pecially childhood diseases, TB, Malaria, Hepatitis-B & HIV- AIDS; addressing inadequacies in health care services, especially at primary and secondary levels; improving the District Health System; promoting gender equity; improving the nutrition status of the population; strengthening rural interventions; health education and capacity building for monitoring and evaluation. Instead of reinventing the wheel, I decided to place my energies at moving the wheel faster and smoother. 1

3. I have annexed some information in tabulated form to indicate progress-achieved todate in the health sector. These tables reflect government s commitment to achieve the targets of IPRSP in terms of investments, programmes and projects.. Measurements of outcomes remain an im portant aspect of the activities being undertaken. An important strategy will be to identify gaps in planning and implementation, which are likely to hinder the attainm ent of our objectives. 4. The area, which calls for special attention remains high Infant and Maternal Mortality Rates. I think we need to confront this problem, with more compassion, commitment and concentration. 5. It requires more enabling conditions to promote woman's health - providing a better deal to her at all stages of her life. But it also requires concerns at the sensitive stage of pregnancy and the need for Emergency Obstetric Care. It is my belief that the Health Policy should be even m ore forthcoming on this point, and take firm steps to achieve these objectives. 6. Health S ector received a tot al al loc ati on of Rs. 3309.247 million in the PSDP 2002-2003. Of this, the major allocation (80%) was for National Health Programmes, which involve a partnership between the Federal and Provincial Governments in terms of contribution of resources, capacity building, target setting and monitoring and evaluation. These programmes are: - 2

I. National EPI Programme II. Polio Eradication Initiatives III. Introduction of Hepatitis-B vaccine in EPI with GAVI grant IV. Strengthen routine EPI with GAVI grant V. Eliminati on of MNT i n high risk districts VI. The Lady health Workers Programme VII. Women Health Project (Federal Component) VIII. National AIDS Control Programme Enhanced HIV/AIDS Control Programme (2003-08) IX. National TB Control Programme X. National Malaria Control Programme (RBM initiatives) XI. National Nutrition Programme 7. The rationale for National Health Programs is that these impinge directly on key health indicators, which are amongst the most unfavourable, even regionally. The limited curative potential of the hospital sector, the absence of preventive impact of the primary/ secondary services, and the gaps in Reproductive Health / Safe Motherhood and Emergency O bstetric Care all mean that the only hope of effecting improvements in the key health indicators lies in supporting these National Programmes in terms of providing adequate resources and ensuring effective implementation. These programmes are at the core of IPRSP. The most important programme addressing IMR, MMR, Nutrition Status, Reproductive Health and Family planning is the Lady Health W orkers Programme. 3

8. The other key project to reduce MMR, IMR and improve Women/ Child Health is the Woman Health P roj ect with ADB assistance. The Project, which has Federal/ Provincial components, aims to provide O bstetric Care facilities at Tehsil/ District Level Hospitals in 20 Districts. 9. Three important gaps have been highlighted in recent strategy discussions as basic to reducing maternal/ infant mortality and improving Women/ Child Health. These are:- I. Improvement of Midwifery skills of LHWs (Elementary first aid in Obstetric Care). II. Development of New Rural Cadre of community Midwives to ensure advanced first aid in O bstetric Care. The programme envisages: training at government expense; micro-credit facilities; community orientation; utilizing Monitoring/ Supervisory tiers of LHW programme. III. Research indicates that Perinatal related mortality has rem ained unchanged despite mother/ child health investments. More focused and integrated interventions are therefore required. A project on these lines, in consultation with stakeholders, is under formulation. 10. Immunization levels are universally regarded as most cost-effective insurance against mortality and morbidity in the population. While the Polio Eradication Initiative and Maternal and Neonatal Tetanus Campaigns in High Risk Districts with assistance from the government of Japan have been eminently 4

