HEALTH In its Human Development in South Asia 2004 report, the Mahbub ul Haq Human Development Centre at Islamabad took stock of the health situation of all countries in the region It emphasized that while South Asia had only 25 percent of the world’s population, it was home to 40 percent of the malnourished people; the region also accounted for 33 percent of the world’s child mortality and 35 percent of maternal mortality Considerable progress had been made by the South Asian countries-life expectancy had increased from 44 years to 63 years over the last four decades-but according to the index, with values assigned from zero to one, the situation in South Asia was precarious compared to several other regions in the world Pakistan was the second poorest performer among the seven countries of South Asia in terms of the health index, a notch above Nepal, with a score of 0458 India, at 0476, was only slightly better than Pakistan Pakistan’s relatively poor performance was largely on account of the infrastructure component of the index, with a score of only 0283 There were six indicators for measuring the quality of infrastructure
They include public expenditure on health, child immunization rate, physicians per head of the population, skilled attendants at birth, access to safe water, and access to sanitation facilities Pakistan did poorly on all these counts It allocated only 1 percent of its GDP to health, there were only 68 physicians per 100,000 of the population, and only 20 percent of the births were attended by skilled health personnel The last fact was one of the more important reasons for the high rates of infant and maternal mortality (83 per 1000 live births and 500 per 100,000 live births, respectively It was largely because of this that Pakistan had life expectancy that was two years less than the weighted average for South Asia: 61 years as opposed to 63 years The country spent only$16 per person on health compared to the South Asian average of$21 Of this total expenditure, slightly less than a quarter (244 percent) is spent by the government, and the rest is spent by the citizens themselvesThe relatively low expenditure on health, particularly by the public sector, had several unpleasant consequences It hurt the more vulnerable groups in the population, especially children and women While unattended births meant a high infant mortality rate, poor health services contributed to a high rate of child mortality
At 107 deaths per 1000, the under-five (child) rate of mortality in Pakistan was by far the highest in South Asia Relatively poor performance in terms of immunization was one reason for high rates of death among children Slightly more than one half of all children were immunized against measles, and slightly less than two-thirds against polio Both diseases took a very heavy tollDiarrhea was another large killer of children, much of it the consequence of the poor quality of drinking water, poor quality of sanitation, and low levels of education among women In 2000, according to Pakistan’s government, 90 percent of the country’s population had access to safe drinking water and two-thirds of the population had sanitation of a reasonable quality available to them And yet 12 percent of the children in the period 1998-2001 had had diarrhea at some time Diarrhea is not fatal, provided parents know how to deal with the disease Oral rehydration-a cheap and readily available remedy-is an effective cure However, only 19 percent of the children who had suffered from the ailment were treated with this remedyWomen were the other vulnerable group in the Pakistani population that did poorly in terms of health
This was unfortunate, since women’s poor health affected all members of the family, in particular their children This was especially the case when, as was the situation in Pakistan, high rates of fertility meant that births were not spaced sufficiently well apart to ensure adequate parental attention In 2001, at 54 births per woman, women in Pakistan’s villages had one of the highest rates of fertility in the world High fertility rates were the result of the relatively low status of women in the Pakistani society, prevalence of illiteracy among them, and either lack of familiarity with or inability to access family planning devices Contraceptive prevalence rate among the Pakistani women was only 276 percent compared to 482 percent in India and 70 percent in Sri LankaSome of the diseases that had been brought under control have returned to Pakistan in recent years, complicating the health situation and further burdening the health system Malaria and tuberculosis were the most notable examples of diseases that reappeared In 2000, the country had 58 cases of malaria per 100,000 of the population, and 379 cases of tuberculosis
These two diseases not only kill; they take a heavy economic toll since they result in a loss of energy of those who are afflicted The return of both malaria and tuberculosis was caused by environmental factors-poor drainage of water and the presence of high levels of particulates in the environmentSome lifestyle changes are also contributing to the poor status of health in the country The most serious among these was the increased prevalence of smoking Pakistan had a considerably higher rate of smoking ( 36 percent of the male population) than the average for Asia Smoking is spreading among women also; in 2000, 9 percent of Pakistani women were smokers, compared with only 3 percent in India.