The COVID-19 pandemic has made the world realize the significance of healthcare. Many governments, including Pakistan’s, are now allocating more funds towards strengthening their healthcare systems. Resultantly, there is now a need to identify a key healthcare area for diverting funds based on Value for Money (VfM) analysis.
Ensuring Value for Money during COVID-19
Value for Money (VfM) analysis is an essential decision-making tool used for aiding the allocation of government funds. It aims to maximize the efficiency and effectiveness of outputs for each penny spent. This analysis helps in picking up projects that are cost-effective and maximize benefit to the general public. It is also an accountability tool and aids in avoiding the plunder of public funds.
When observing government’s COVID interventions, some major steps dominate the scene and are immediately visible. These include government’s immediate response to the pandemic which was to increase the number of hospital beds and procure more ventilators. The provincial governments also created many temporary hospitals, which will disband in the post-pandemic period. All these measures, while fully justified, important and needed at the time, in terms of VfM prospects appear equivocal. On the other hand, responses that will have more of a long-lasting impact include: improving the capacity of existing health system to deal with a health emergency, introducing and expanding telehealth, and taking steps to allocate more funds to the health sector.
Where & How of Investing
The government of Pakistan doesn’t have enough funds to change the entire health system radically overnight, so it has to prioritize an area that will result in high VfM. Maternal Newborn and Child Health (MNCH) programs are one of those health programs that yield high VfM due to multiple factors, with the most important one being their role in solving Pakistan’s already existing health issues.
The Maternal Mortality Rate (MMR) in Pakistan is 140 deaths per 100,000 live births, while the Infant Mortality Rate (IMR) is 52.30 per 1,000 live births. UNICEF projects that five million babies are to be born in the nine months following the pandemic. Investing more funds into this area will save the lives of women and children who are at risk in normal circumstances, with the pandemic further adding to this vulnerability.
A case in point is the disruption caused in routine immunization programs for newborns due to the pandemic. This situation has increased the risk of outbreak-prone Vaccine-Preventable Diseases (VPDs). COVID-19 has also became a hindrance in the continuation of birth spacing services, which, according to Health Policy Plus, could lead to over 750,000 deaths of mothers and newborns in low and middle income countries. Ongoing immunization is needed for a healthy Pakistan, while birth spacing is the only way to counter the course of a country set to double its population in the next thirty years – neither can stop, even during a pandemic.
During the pandemic, many countries resorted to lockdowns to control the spread of the virus. Though there is an ease in lockdowns now, there might be a need to enforce them again in the future. One of the most significant downsides of this lockdown was a rise in domestic violence on women and children. MNCH programs provide a safe space for many women. These programs provide awareness to women about their reproductive health rights. In some countries, these programs also cover mental health services. Pakistan doesn’t provide any mental health coverage to its citizens, especially women who are severely affected by various mental illnesses during pregnancies. One study found 81% of pregnant women in Karachi suffering from depression. Incorporating this angle in the MNCH program can further elevate women’s health thereby adding value to the investments made in these.
Spending on the health of mothers and children will make a whole generation healthy. The cycle of life begins when a baby is in the womb of the mother, and until the child is two, he or she needs proper care. This period, called the first thousand days of life, presents a window of opportunity for all health-related interventions, which will make the baby healthy for his or her entire life. Investing in MNCH therefore guarantees the lifetime well-being of a country’s population. Nothing is more important.
After the COVID-19 pandemic, the significance of spending more on health is apparent to all. The government of Pakistan has also decided to increase its healthcare budget. However, it cannot possibly improve every aspect of healthcare. There is a need to prioritize and focus, and starting with improving the health of mothers and children offers the most promising value for money both in the short and long term. This is best put in the words of Hilary Clinton who said that, “If you want to know how strong a country’s health system is, look at the well-being of its mothers.”