improving health indicators – post devolution population, health & climate change

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Improving Health Indicators – post Devolution Population, Health & Climate Change Policy & Research Issues for Pakistan Muzaffar Mahmood Qurashi February 15, 2013

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Improving Health Indicators – post Devolution Population, Health & Climate Change. Policy & Research Issues for Pakistan Muzaffar Mahmood Qurashi February 15, 2013. Looking Forward and Looking Beyond. How does one look forward ? and beyond ? Did we? - PowerPoint PPT Presentation

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Page 1: Improving Health Indicators – post Devolution Population, Health & Climate Change

Improving Health Indicators – post Devolution

Population, Health & Climate Change

Policy & Research Issues for PakistanMuzaffar Mahmood Qurashi

February 15, 2013

Page 2: Improving Health Indicators – post Devolution Population, Health & Climate Change

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Looking Forward and Looking Beyond

• How does one look forward? and beyond? Did we?• Slow (delayed) wake up; if threat immediate• Models? India; Sri Lanka; Europe; USA; new

medicines, new therapies? Replication here? • Handicaps: Health Indicators already poor; Population programme

embarrassment; Devolution (after 2 years) lacks vibrancy; weaknesses magnified

• The familiar pattern: trailing behind most (all) others– Particularly in science and technology; A few fast track replications –

seldom abreast; Never, never, ahead; Even when we were (pop programme) soon lost out

Page 3: Improving Health Indicators – post Devolution Population, Health & Climate Change

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Health endangered by media-promoted habits

• Earlier attitudes (food, clothing, walking to work) demolished - aggressive marketing of branded products; vulnerable

• No sponsor for promoting fruit, vegetables, milk• “Shirt sleeve” comfort – over heating, over cooling; thin cloth for

winter suiting enhanced risk for unexpected weather

• Grandparents were immune to extreme weather (cold baths at the best college; in villages, only cheddar during coldest winter, never a jacket, sweaters were rare, blanket used as overcoat.

• free therapy - sunshine in winter and sleeping in the open during summer nights - wasted ; AC/heater compulsion, vulnerability

• fast food, refined flour, chemical-loaded beverages - undermined health: dependence on pharmaceuticals, loss of resistance

Page 4: Improving Health Indicators – post Devolution Population, Health & Climate Change

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Draft Chapter on Health in V Year plan seeds for climate change protection

[prepared and circulated. But set aside, because the Plan was not launched]

After devolution, Health presents the following challenges:

• Capacity building , control of communicable diseases, Improved child and maternal health, Prevention and control of non-communicable diseases, Control and management of accidents and trauma.

• Control of environment and unhealthy social habits.

• shift from curative to preventive and promotive care -MDGs/PRSP • assures health care to all on equitable basis

Page 5: Improving Health Indicators – post Devolution Population, Health & Climate Change

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Draft Chapter on Health in V Year plan policy measures [also in Health Policy]

• access to health services for poor and vulnerable • reduce burden of disease among the vulnerable • Protecting the poor and under privileged subgroups • Strengthening stewardship for service provision• Improving access to and use of health information• evidence based policy making and strategic planning • social, economic and environmental determinants of

health through intersectoral action• promoting health in all policies

Page 6: Improving Health Indicators – post Devolution Population, Health & Climate Change

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Strategic Priorities: Draft Chapter on Health in V Year plan

• Ten strategies. last four focus vulnerable groups and the threat of climate change:

• Protection of poor against catastrophic expenditure.• Access of the poor to affordable quality drugs.• social protection to assure provision of health care to the

poor for nationwide Health Care System.• Social determinants of health: healthy environment, health

awareness community-based initiatives• strengthening linkages with health-related ministries,

gender mainstreaming

Page 7: Improving Health Indicators – post Devolution Population, Health & Climate Change

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Health priorities - Annual Plan 2012-13 Ch 17 – Health, Nutrition and Population

Post dev: vertical programmes, funding NFC award, lack of evidence based planning and decision making; weak management, partially functional system, motivation, inequitable distribution of expdr

• Strategic priorities: strengthen primary health care, communicable disease control, social protraction /health insurance; Need based funds for Tertiary care; diagnostic facilities;

• National Zero Hunger Programme (UN); • iron supplementation MCH; scaling up Nutrition

surveillance system

Page 8: Improving Health Indicators – post Devolution Population, Health & Climate Change

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Population increase – Fears, Hopes, pointers for climate change thinking

• PDHS Survey (2006-07): births in serious health and life risk conditions: (i) childbearing in teens; (ii) childbearing beyond age 34; (iii) short birth interval

• urban agglomerates overstretch existing amenities• population density, slums, declining water resource• Ambition: every pregnancy planned; every child

nurtured, cared; Improve maternal health• strategy - Healthy timing, spacing of pregnancies. • aggressive communication campaign is required

Page 9: Improving Health Indicators – post Devolution Population, Health & Climate Change

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Very little progress in Mainstreaming Population for Development Planning

• Universal safe family planning services - 2030 (2020)• Female education critical for fertility transition. • urbanization - pressure for services and amenities. • sectoral linkages - education, health, social welfare,

women development, labour and manpower, youth, environment and urban growth.

