THIS is with reference to the article `Health expenditure and choices` (Dec 25), which carried certain information regarding maternal and child health (MCH) that needs to be revisited. Over the last 20 years, the money coming in for MCH from the two main donor countries, the United States and the United Kingdom, has been more than twice the amount mentioned. The funds contributed by multilateral entities are in addition to this amount.

Besides, it is not quite truthful to say that Pakistan has not achieved any tangible gain in this area. According to successive demographic and health surveys, Pakistan has reduced death rates of mothers and children from the late 1990s till 2020. For every 1,000 live births, the under-five mortality decreased from 112 to 74 (34 per cent), infant mortality decreased from 86 to 62 (28pc), and for every 100,000 live births, maternal mortality fell from 276 to186(33pc).Thefact that otherSouth Asian countries have made better progressindicatesthe needforeven more attention to MCH rather than diverting resources elsewhere.

As a public health scientist who has advised nationalandinternational MCH programmes for over 15 years, I would argue that MCH outcomes have many biomedical, social, economic, cultural, and systemic determinants, which a surgical unit in any hospital does not face. Comparing the effectiveness of the country-wide MCH programme with a few hundred thousand surgeries in two hospitals of Karachi is not a valid comparison. The fact that the MCH programme relates to 50pc of the national population, and about seven million of them undergo maternity experience each year, makes the comparison even more wrong.

While striving to achieve clinical excellence in the surgical domain is undeniably a worthy ambition, it should not at all be at the cost of shunting money from vital primary healthcare areas, like MCH, as it will further threaten our generational outcomes.

Dr Zaeem ul Haq Mississauga, Canada