successful, the Routine EPI shows less than satisfactory performance requiring serious rem edial and reform efforts. The Federal government has negotiated a grant from GAVI, which has provided an opportunity for addressing this issue. Federal Provincial partnership will have to deliver in this vital area. 11. I have good news to report on the Polio front. Last year we had 98 cases in 38 districts as against 76 districts in 1999. This year upto today, there are 21 cases in 13 districts. W e have planned a series of onslaughts this year in close partnership with different global and local stakeholders. The, "Buy Down project of the World Bank will ensure the plugging of the resource gaps. We are hopeful of good results. The strength of the polio surveillance system needs to be utiliz ed for revitalizing our routine EPI. I have arranged a national consultation on Routine EPI and a National Technical Advisory Group to advise on im plementation of GAVI assisted project on strengthening of Routine EPI. Very good results have emerged from the MNT campaigns in High Risk Districts. This programme will be continued in other areas. Hepatitis-B has since been included in EPI package. Satisfactory levels of immunization are the best guarantee of safe m otherhood and childhood. W e hope to take up reform measures involving effective District Health System and functional Primary Health Care System -properly monitoring intermediate indicators like utilization rates of First Level Care Facilities, percentage of birth attended by skilled attendants, immunization coverage, the situation of stock -outs including contraceptives and staff presence. The Provinces have taken a number of Innovative steps in this direction, like local appointments of Medical Officers, 5

posting of lady doctors, training programmes etc. The preventative, curative and population cadres all report to the Executive District Officer (EDO-Health) under the District government. However, I admit that this continues to be requiring attention. We have a long way to go, especially in capacity building at that level. This calls for a comprehensive vision of institutional reform in public health administration. 12. I am also happy to report reasonably good progress in the implementation of the TB Control Programme based on Directly Observed Treatment (DOTs) and the Roll Back Malaria (RBM) based on Malaria Project. Coverage for DOTs has reached to over 40% and annual parasite incidence in Malaria has already noted a decline. Even Falciparim rates are down. The year 2001-02 saw additional allocation in Health Sector to the tune Rs. 2 billion. It was translated in term of project vehicles, setting up of laboratories and extending microscopy in both TB and Malaria sectors. Both programmes have set up a reasonable monitoring infrastructure, including setting up of training programmes. The basic soundness of their approach was refl ect ed when pos itive si gnals w ere received from t he Gl obal Fund to Fight against HIV-AIDS, TB and Malaria (GFATM) that all three of Pakist an's propos als w ere accept ed- for TB, Malari a as well as HlV-AIDS. 13. In HIV-AIDS and Blood S afety Project, a good infrastructure surveillance has been created by the completion of a number of studies connected with the World Bank assisted project. We intend to implement, this critically important project 6

with full commitment. It will open up new avenues of blocking the epidemic while providing services to the vulnerable and high-risk populations. W e have also moved ahead on the side of Blood Safety. Legislations setting up Blood Regulatory Authorities have generally been approved. A national committee on Blood Transfusion met recently and approved a national Policy arrived at after extensive collaboration. 14. I have no doubt in saying that the core programme addressing poverty, rural improvement, rural health, reproductive health priorities and behavioural change at grass root level is the Lady Health Workers Programme, or the National Programme for Family Planning and Prim ary Health Care. The programme has trained and deployed 70,000 Lady Health Workers (LHWs) to date and would reach the target of 100,000 by 2005 to cover 85% of the target-population. The PC-I will end its tenure on 30 th June 2003. However, a new PC-I has already been submitted to Govt. to continue the strategy upto year 2008 at a cost of Rs. 22.6 billion. The investments in this programme in the next five years are likely to go a long way. 15. In my view, this programme is one of the most costeffective ways of reducing poverty by improving family health and reducing maternal, infant and child mortality and morbidity rates. We need to continue the programme for the sake of sustaining our efforts at poverty alleviation and gender equity. For the future it needs to be assured that the programme is not starved for essenti al c urati ve drugs, m icronutri ents, contrac epti ve and other supplies that have demonstrably, made a difference to the 7

