What is the situation on ground in Sindh?
Sindh has a very young population and over the next few decades the share of the working-age population will grow. Out of a total population of 50.4 million (23 percent of country’s population), 56 percent are between 15 and 64 years old, 27 percent are between six and 14 years old and about 14 percent are under 5 years. Economic growth will require an environment that supports the health and well-being of all people in Sindh, especially young people, and women. It is essential to invest in reproductive, maternal, and child health and nutrition.
What is the state of public health and health systems in Sindh?
There is evidence of improvements in some indicators related to child health in Sindh. Under-5 mortality declined from 93 deaths per 1,000 live births in 2012-13 to 77 deaths per 1,000 live births in 2017-18. Childhood stunting declined from 56.7 percent to 49.9 percent in the same period. This has been accompanied by an increase in babies being delivered in health facilities—from 58.6 percent to 71.8 percent. Immunization coverage also improved from 29.1 percent to 48.8 percent during the same period. A key factor contributing to significant improvement in these indicators is an increase in investments and financial resources for the health sector, including public-private partnerships (PPP) for primary healthcare.
There remain significant disparities in Reproductive, Maternal, Newborn, Child, and Adolescent Health and Nutrition (RMNCAH+N) services across districts, economic status, educational status of women, and the urban/rural divide. Women in higher income households who have more education and live in urban areas are more likely to seek reproductive and maternal health care compared to poor, less educated rural women. Only 32.7 percent of children in Sindh received age-appropriate vaccinations with the majority being urban (39 percent compared to 27 percent in rural areas), from more educated households (47 percent with tertiary education compared to 26 percent with no education) and higher wealth quintiles (58 percent in the highest quintile compared to 22 percent for the lowest).
What are the gaps in the Sindh’s heath system?
- Sindh lags other regions of Pakistan in maternal health outcomes. Sindh shows higher levels of pregnancy-related deaths (345 per 100,000 live births) and maternal mortality rate (224 per 100,000 live births) compared to Punjab (219 deaths per 100,000 live births and maternal mortality rate of 157 per 100,000 live births) and Khyber Pakhtunkhwa (175 deaths per 100,000 live births and maternal mortality rate of 165 per 100,000 live births). Sindh’s under-5 mortality (77 percent) is closer to the national average (74 percent) and that of Balochistan (78 percent), but higher than Khyber Pakhtunkhwa (64 percent).
- Contraceptive use remains low in Sindh. About 31 percent of married women use some form of contraception and under a quarter of married women use modern contraceptives.
- Lower quality rural health facilities. Health facilities in rural areas lack adequate and trained human resources, medicines and medical equipment and have insufficient infrastructure for healthcare providers to practice minimum service delivery standards for quality care.
- Barriers to health services for women- About 54 percent of women in Sindh have problems accessing healthcare, with nearly 46 percent not wanting to go alone to a health facility. Women also face barriers in exercising their sexual and reproductive health rights. Among those who are unable to access services, at least 10 percent cite not being allowed by family members due to the cost of services and social norms.
What was the impact of the 2022 floods on health systems in Sindh?
In Sindh, 23 of 30 districts are classified as calamity-affected by the heavy monsoon and flooding since June 2022. Preliminary assessments confirm that more than 700 health facilities are partially damaged, and about 100 health facilities are fully damaged. Healthcare is inaccessible due to damaged roads, inactive health facilities, and lack of human resources and medicines. Vector borne diseases such as malaria and dengue, acute watery diarrhea, cholera, skin diseases and malnutrition are on the rise.
How will the Sindh Integrated Health and Population Project help the people of Sindh?
The Sindh Integrated Health and Population Project will help improve both the quality and utilization of basic reproductive, maternal, newborn, child and adolescent health and nutrition services. It will also help in rehabilitation and reconstruction of health infrastructure that was damaged in the floods, disrupting the delivery of these services. The project will improve access to quality healthcare services for people living in the vicinity of the selected government dispensaries in remote and peri-urban areas and in the flood-affected settlements in Sindh.
Who will benefit from the project?
The direct beneficiaries of the project will be the population, especially women and children, living in the areas supported by the Government Dispensaries, that provide free healthcare, and flood affected population living in the areas of health facilities damaged by floods in Sindh.