© Katrijn Van Giel
die before their 5th birthday
people living below the poverty line
women die giving birth every year
Médecins du Monde’s emergency response includes a range of humanitarian assistance programmes. Find out more below about our work and missions in Pakistan.
Pakistan is ranked 154 out of 189 countries by the Index of Human Development (IHD) and the country invests very little in its health sector, with just 3.4% of GDP spent on health. Women and children are among those most affected by the failures of the healthcare system.
The public health system is extremely fragile in Pakistan, especially in rural areas that have suffered from multiple crises, armed conflict and natural disasters. The services provided are inadequate and there is a severe lack of qualified medical staff, equipment and essential medicines.
The situation is particularly concerning in the region of Khyber-Pakhtunkhwa (KP), especially in the former tribal areas on the border with Afghanistan. According to the United Nations High Commissioner for Refugees (UNHCR), in 2021 Pakistan was host to around 1.4 million Afghan refugees and 100,000 internally displaced persons, with 59% of these refugees accommodated in KP.
The local healthcare system struggles to cope with influxes of displaced persons when the care available for the host communities is already of poor quality. Although almost all those who were internally displaced have now returned to the former tribal areas, they have been confronted with infrastructure that has been damaged or destroyed and there is limited access to health services.
With the arrival of the Covid-19 pandemic, healthcare facilities soon experienced shortages of testing capability and were hard-pressed to care for patients who presented with complications. The pandemic caused widespread disruption to routine health services, particularly in sexual and reproductive health.
Women in Pakistan are particularly vulnerable and face significant barriers to exercising their rights and the freedom to exert control over their own bodies, sexuality and family life. It is difficult for them to access good quality sexual and reproductive health services. Although Pakistan is the fifth most populated country in the world, with population growth of 2.4% per year, rates of contraceptive use have stalled at 34.2%. Apart from limiting their socio-economic opportunities, this situation puts women at risk, as they tend to have early and frequent pregnancies and experience miscarriages. Furthermore, 40% of births are not attended by qualified healthcare professionals. Too many women die during pregnancy or while giving birth and many children die from asphyxia at birth or from diarrhoea or pneumonia during their first years of life.
On top of poor healthcare provision, socio-cultural norms present an additional barrier to exercising the right to sexual and reproductive healthcare. In Khyber-Pakhtunkhwa (KP), women cannot travel alone and they usually need permission from their husband or mother-in-law to attend healthcare facilities. Very few female medical staff, particularly doctors, are employed in this region.
© Lam Duc Hien
Médecins du Monde has been working in Pakistan since 2009, responding to emergencies and supporting facilities which provide primary healthcare to internally displaced people and host communities.
ENSURING ACCESS TO HEALTH SERVICES IN KHYBER-PAKHTUNKHWA
In addition to general medical care and sexual and reproductive healthcare, Médecins du Monde has been supporting the health authorities since 2018 to provide 24-hour basic emergency obstetric and new-born care.
Between 2020 and 2021, the 4 healthcare facilities supported by Médecins du Monde were all successfully transferred to the local health authorities. Thanks to coordinated advocacy work with the authorities, sufficient public resources were allocated as part of a wide-ranging provincial development plan, securing our work for the long term.
Following this intervention, we turned our attention to the former tribal areas on the border with Afghanistan, where years of conflict and lack of public infrastructure development has left the healthcare system extremely fragile. In December 2021, we began to provide primary healthcare at a healthcare facility in Khyber District, an area to which access has long been restricted for security and administrative reasons. This was a first step in responding to the needs of a very disadvantaged community.
When Covid-19 struck the province, Médecins du Monde helped to boost the prevention and response capacity of the public authorities through a broad consortium of seven NGOs. The healthcare staff mobilised by MdM and the Ministry of Health in the province were trained in infection prevention and control, preventative measures and good hygiene practices. Access to healthcare was thus maintained despite the pandemic.
Médecins du Monde also provided personal protective equipment (surgical masks and gloves) and medical and non-medical supplies to the health authorities for the region’s health centres. We also installed around 60 hand-washing stations. In all, 41 health centres in 4 different districts of Khyber-Pakhtunkhwa were supported by Médecins du Monde to provide appropriate care for patients infected with Covid-19, including those experiencing complications, and to ensure continuity of care in a safe environment for staff and patients.
In response to the movement restrictions and other rules imposed by the authorities to slow the spread of the epidemic, Médecins du Monde also developed a large-scale Covid-19 information and prevention campaign, with leaflets, billboards and two months of radio broadcasts which reached over 100,000 people in KP.
In 2021, we:
SRHR: IMPROVING ACCESS TO FAMILY PLANNING
Médecins du Monde has been working in Punjab since 1996 and has developed a thorough understanding of the health issues and challenges in Pakistan.
Since 2015, and with the aim of improving access to good sexual and reproductive healthcare (SRH) services in Punjab, MdM has made access to family planning a particular focus of its work. Capacity-building support has been provided to family planning centres and staff from the Population Welfare Department (PWD).
In addition, there is a focus on young people, with the development in collaboration with the PWD of a marriage preparation guide. The intention is to improve access to SRH and family planning services. The handbook provides guidelines for healthcare staff to enhance understanding and improve communication between young couples about sexual and reproductive health and the services available. The aim is to empower them to make clear, informed choices together about their future lives together as a couple and as a family.
The guide was trialled in Lahore in 2021 to evaluate its potential. Training was provided to PWD staff and the communities involved received information about the aims, objectives and content of the marriage preparation guide. A study was carried out to evaluate the different stakeholders’ perceptions of the issues around sexual and reproductive health and the introduction of the guide. The results of this study were encouraging. Marriage preparation could be a key factor in improving contraceptive usage rates and the use of sexual and reproductive health services. It may also play a role in empowering women’s decision-making and thus may be a valuable tool in enhancing gender equality.
In the context of financial challenges associated with the Covid-19 pandemic and reduced funding from the United Kingdom after Brexit, Médecins du Monde temporarily closed its base in Punjab after the end of the marriage preparation guide trial.
Nevertheless, we are determined to continue our work with the authorities and civil society in the future to improve both the availability and the take-up of services.
MdM therefore planned to further develop its pilot projects for the marriage preparation guide in 2022 and to explore new technical and financial partnerships.
In 2021, we:
SUPPORT FOR HEALTH CENTRES AT AFGHAN REFUGEE CAMPS
The majority of Afghans who have arrived in Pakistan since the onset of the crisis in the 1980s have been accommodated in the province of KP. Today, 60% of them are still living in refugee camps. Although most of the families arrived several decades ago, the public health system has struggled to adapt and is unable to meet the needs of both the host community and the refugee communities. Each refugee camp has its own health centre, which helps to ease the pressure on public healthcare facilities.
Since 2018, Humanity & Inclusion (HI) has been managing 11 primary health centres and two 24-hour basic emergency obstetric and new-born care centres at 11 refugee camps in 6 different districts. Since September 2021, Médecins du Monde has been providing technical consultancy to Humanity & Inclusion to guarantee the standard of medical expertise in the management of these health centres. This technical supervision allows our teams to advise and support medical staff at the health centres to provide a high standard of primary healthcare, including sexual and reproductive healthcare (such as family planning and antenatal and postnatal consultations), as well as emergency obstetric and new-born care.
Beneficiaries in 2021.
Budget in 2021
Beneficiaries in 2021.
Budget in 2021
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