very year, World Health Day is celebrated on April 7. This year’s theme is Healthy Beginnings, Hopeful Futures. The day will kick off a year-long advocacy on maternal and newborn health and will urge governments and health communities to enhance efforts to end preventable maternal and newborn deaths and long-term health and wellbeing of women. The four goals of the campaign are awareness, investment, providing information and encouraging support to parents and healthcare providers.

Globally, current estimates indicate 300,000 maternal deaths per year; two million babies die in their first month and two million are stillborn, which makes one preventable death every 7 seconds. The situation in Pakistan is no different from other low- and middle-income countries. In fact, the country falls in lower ranking in maternal and newborn mortality. There are 154 maternal deaths per 100,000 live births with regional disparities, although 74 percent of these deliveries are by skilled workers and 51.4 percent have had more than four antenatal visits. 42 percent of women in reproductive age are anaemic and every fourth mother has perinatal depression. Pakistan has made progress towards reduction in under-five mortalities but infant mortality rate stands at 61 deaths per 1,000 live births and neo-natal (one month) mortality rate at 39 deaths per 1,000 live births.

Child mortality is a matter of concern due to lack of access to healthcare, maternal and child malnutrition and limited access to essential child specific (under-five) interventions. Stunting rate of 37.6 percent remains static since 1963 with marked regional disparities. Every fifth child has some sort of behavioural and emotional problems at school. There is a big gap in need and adequacy of the health system. Interventions made to improve health indicators are masked by population growth at 2.55 percent (highest in the region), unchanged for the last 15 years. There are 4 million unwanted pregnancies every year, increasing chances of unsafe abortions and enhanced by contraceptive stock outs. There is a rise in non-communicable disease and risk of climate induced emergencies and pandemics. It is well known that 80 percent to 90 percent of the health needs of a person are covered by primary healthcare.

In Pakistan, key areas to focus on are implementation of universal health coverage essential health services package, nutrition, social health protection and revisiting health financing and interventions outside health.

Pakistan is a signatory to SDG 2030 agenda where Target 3.8 deals with the provision of UHC, which has two components: 3.8.1, improving access to healthcare; and 3.8.2, financial protection. Pakistan has developed essential package of health services for UHC and is monitoring UHC service coverage index on 16 indicative services. This index is used to judge and indicate where the country stands in terms of coverage of basic services. At the national level, monitoring report of 2024 indicates that UHSCI stood at 53.9, an almost 36 percent improvement from 2015. The improvement in maternal and child health is indicated by the fact that the index stood at 66.6 as compared to 51 in 2015. That means more investment in this area will lead to ensuring UHC under this head. A major hurdle is family planning services.

Maternal and child nutrition is another important area to address maternal and child wellbeing. For example, stunting in children—a key measure of malnutrition—is directly linked to the 1,000 Days opportunity (from conception to age two, which is a critical window for early childhood development). Targeted investments in the nutrition sector, including sustainable or one-time relief programmes are required. School feeding programmes, micronutrient supplements and fortified food programmes are key areas to consider for adolescent health.

Estimates suggest that every year, 13.4 million people are at risk of falling in poverty due to catastrophic out-of-pocket health expenditures.

We have a mixed healthcare system where 50 percent of the expenditures are out of pocket and 70 percent consultations are done in the private sector. Estimates suggests that every year, 13.4 million people are at risk of falling into poverty due to catastrophic out-of-pocket health expenditures. Pakistan has a social health protection programme, which started in 2015 as the Prime Minister’s National Health Programme to reduce OOP health expenditure on in-patient care for the poorest of poor. This programme passed through several phases and has provided people financial cover for indoor healthcare services, covering almost 59 million families. One data analysis of representative sample in the Punjab has shown reduction in OOP expenditure; maternity care is one of the most utilised services. A recent evaluation done in Khyber Pakhtunkhwa shows that indoor services should be linked with PHC and OPD services. This is because catastrophic expenditures in indoor services are high and need to be cut down but after hospitalisation, a patient needs regular treatment which is not covered in insurance programmes so it is important to link health insurance programmes with PHC. This could be done by creating synergies between the UHC/ essential package PHC and the health insurance programme. It is seen that those who avail this programme have a higher spending on OPD, particularly for children due to higher disease burden in poor socioeconomic background.

The landscape of health challenges is ever-evolving. From disease outbreaks to the aftermath of the Covid-19 pandemic, these challenges demand robust healthcare systems. When considering financial investments in this sector, the numbers are concerning. Currently, Pakistan invests only 1 percent of its GDP in the public health sector, and 3.5 percent of the GDP including private sector. Two-thirds of the healthcare spending is out-of-pocket expense. Public sector spending amounts to roughly $29 per capita for UHC. Most of these funds are directed towards tertiary care. Very little is allocated to maternal and child health at PHC. Public financing in health and nutrition is a key area for improving maternal and child health while addressing urban-rural and regional disparities; for instance, spending on children is three times higher in developed districts.

Access and affordability are the major barriers in reaching health services. A majority of the population is living in rural areas where health services are lacking, being concentrated in urban areas. This creates disparity in the distribution of healthcare service delivery. The LHW programme was initiated with a focus on maternal and child health but now they are performing other duties as well leading to overburdening and high workload. LHW programme as an outreach programme needs to be strengthened and realigned; it needs more investments to be effective for maternal and child care and long-term wellbeing of families. Pakistan is recognised as the best PHC network in the world. This shows that we have the capacity and the focus; all we need is the finances to improve it.

Pakistan needs to be part of this campaign actively. Listening to women and supporting families should be central along with the provision of quality healthcare which supports them physically and emotionally before, during and after birth. Health systems must evolve and mange health impacts on maternal and newborn health with a multi-sectoral approach. This requires healthcare that is accessible, affordable and of high quality. Limited human resources, insufficient infrastructure and low public health spending continue to hinder progress. Initiatives like the Sehat Sahulat Programme, aimed at expanding health insurance coverage for low-income households, represent important steps forward. However, gaps in rural healthcare access, service quality and funding persist, underscoring the need for systemic and programmatic reforms.

The writer is a senior policy advisor/ researcher at SDPI Islamabad. She can be reached at Razia@sdpi.org.