• National Commission on Population Welfare• youth for productive involvement in the society. • Population Bomb – climate change threat multiplier

Page 10: Improving Health Indicators – post Devolution Population, Health & Climate Change

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Annual Plan 2012-13 – Population Ch 17 – Health, Nutrition and Population

• Pakistan - highest growth rate (2%) in the world• TRF 3.5 is high, whereas CPR is lowest at 30%• ranked 6th in the world, 4th largest by 2050• FP services not kept pace with increased demand• stagnant CPR 30% - provision of fp services; • 1 of 3 women want birth spacing, un-met need • one child out of 4 on average is unwanted• Strategy: commitment, pol will, PPP, M&E • Climate change Poor services to become worse

Page 11: Improving Health Indicators – post Devolution Population, Health & Climate Change

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Women and Population seeds of climate change protection

• population policies have to address– social development beyond family planning services– family planning (reproductive health care) to be

provided despite limitations of climate change. • ensuring healthy and safe childbearing• addressing other factors that contribute to

poor living and poor health• Un-met need for contraception is unforgivable

Page 12: Improving Health Indicators – post Devolution Population, Health & Climate Change

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Most vulnerable: women, the elderly, young children, the poor

• extreme weather affects all• greater risk to women, the elderly, children, the

poor, the disabled, with heart problems or asthma. • Women sweat less, have higher metabolic rate ,

thicker subcutaneous fat that prevents them from cooling themselves as efficiently as men. less able to tolerate heat stress. experience greater decline in nutritional health, go hungry to protect families.

• Many have no access to health services, during pregnancy and childbirth

• climate change - gaps in programme become bigger

Page 13: Improving Health Indicators – post Devolution Population, Health & Climate Change

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Women Bear the Brunt of Climate Change – can lead protection effort

• Women create family cohesion, give up jobs, but more vulnerable.Activist Role of Women

• meeting women’s needs of RH improves health and wellbeing of women, increases resilience against climate change, slows down population growth (lessens greenhouse gas emissions)

• Climate protection needs women’s expertise, key agents of change management(Nampinga 2008).

• consumers of resources, more vulnerable, agents of relief against climate change.

Page 14: Improving Health Indicators – post Devolution Population, Health & Climate Change

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Policy vs. Reality

• Policies , Plans, schemes good: little accomplished• Population programme – a model; embarrassing• Private sector = 70% health services, unregulated • Devolution hasn’t made the Provinces vibrant• Donor support reinforced flour; not to prevent

depletion of wheat flour from whole meal to maida?The Express Tribune dated February 13, 2013

• vaccination teams not under control of Health Minister; department failed to control measles

• Security at hospital; doctors released from jail threatened to attack MS

Page 15: Improving Health Indicators – post Devolution Population, Health & Climate Change

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programme dimensions in response to climate change issues

• infant mortality and child mortality – safeguards• Poverty alleviation – missing components health

needs, breast feeding, food supplements for maternity, new born, elderly, disabled

• Flood relief – delivery by rescued mother on boat (transport need - one of the “four delays”)

• Documentation of experiences ; clinics, flood relief,• ARE WE DOCUMENTING, PREPARING?

Page 16: Improving Health Indicators – post Devolution Population, Health & Climate Change

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Social Response to Hardship

• Weather effect - during pregnancy, delivery, on mother, new born

• medication, foods, habitation, living • classification of desi foods suji, panjeeri, herbal therapy in terms of

“thandi (cold)” and “garam (hot)”; all of it couldn’t be trash• Protecting new born from weather – blanket, wrapping • cold, colder, freezing; warm, warmer, hot, sizzling heat

• search backwards - healthy eating, protective clothing? the Gilgit model

• attitudes in managing relief - Cards of IDPs, stocks, throngs of claimants, managers under stress, complaints by local philanthropists, reports of disorder

Page 17: Improving Health Indicators – post Devolution Population, Health & Climate Change

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NCCP 2012

• List 9 threats – health at serial 9: “increased health risks and climate change induced migration.”

• population issues implicit as “health threat” • The five GOP measures comprehensive. thoughts,

will they BECOME ACTIONS.• Assess vulnerabilities of communities, ensure

“climate change issues incorporated in health plans”• “Renewed efforts” involve communities in fp• manage natural resources as training for economic

well being; model that can be replicated? Where to start? Stages?

Page 18: Improving Health Indicators – post Devolution Population, Health & Climate Change

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Climate change tasks• Replicate Murree, Gilgit, Chitral and Jacobabad experiences

– Falling ill, pregnancy, delivery during frequent visits, severe weather • NCCP very recent; intersectoral programmes to be edited• Lead initiative most timely, to be expanded• Issues highlighted: health care cost, investment in health integral to

poverty alleviation, (faulty questionnaire for poverty survey; elderly, women, disabled missed out; above all women who are elderly as well as disabled); implement policy commitments not carried out

• Ratio of nurses to doctors; barefoot Para medics required; improve primary health, reducing dominance of doctors

• Non Dev expdr; operational cost of social sectors ignored• A new indicator needed for implementing what we have• Social setting, attitudes, gaps, misreporting, care for the needy

Page 19: Improving Health Indicators – post Devolution Population, Health & Climate Change

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Looking for the doables

• Policies, plans, strategies visa vis performance: will the policy we are making do what it says?

• Research – medical, sociology, management - 1950, 1970,1990, 2000Changes in lifestyle, dress, food, one room habitats replaced by threebedrooms + attached bath, Heating and cooling, beverages, snacks,medication, care for the vulnerable, Costs (personal, social),pregnancy,maternal mortality, missing work; New diseases; new drugs

• Understanding health impacts (increased communicable diseases, malnutrition, food-borne illness, heat/cold-related exposure, migration-related negative health effects, etc.)

• Decision making – SSCC (ECC for the poor)