lives of rural families especially women. We hope the National Health and Population Facility of DFID will be a giant step in this direction. Out of 30 million children immunized last year, 16 million were vaccinated by LHWs. Out of 5 million women immuniz ed under MNT campai gn, 4. 5 m illi on were vaccinat ed by LHWs. It is gratifying to note that despite many adverse developments, the latest nutrition survey shows that the Vit-A deficiency is no longer a problem and severe anemia in both women children has declined. 16. Allow me to take the opportunity of quoting from Oxford Policy Management Groups - Third Party Evaluation of this programme through, the following excerpts. "Overall the Lady Health Workers (LHW) Programm e seem s to have had a substantial impact on the uptake of important preventive health services in the population it serves. It can be considered to have effectively met one key objective-that of promoting primary health care services to W omen and children. The strongest evidence for its effectiveness is in the rural areas. Indicators in the served population are often better than the national population Regression models suggest that the programme has had a large impact on the uptake of modern contraceptives in rural areas. The population served was found to have substantial better health indicators than the control population. This was the case for the use of antenatal services, medical assistance at birth, the use of Family Planning, use of 8

preventive child health services and treatment of childhood diseases. 17. Allow me to mention some of the new initiatives planned for the future. These are:- I. The need for a national intervention programme for perinatal and newborn care in Pakistan, if we are to reduce the infant mortality and m orbidity. This was also a strong recommendation of the recent situational analysis and review of Maternal and Child Health intervention strategies in Islamabad January 2003. An intervention programm e to improve perinatal and newborn outcomes is being proposed, through a pilot programme to be initiated in 10 districts in Phase-I. It can be then expended and also integrated with future strategies for provision of safe delivery and maternal care at the community level. II. Non-c om municable diseases s uch as c ardiovasc ul ar disease, cancer, m ental illnesses and injuries are becoming a major health challenges in the developing countries. The World Health Report 2002 has outlined 4 out of the top ten risks to health as being related to non-communicable diseases in countries such as ours and highlights the magnitude of benefit that preventive interventions can achieve in a range of cost effective manner. Within this context, the Ministry of Health, Government of Pakistan is initiating a partnership model for the prevention and control of non-communicable diseases. For this purpose a 9

Memorandum of Understanding has been signed to outline a tripartite collaboration between the Ministry of Health, the WHO Country office and a well known NGO, Heartfile, which has received assistance form CIDA. This innovative public-private-international health agency collaboration will develop a strategic plan of action in consultation with all stakeholders and will implement a series of interventions through an inter-sectoral collaborative process to address the rising burden of on communicable diseases in Pakistan III. The current HMIS is already a decade old system. After several years of its im plementation there is a growing concern amongst the Provincial Health Departments and the National Programme Managers to make it more responsive to the information needs of its multiple stakeholders, certain alternations / modifications in the existing structure of the system are urgently desired. To address this demand a plan has been developed by the National HMIS Cell in coordination with the Provincial HMIS Cells. The Ministry of Health has prepared a project document at a cost of Rs. 198.310 million. This project will enable the Ministry of Health to develop a National Health inform ation resource centre, which will facilitate institutionalization of HMIS and would play a useful role in the assessment of policy indicators. 10

IV. The Ministry of Health has envisaged the development of its capacity through the establishment of National Health Policy unit. This is to enable the Ministry of Health to respond to evolving health policy challenges. The business of the policy unit would be to provide advice on strategy and resource allocation monitoring and evaluation of health strategies across the health sector and ensuring that the national policies and strategies are responsive to the emerging data and evidence. DFID s Technical Assistance for the establishment of this unit is greatly welcomed. 18. In the end, I thank you for giving me a patient hearing. I know that issues of human health, especially m easures that enable the weak and the dis-advantaged to have more opportunities to fulfil themselves, are the common priority of all of us. We shall neither flinch from these challenges, nor fail in the discharge of our responsibilities. 19. On behalf of the women, children and people of Pakistan, I want to personally thank all of you for tremendous support and assistance to Health sector. We look forward to a continuing partnership in the days to come. ************ 11