Healt Status and Demographics

8/6/2019 Healt Status and Demographics

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Health Systems Profile- Pakistan Regional Health Systems Observatory- EMRO

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3 H EALTH STATUS AND DEMOGRA PHI CS 3.1 Health Status IndicatorsTable 3-1 Indicators of Health status

Indicators 1990 1995 2000 2002

Life Expectancy at Birth: 59.10 60.88 62.96 65

HALE: - - 50.9 53.3

Infant Mortality Rate: 96 90 81 76

Probability of dying before 5P

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birthday/1000:138 125 108 101

Maternal Mortality Ratio: 550 - - 340-400

Percent Normal birth weight babies: 75 75 66-75 66-75

Prevalence of stunting/wasting: 51 (88) 23* - 61.9

Source:DG report 2002-3State of worlds children 1990World health report 2003- Background country papers*National health survey of Pakistan 1990-96

Table 3-2 Indicators of Health status by Gender and by urban rural

Indicators Urban Rural Male Female

Life Expectancy at Birth: - - 64 66

HALE: - - 54.2 52.3

Infant Mortality Rate: 65 88 84 81

Probability of dying before 5thbirthday/1000:

- - 98 108

Maternal Mortality Ratio: 55-150 200-500 - -

Percent Normal birth weight babies: - - - -

Prevalence of stunting/wasting: - - - -

Source:PIHS 2001-2002PDS 2001WHO World Health report 2003


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Table 3-3 Top 10 causes of Mortality/ Morbidity

Source:1. Adnan A. Hyder, Applying Burden of Disease Methods in Developing Countries: A CaseStudy From Pakistan, American Journal of Public Health, August 2000, vol 90. N0. 80

2. Top 10 Causes (by Rank Order) of Premature Mortality and Disability in Pakistan, 1990,www.worldbank.org/transport/forum2003/presentations/hyder.ppt

The current health status of the nation is characterized by a high population growth rate,high incidence of low birth-weight babies and maternal mortality. While communicable,

infectious, and parasitic diseases remain a severe burden, malaria and tuberculosis (TB)continue to be potential threats. People in Pakistan have grown healthier over the pastthree decades: the rates of immunization of most groups of children have more than

doubled over the past decade, and knowledge of family planning has increasedremarkably and is almost universal. Pakistans per capita income is much higher than theaverage for low-income countries. Yet, despite these positive aspects and government-and donor-financed interventions, health indicators have been improving very slowly.

Communicable diseases such as diarrheal diseases, respiratory infections, tuberculosis,and immunizable childhood disease still account for the major portion of sickness anddeath in Pakistan. Maternal health problems are also widespread, complicated in part byfrequent births. In fact, Pakistan lags far behind most developing countries in womenshealth and gender equity: of every 38 women who give birth, 1 dies. The infantmortality rate (76 per 1,000) and the mortality rate for children under age five (101 per1,000 births) exceed the averages for low-income countries. Although use ofcontraceptives has increased, fertility remains high, at 4.5 births per woman, andpopulation growth rates are much higher than elsewhere in South Asia. The underlyingproblems that affect health-poverty, illiteracy, womens low status, inadequate water

supplies and sanitationpersist. Nevertheless, Pakistan is committed to the goal ofmaking its population healthier, as evidenced by the National Health Policy.

Although, consolidated public health expenditure rose during 1995-96 to 2000-01, itrepresents 0.60 percent of the GDP. Additionally, a major share of these expenditures isfocused towards tertiary health care facility with the result that primary and secondarytiers especially in rural areas have been neglected. In addition, serious institutional andgovernance deficiencies mar the health sector. The other challenges facing the healthsystem are access (availability and affordability), unawareness, and inadequatebudgetary spending. Analysis of the burden of disease (BOD) conducted in 1996

