2. Goal 4: Reduce child mortality

3. Existing Target 5 Reduce by two thirds between 1990 and 2015 the Under Five Mortality Rate Proposed Target 5 Reduce by two thirds between 1990 and 2015, the Under Five Mortality Rate for Girls & Boys

4. Under-five mortality rate Infant mortality rate Proportion of fully immunised children 12-23 months Proportion of under 1 year children immunised against measles Prevalence of under weight children (under 5 years of age) Proportion of children under five who suffered from diarrhoea in the last 30 days and received ORT Lady Health Worker coverage of target population Under five mortality rate for boys and girls divided by income quintile Infant mortality rate for girls and boys divided by income quintile Proportion of 1-year-old children (girls and boys) immunized against all preventable diseases including measles. Proportion of women in the reproductive age (15-45) with access to quality, affordable and comprehensive SRHR services, including contraceptive, safe delivery, safe abortion, and safe motherhood services at the primary health care level divided by income quintile. Existing indicators approved by GOP Proposed additional Indicators

5. Rationale for inclusion of Indicators Gender and income quintile disaggregated data help in understanding health seeking behaviours at the household and community levels. The already existing system of government measures gender disaggregated data these systems should be further strengthened and maintained.

6. Early And Late Childhood Mortality Rates RateOverallMaleFemale Neonatal Mortality Rate (1997 – 2000) / 1000 live births 546840 Infant Mortality Rate (1997 – 2000) / 1000 live births 859571 Under 5 Mortality Rate (1997 – 2000) / 1000 live births 10311293 Child Mortality Rate (1997 – 2000) / 1000 live births 201524 Neonatal Mortality: probability of dying within the first month of life Infant Mortality: probability of dying before the first birthday Under Five Mortality: probability of dying before the fifth birthday Child Mortality: probability of dying between the first and the fifth birthday, having survived the first year Source: Pakistan Population Assessment Report 2003 and NIPS 2000-01

7. Regarding Immunization Since measles is not the only preventable disease that threatens Pakistan’s population and TB, hepatitis, diphtheria, pertusis (whooping cough), tetanus etc have a higher incidence in our population it is recommended that the indicator measuring ‘proportion of children immunised against measles’ must be modified to measure ‘proportion of children immunised against all preventable diseases, including measles.’ Other diseases such as diarrhoea and Acute Respiratory infections (ARI), which account for two-thirds of child and infant mortality rates, must also be considered and measured. This is already part of the Pakistan Government’s plans and should be included as part of the MDG framework.

8. Source of data: UNICEF State of the World Children - 2005 Name of disease% immunized (2003) 1 year old children TB82 Diphtheria67 Polio69 Measles (MMR)61 HepatitisNo data DiarrheaN/A ARIN/A PneumoniaN/A

9. Access to Quality Health Services One of the pressing challenges towards achieving the child health goal has been mentioned in the MDG progress report as “Access to high quality essential health services, especially reproductive and emergency obstetric care” Since access to quality SRHR services is directly linked to child health, it is proposed that the MDG framework include an indicator that measures ‘the proportion of quality, affordable and comprehensive SRHR services, including contraceptive, safe delivery, safe abortion, and safe motherhood services at the primary health care level.”