Per capita healthcare spending

The State of the World's Children Report 2009, launched by Unicef's representative in Pakistan, Martin Nogwanja, provides a disturbing peep into the per capita healthcare spending in Pakistan, i.e. only $18 per annum, of which only $4 is spent by public sector.
While launching the report, Nogwanja has called on Pakistan to raise the per capita allocation to at least 45 dollars. However, according to Mogwanja, even the existing meagre allocation is not being properly utilised. Lack of equipment, absenteeism among the staff, and inadequate training have created a vicious circle which has further handicapped the system.
According to Nogwanja, mothers and children have been badly affected due to the worsening law and order situation in the country, which has further restricted their access to medical services, especially in NWFP and Fata. The statistical data provided in the Report portrays a very dismal picture of the state of the country's healthcare system. For instance, an estimated 216,000 new-born babies die annually in Pakistan before they reach the first month of their age, which represents 58 percent of deaths of children under five.
This means that there should be greater focus on post-natal specialised care. Pakistan has the eighth highest rate of new-born deaths, which makes it rank below only Afghanistan and Iraq among the Asian countries. Of every 1,000 live births, 53 infants would not survive their first month of life. Further, 94 out of every 1,000 Pakistani children die before the age of five years, while 78 of these children die before they are one year old. About 38 percent of the children under five in Balochistan are moderately or severely underweight and about 59 percent of rural Pakistanis do not have access to adequate sanitation facilities. Pakistan is one of the four countries where polio cases are still found.
Most of the deaths can be prevented through adoption of an integrated approach to mother and child healthcare, hygiene, nutrition and protection. Among the major reasons for death of new-borns is that mothers are not given proper medical care during pregnancy and childbirth, with lack of literacy, restricted access to medical services and low status of women in Pakistani society making things much worse. Early marriage of girls is said to be a major cause of premature births. A survey has shown that although there has been a decline in the number of teenage marriages in Pakistan, one out of six women, aged 15-19 is already married. Further, women in rural areas run twice the risk of dying of maternity-related complications than their urban counterparts.
Economic Survey for 2005-06 had acknowledged that Pakistan lagged far behind other countries in the region with regard to indicators on children, while Save the Children had reported that approximately one-third of the population lived in poverty in Pakistan, 70 million did not have access to healthcare, with children being the worst victims of this social sector disaster. The government policy of shifting healthcare responsibility to the private sector has meanwhile made healthcare increasingly expensive, thereby putting it out of financial reach of a majority of the Pakistanis, particularly women and children.
This is clearly a grave infringement of the rights of the child, as guaranteed under the UN Charter. Unicef's 2007 report on the State of the World's Children had ranked Pakistan 47th among 157 countries in terms of basic indicators for child welfare.
Incidentally, Pakistan had ratified the UN Convention on the Rights of the Child that includes access to quality healthcare, way back in 1990, and was one of the six initiators for holding the World Summit for Children the same year. It is also a signatory to such important international instruments as the Stockholm Declaration and Agenda for Action, the UN Millennium Development Goals, 2000 and various ILO conventions. Further, Articles 11(3), 379(e) and 3(1) of the Constitution of Pakistan have set specific parameters concerning welfare and protection of children, that includes provision of proper healthcare.
Pakistan should increase the per capita health spending to at least $45 per annum, as proposed by Unicef country representative Martin Nogwanja. Although the proposed increase does not amount to much, it will certainly make a big difference in provision of public sector healthcare. Secondly, the government should ensure that the funding is spent only on actual provision of healthcare, and is not diverted to meeting administrative expenditure etc. The government should ensure that the benefit of raise in per capita healthcare spending is translated into provision of better health services to the common citizens.