1. Achieving MDG-5 requires a Health Systems Solution: A Message from the State of Qatar Dr. Sajjad ur Rahman Lead PI PEARL Study Senior Consultant Neonatal Perinatal Medicine Women’s Hospital Hamad Medical Corporation & Associate Professor of Clinical Pediatrics Weill Cornell Medical College Doha State of Qatar

2. What is our challenge? Where do we stand? Reflections from PEARL Study How to Move forwards? Today’s Presentation

3. What is our challenge? Where do we stand? Reflections from PEARL Study How to Move forwards? Today’s Presentation

4. A. Three quarters (75%) reduction in Maternal Mortality Ratio (MMR) between 1990 and 2015 B. Achieve universal access to reproductive health by 2015 Millennium Development Goal-5

5. What is our challenge? Where do we stand? Reflections from PEARL Study How to Move forwards? Today’s Presentation

6. Global maternal deaths in 2008= 342,900 50% of Global Maternal Deaths occur in six countries India Nigeria Pakistan Afghanistan Ethiopia DR Congo Source: Lancet 2010; 375: 1609–23 Maternal Mortality in Pakistan

7. Pakistan's MMR compared with MMRs from Global, EMR, GCC countries and some high income countries from West and East. Source: World Health Statistics 2011

8. Maternal Mortality Ratios in Pakistan and Surrounding countries – 1990 WEST EAST PAKISTAN Source: World Health Statistics 2011, WHO

9. Maternal Mortality Ratios in Pakistan and Surrounding countries – 2008 WEST EAST PAKISTAN Source: World Health Statistics 2011, WHO

10. Maternal Mortality Ratios in Pakistan and Surrounding countries 19902008

11. What is our challenge? Where do we stand? Reflections from The State of Qatar How to Move forwards? Today’s Presentation

12. A National Epidemiologic Reproductive Health Study Collaborating institutions: 1. Hamad Medical Corporation (HMC), Qatar 2. University of Gloucestershire, UK AObjectivesOIM&BJECTIVES: Qatar’s National Perinatal Registry Maternal Mortality and Morbidity Neonatal Mortality and Morbidity Perinatal Mortality and Morbidity Strategic Guidelines to improve Health Systems and Care Processes PERINATAL NEONATAL OUTCOMES RESEARCH STUDY IN THE ARABIAN GULF PEARL STUDY

13. State of Qatar’s National Maternal, Neonatal and Perinatal Mortality Rates 2011-12 PEARL Study Analysis

14. 2011Maternal Mortality Rate (MMR) 2012Maternal Mortality Rate 9.85/100,000 8.99/100,000 Maternal Mortality Rate Qatar 2011-12 Maternal Deaths (Criteria A,B & C) n= 2

15. COMPARATIVE ANALYSIS of Mortality Rates Qatar versus Global, Regional and High Income Countries Rates

16. Maternal Mortality Rate Source: World Health Statistics 2011

17. Maternal Mortality in Qatar was Zero for several years between 1998 and 2004 Maternal Mortality in Qatar Qatar had two maternal deaths in a year during 2011 and two in a year during 2012 United Stated had Two Maternal Deaths a day in 2011 Source: Amnesty International WWW.amnesty.org

18. A PEARL Study Analysis of Trends in Qatar’s Maternal Mortality Rates 1990-2012

19. MMR Trends within Qatar 1990-2012

20. The State of Qatar

21. The Changing Landscape and lifestyle in the Arabian Gulf

22. The New Landscape and Life style in the Arabian Gulf

23. The State of Qatar Area11437 Sq Km Population 20132.1 million LNG Production 77 million tonnes per year in 2011 GDP Per Capita (Global Finance) $ 90,149 in 2010 $179,000 in 2011

24. GDP Per Capita 2011 GCC Countries & Other High Income Countries

25. Qatar's population growth and live births over 36 years (1975-2012) (Source: Qatar Statistics authority www.qsa.org )www.qsa.org

26. Profile of Reproductive Health Care in Qatar

27. Qatar provides Universal health care to all its citizens Health Qatar Spending in Qatar was 15% of national budget till 2010 Health care spending in 2011 increased to 27% of National Budget Health Care Expenditure in Qatar

28. Maternal and Child Health care in Qatar

29. Maternal and Childhood Mortality in Qatar Indicator 19801986199320002008 2010 MMRNA 0011.6 10.3 <5 MRNA 14.513.19.5 8.5 IMRNA 12.511.77.7 6.8

30. The Message

31. Rahman S, Salameh K, Bener A, El Ansari W. Socioeconomic associations of improved maternal, neonatal, and perinatal survival in Qatar. IJWH 2010;2: 311–318

32. Reduction in poverty, high rates of maternal education, and improved perinatal health care were temporally associated with improved maternal, neonatal, and perinatal survival in the State of Qatar. Rahman S, Salameh K, Bener A, El Ansari W. Socioeconomic associations of improved maternal, neonatal, and perinatal survival in Qatar. IJWH 2010;2: 311–318

33. Women’s LITERACY RATE IN QATAR 1986-2007 Source: www.qsa.gov.qa

34. Female (15 – 24 Years) Literacy Rate over 15 years period Qatar Vs Pakistan Source: www.indexmundi.com, Qatar Statistics Authoritywww.indexmundi.com

35. What is our challenge? Where do we stand? Reflections from PEARL Study How to Move forwards? Today’s Presentation

36. Maternal and Child Health a top national priority Invest in Primary Maternal and Child Health Care Invest in Female Literacy Reduction in Poverty Improvement in social and living conditions (Clean drinking water, sewerage and drainage, pest control) Launch a Mandatory National Birth Registry Use of Low Cost Technology Pakistan: How to Move forwards? Back to Basics

37. Future is NOT a Gift It’s an Achievement Future is NOT a Gift It’s an Achievement

38. Thank You!