Madam, Pakistan\'s maternal mortality rate, according to maternal and infant mortality survey, is 279 per 100,000 live births.¹ Moreover, the infant mortality rate is 69 per 1000 live births.² In an attempt to improve MNCH (maternal, neonatal and child health) all around the world, United Nations presented 8 goals under the title of Millennium Development Goals in September, 2001³ and in order to expedite country\'s progress towards those goals, the Ministry Of Health of Pakistan has commissioned its National MNCH Strategic Framework.⁴
For a needs assessment on MNCH, we, the first year medical students, went to Muslim Colony in Nurpur Shahan, near the state capital, Islamabad.
Our first visit was an eye-opener. Though it was a foregone conclusion that we would be coming face to face with real poverty, the conditions the residents were living in were not something we expected. There was no proper infrastructure, e.g. there were no proper roads, houses, sanitation, as well as non-uniform electricity and water supplies. Apart from that, general, and personal hygiene were not maintained. As a result, the overall health was miserable.
Above stated observations only touch the surface. The deeper we probed, the situation seemed more alarming. According to our survey, 36.6% of the residents were illiterate; there was only one school in the area, attended by those who could afford it. It was also noted that about 50% of the household income was spent on healthcare, which imposed a lot of strain and stress on the families to make ends meet. They frequently had to ask relatives for help. We also discovered that this area did not get any visits from health workers, which could result in a major improvement in the general health and hygiene, of the locals, if introduced.
In Nurpur Shahan, 26.8% of women did not receive any antenatal care, 43.9% did not access any health facility during pregnancy, and 51.2% had their last deliveries at home. Apart from this, we discovered that many residents preferred to visit a tertiary healthcare centre in Islamabad for their health problems, claiming that they received more attention there.
Although, we went to do a survey on MNCH, there were many things which moved us more. What really needs to be done is to educate the people on the benefits of hygiene, and to prevent illness, simple things are to be done e.g. boiling water before consumption, washing hands before eating and after using the toilet, and way to make ORS at home to prevent dehydration.
Furthermore, 10% of children in Pakistan die before the age of 5 years, 70% of them die due to infectious diseases, e.g. diarrhoea, tetanus, malaria and hepatitis, which are otherwise treatable.⁵
In a nutshell, illiteracy, scarcity of medical centers, no visits by the lady health workers, unemployment, poverty and poor hygiene turned out to be the key factors hindering MNCH. Focus on these factors and proceedings to eliminate them can appear as a ray of hope towards the betterment of MNCH.

Sualeha Saleem, Muhammad Jawad Noon
Students, MBBS, Class of 2014, Shifa College of Medicine.

1.Pakistan Demographic And Health Survey 2006-07. (Online) 2010 (Cited 2010 June 25). Available from URL: http://www,healthnwfp.gov.pk/downloads/PDHS.pdf.
2.Pakistan Social And Living Standards Measurement Surveys 2007-08. (Online) 2010 (Cited 2010 June 25). Available from URL: http://www.statpak.gov.pk/depts/fbs/statistics/pslm2007_08/pslm2007_08.html.
3.United Nations Millennium Development Goals. (Online) 2010 (Cited 2010 June 23). Available from URL: http://www.unmillenniumproject.org/ goals/index.htm, accessed on 23rd June, 2010.
4.National MNCH Program, Ministry Of Health, Government of Pakistan. (Online) 2010 (Cited 2010 June 24). Available from URL: http://mnch.gov.pk/overview.php.
5.Lubna Agha, Accelerated Learning , AS Level textbook, 2004, 1st edition, Page 151.