By David Morgan

Negligence and delays are the factors, which account for high maternal and infant mortality rate in the country. This was stated at a seminar for journalists on "Giving basic priority to women's and children's health", organized by the Pakistan Press Foundation (PPF) at its Vicky Zeitlin Media Library.

The seminar was held to mark the World Health Day 2005 with the focus on healthy mothers and children. Sindh Additional Secretary Health Dr Shafqat Abbasi; Sindh WHO's Operation Officer Dr G.N. Kazi; Pakistan Medical Association Secretary General Dr Shershah Syed; Gynaecologist Prof (Dr) Rubina Hussain of Ziauddin Hospital and University and Civil Hospital's paediatrics department head Prof Iqbal Memon addressed the seminar. PPF Director Samina Ishaque conducted the seminar and journalists from print and electronic media participated in the seminar.

Dr G.N. Kazi said that in order to reduce maternal deaths, all women needed access to high quality delivery care with at least three key elements including skilled care at birth, emergency obstetric care in case of complication and an effective referral system ensuring access to emergency care.

Despite the fact that 40 per cent (60 million) of the people were living below the poverty line, he said that the public spending on social sectors still remained low. "Despite massive investment, fresh medical graduates are ill-equipped to take on the responsibility of addressing community needs warranting major reforms in medical curricula, teaching environment and methodology," he added.

"Gender inequity persisted in spite of religious instructions and national policies," he remarked. According to him, other determinants of ill health are poverty, population explosion, malnutrition, gender inequality, unsafe water, lack of sanitation, improper waste disposal, environmental pollution, low literacy rate, unsafe deliveries, lack of community oriented medical education, low utilization of health facilities in rural areas, unhealthy lifestyles and lack of health awareness.

He said that district health system were facing challenges including inadequate supportive supervision and monitoring, verticality in preventive programmes, lack of human resource development for health care professionals and providers and lack of minimum quality standards at facility level and inadequate inter sectoral collaboration and community involvement.

To address maternal mortality issues, he emphasized that availability of antenatal, natal and postnatal care for pregnant women during labour and after birth should be ensured. "Magnesium sulphate should be used to treat severe pre-eclampsia.

Antibiotic prophylaxis should be used for women undergoing caesarean delivery. Assisted delivery should be performed in cases of obstructed labour, while iron supplements should also be given routinely during pregnancy to prevent anaemia," he added.

Sindh Additional Secretary Health Dr Shafqat Abbasi discussed provision of mothers' and children's healthcare in the proposed health policy. He said that they had ensured its effective implementation as well.

To provide medical help to all in Sindh, there were about 17,000 Lady Health Workers and 5,000 Lady Health Visitors in the province, playing role in reducing maternal and infant mortality.

"We are also planning to launch a campaign and suggesting legislations for legal action against quacks. Media should play positive role to create awareness among the masses about this campaign," he urged.

In the provincial health policy, he suggested that the basic salary being given to healthcare providers working at Basic Health Units and Rural Health Centres should be increased. Another valid suggestion for the government, he said, was to pay half of additional basic salary to persons working at taluka facilities.

"This matter has already been discussed with the chief minister and he has approved the same. Now it will be implemented within one year after getting approval of finance department. We are making all out efforts to improve facilities in rural areas," he maintained.

PMA Secretary General Dr Sher Shah Syed explained the role of his association and other such organizations for improving the performance and responsible ethical practice of doctors attending to mothers' and children's health issues. He said free education, emergency and primary healthcare and justice were the responsibility of government and it should be provided to people without any cost.

"In case of medical emergencies, delays are very common and frequent. First delay happens at home as men are generally not available in emergency time and women cannot go out without prior permission of husbands.

The second delay happens on the way to hospital as majority of people do not spare way for ambulances. Third delay takes place at hospital due to non-availability of necessary facilities," he added.

Appreciating the health policy, he said, dignity of women must be honoured in society to reduce maternal mortality rate. "Without realizing this responsibility, the goal cannot be achieved," he added.

He termed accountability as an essential factor that urgently needs to be developed; at present there is no concept of it in our medical practices. "The government should not interfere in the affairs of Pakistan Medical and Dental Council, and the PMDC should take strong action against doctors, held responsible for negligence during their performance and medical practices," he urged.

Prof (Dr) Rubina Hussain delivered talk on safe motherhood saying that there is an urgent need of interventions to overcome maternal mortality. "Gender inequity should be reduced, nutritional status before and during pregnancy be improved, girls access to education be increased and professional care should be delivered.

Skilled attendance during labour and delivery must be ensured. Effective referral system should be built and emergency maternal care for all women must be ensured," she recommended.

Dr Iqbal Memon discussed healthcare situation for infants and children. He said that 45 per cent of population comprised of children below 15 years of age; such a large segment was entitled to the best, especially healthcare. Every new born should have a safe and clean birth experience.

Breast-feeding should be started within one hour after birth, colo strums is enriched with all nutrients that protects the child from health problems, for years to come. Exclusive breast feeding should continue for at least six months, he said. The seminar was followed by a question answer and discussion session.