Rank Mortal ity Morbidity/Disabil ity

1. Diarrhea Hypertension2. LTRI-Child Injuries3. Tuberculosis Eye diseases4. Rheumatic heart disease Malnutrition5. Chronic liver disease Birth diseases6. Congenital malformations Congenital malformations7. Birth diseases Dental diseases8. Ischemic heart disease Ischemic heart disease9. Child septicemia Anemia (in females)10. Other respiratory diseases Mental retardation


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indicated that around 60% of BOD is because of poverty related communicable diseases,childhood illnesses, reproductive health problems and malnutrition. Major impact of

these diseases is borne by poor segments of society and vulnerable groups. The majorchallenges facing the health sector are slow progress in improving the indicators relatedto maternal health, child health, and morbidity and mortality caused by communicablediseases. Although, the coverage has improved over recent years, however, providing

quality health care to vast majority of population is a formidable task. The government iswell aware of the magnitude and depth of the problem. It has endeavored recently toaddress the broader issues in social sector delivery through major reforms while IPRSPreflected the governments commitment to improving public service delivery as central toachieving the goals of reviving growth and reducing poverty. The medium term healthstrategy is focused towards raising public sector health expenditures through a focus onprevention and control of diseases, reproductive health, child health, and nutrientdeficiencies. The thrust of public expenditures is geared towards primary and secondarytiers. This approach provides a clear shift from curative to preventive health care andfocuses on disadvantaged, weaker sections of society especially those belonging to ruralareas. It aims at promoting gender equity through targeted interventions like increase ofLady Health Workers (LHW) and improvements in maternal health care

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As per BOD study 1998, Pakistan is also facing significant burden of non-communicablediseases, unlike other developing countries. The major non-communicable health issuesare injuries, cardiovascular diseases, Diabetes, Hypertension, psychological disorders,geriatric problems etc. The burden of non-communicable group of diseases is 44%,indicating that Pakistan is facing double burden of diseases, where communicablediseases are not fully controlled, while non-communicable diseases are emerging as amajor problem.

3.2 DemographyDemographic patterns and trends

The Islamic Republic of Pakistan, with a population of about 153 million (2005), has anarea of 307,374 square miles (796, 095 square km) and an overall population density of182 persons per square km. There are four provinces and two regions. Provinces arePunjab (the most populous), Sindh, North Western Frontier Province (NWFP) andBalochistan (largest by area), and regions are Azad Jammu Kashmir (AJK) and Federally

Administered Northern Area (FANA). Afghan refuges and religious minorities reside incertain areas of the country in significant numbers.

Geographic Distribution

The majority of southern Pakistan's population lives along the Indus River. In thenorthern half, most of the population lives about an arc formed by the cities ofFaisalabad, Lahore, Rawalpindi

H

/Islamabad, and Peshawar.

Ethnic groups: Pakistan's ethnic diversity is obvious and yet accurate numbers have beenelusive. Rough estimates vary, but the consensus is that the Punjabis are by far thelargest group, and that Pukhtuns and Sindhis are the next two largest groups. The mainethnic groups include the following: the Punjabi, Pashtun, Sindhi, Baloch, Muhajir

(immigrants from India at the time of partition and their descendants), Seraiki, Brahui,Kashmiri, and the various peoples of the Northern Areas. In addition, a large number of

Afghan refugees came to Pakistan during theH

Soviet invasion of AfghanistanH

, and it isestimated that over three million remain, with a large proportion settling in the country.


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Religions:H

MuslimH

97% (H

SunniH

77%,H

ShiiteH

20%),H

BuddhistH

,H

ChristianH

,H

HinduH

, and other3%

Languages: As a first language, Pakistanis speak: Punjabi 48%, Pashtu 15%, Sindhi12%,

HTU

SiraikiUTH

(a Punjabi variant) 10%, Urdu (official) 8%, Balochi 3%, Hindko 2%, Brahui1%, English (official and lingua franca of Pakistani elite and most government

ministries), Burushaski, and others 1%. The majority of Pakistanis can speak orunderstand two or more languages.TP

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The health and population characteristics of Pakistan are high fertility, low lifeexpectancy, a young age structure, high maternal and child mortality, high incidence ofinfectious and communicable diseases, and wide prevalence of malnutrition amongchildren and women. The country is going under a demographic transition, characterizedby a change from high mortality and high fertility to lower mortality but still relativelyhigh fertility.

