By Ishtiaq Ahmed Yaad
Gilgit Baltistan (GB) is a newly born province of Pakistan, spread at anarea of 72, 496 Sq. Km, and inhabiting about 1.4 million people (projected) Presently it is divided in seven administrative units (districts) including Gilgit, Hunza-Nagar, Ghizer, Diamer, Astore, Skardu and Ghanche. According to NCHD-GB, overall literacy rate of GB is 53% (projected) whereas female and male literacy rate is 41% and 64%, respectively. According to estimates about 30% population of GB is living below poverty line.
Geographically, it is located longitudinally 35˚ and attitudinally 75˚ in the Himalayan and Karakoram ranges. Moreover, this region is famous for its world’s highest peaks, world’s three most longest mountain ranges, world’s big glaciers outside the poles, water resources, gems and precious stones, landscapes, Alpine meadow forest, cultural heritage, ancient archaeological sites, biodiversity and linguistic diversity.
Lamentably, natural beauty of this region is fabulous on one hand and the socio-economic conditions are nastiest on the other. Although the overall population of GB is suffering from various socio-economic problems but women are more deprived and disadvantaged segment of the society because of man’s chauvinistic attitude and gender inequality prevailed in this region.
Though women in GB are facing with many problems but low accessibility to “health education” and to basic and secondary health facilities are major concerns. Presently, malnutrition, anemia (about 70-80%), high prevalence of Maternal Mortality Rate (MMR) (i.e. 350-450/100000 live birth), lack of prenatal, natal, antenatal and postnatal care, high fertility rate (4.6 children per women-NIPS 2008), early age marriages, endogamy and psychological problems are main health issues of women of Gilgit Baltistan. These issues affect not only the women’s health badly but also children’s health at large. We can realize the alarming health situation of women in GB by some health indicators such as. MMR and anemia are respectively about 350-450/100000 LB and 70-80%. According to public health specialists MMR and anemia in GB are very high that indicates lack of health education programs and poor health facilities existed in the region. This critical situation can also be understood by comparing GB’s MMR with some developed countries like America, central European countries and Scandinavian societies where MMR is not more than 5-10/1000000 LB. So there is a huge deference between these two specific areas with regard to MMR. We need to keep it in mind that the developed counties have decreased their MMR by promoting Health Education as well as providing standardized health facilities at all levels. In Pakistan, unfortunately, health and education are not key priority thematic areas for politicians and policy makers. Consequently, people are badly suffered in getting standardized health facilities and quality education.
To public health specialists’ opinion the key factor of poor health conditions of women of GB is unawareness about “health education” among them. In last few decades public health trends have been changed from “cure” to “prevention”. That’s why every person emphasizes on all time famous proverb “prevention is better than cure”. While it is observed that about 60-70% people especially women do not understand the term “Health Education” as well as its true essence in Gilgit Baltistan. Regarding the nature of “Health Education” we can say that it educates people and creates awareness about balanced diet, proper sleeping, cleanliness, drinking clean water, vaccination, physical exercise, preventing him/herself from contagious diseases, get informed about reproductive health (RH) and RH Rights as well as sexual health (SH) and SH Rights, awareness about prenatal, natal, antenatal and postnatal care and avoiding from complex lifestyle etc. The Joint Committee on Health Education and Promotion Terminology of 2001 defined Health Education as “any combination of planned learning experiences based on sound theories that provide individuals, groups and communities the opportunity to acquire information and the skills needed to make quality health decisions.” While WHO defined Health Education as “compris[ing] [of] consciously constructed opportunities for learning involving some form of communication designed to improve health literacy, including improving knowledge, and developing life skills which are conducive to individual and community health.”
Keeping in view, promotion and strengthening of Health Education is inevitable for decreasing high prevalence of MMR, IMR, anemia and malnutrition in Gilgit Baltistan that lead to improve mother and child health as well as healthy and productive life. With regard to this all key stakeholders need to realize that the targets of UN Millennium Development Goals (MDGs) and goals of Health Policy of Govt. of Pakistan cannot be achieved until and unless Health Education is promoted at all levels especially at gross roots level.
Thus, in order to address health issues of women in Gilgit Baltistan “Health Education” programs must be promoted at all levels. Firstly, Govt. should put it into Health Policy as a key area and allocate adequate funds for it. Secondly, Govt. and private sector education institutions should inculcate health education as a key topic and/or subject in their syllabus from primary level to higher level. Thirdly, Ministry of health, Ministry of population welfare, Ministry of education, Ministry of social welfare, Ministry of women development and their associated departments including local health department, National Program for Family Planning and Basic Health, MNCH, EPI, PPHI should make their interventions and activities effective regarding health education and expend it to gross roots level with its true spirit. Fourthly, NGOs including UN-Women, AKHS-P, FPAP, NAACC and Global Fund for TB control program etc. should also promote health education through awareness raising activities, Behavior Change Communication (BCC) campaign, training programs and sensitization sessions etc. Sixthly, religious leaders must play a proactive role to promote social aspects of the religion with special focus on health education promotion. Seventhly, GB Women Development Directorate should make Health Education as a key priority thematic area. Finally, electronic and print media can play a pivotal role for bringing a broad change in this regard.
The writer is a Gilgit based social development specialist. He can be reached through email@example.com