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Fertility Transition: Unlike its neighbors- Sri Lanka, India, and Bangladesh- Pakistanhas confounded demographers by maintaining a high rate of fertility. However, thetransition to lower fertility in Pakistan, which had been expected as early as the 1960s,has begun in the 1990s, according to Population Council researchers. The decline,though moderate, is definitive. Several studies confirm that between the 1960s and the1980s, the total fertility rate (TFR) in Pakistan remained above six births per woman.

Pakistan has been a puzzle, a stalwart resister to fertility transition, commentsCasterline. Beginning in the 1990s, however, the fertility rate dipped below six births perwoman for the first time. Among other surveys, the Pakistan Fertility and FamilyPlanning Survey (199697) found a TFR of 5.3 for the period 199296. The researchers

note that all the demographic analyses they examined point to a fertility decline in the1990s. Some of the most persuasive evidence for a fertility decline comes from trends incontraceptive use. During the 1980s, fewer than 10 percent of married women inPakistan practiced contraception. By 1991 that figure had risen to 12 percent, and by1995 to 18 percent. As of the most recent survey, conducted in 1996 and 1997, about24 percent of married women were using contraception. Women in urban areas were

about twice as likely as women in rural areas to use contraception. Demographic trendsthroughout the world show that when mortality declines and social and economicconditions improve, fertility decline follows, often with only a short lag. This has notbeen true in Pakistan, where improvements in these conditions first appeared in the1950s. Several other factors conspired to thwart any reduction in fertility. Women'sstatus remains unusually low in Pakistan, and men make many of the decisions aboutreproduction. A strong economy in the 1960s through the 1980s gave families littlemotivation to restrict fertility. Until the end of the 1980s, people viewed the social,psychological, and cultural costs of contraceptive use as higher than the cost ofadditional births.

Pakistans economy has turned sharply downward in the 1990s, while the spread ofmass media has helped to raise the aspirations of parents for the lives of their children.Together these trends have led to a growing conviction that children are costly. At thesame time, there has been a cultural shift during the 1990s from the bonds of extendedfamily to the autonomy of the couple. In the past, kin had a voice in fertility decisions.But many couples have migrated from rural to urban areas, weakening these family ties.Reflecting these societal changes, the ideal family size has shrunk during the 1990s,from 4.1 children in 1991 to 3.6 children in 1995.

The most important reason that the transition is happening now rather than earlier is asense of economic stress that did not exist before. Sathar and Casterline believe that


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public and private family planning services have not played a large role in stimulating thefertility changes in the 1990s. Family planning services in Pakistan remain seriously

deficient, with one study finding that only 10 percent of the population had easy accessto the services. To sustain the fertility transition in Pakistan, family planning servicesespecially those in rural areasshould be expanded and improved as rapidly as possible.Unmet need for contraception remains relatively high, and many couples desire

appropriately designed services. The potential payoff of investing in and improvingfamily planning services is greater now than ever before, stresses Sathar. Withoutexpanded and improved services, we do not believe the transition will go far or proceedrapidly. Over the long run, however, the demand for children must fall further forpopulation growth to wane significantly in Pakistan. Ideal family size, while lower than inpast decades, remains well above replacement levels.

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Table 3-4 Demographic indicators

Indicators 1990 1995 2000 2002

Birth Rate per 1,000 Population: 41 37 34 27.8

Death Rate per 1,000 Population: 13 10 8 7.2

Population Growth Rate: 2.54 2.46 2.2 2.01

Dependency Ratio %: 0.85 0.87 0.82 0.78

% Population

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