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Of the 10 million annual deaths of children below five years of age, four million are neonates. Pakistan's neonatal mortality rate of 54/1000 live births, which accounts for 57% of the under-five mortality, the contraceptive prevalence rate stagnating at 30%, the meagre number of deliveries assisted by skilled birth attendants (39%) and the low coverage of cost-effective child survival interventions hamper the achievement of Millennium Development Goals (MDGs) 4 and 5. The Government launched the national maternal, neonatal and child health programme in 2007 to promote access to evidence-based cost-effective interventions; strengthen district health system capacities; empower communities; expand the community midwives' cadre; and promote utilization of essential services. This paper reviews the implementation of the programme and the likelihood of attaining the MDG4 and 5 targets by 2015, and provides strategic directions for scaling-up programme implementation.

Maternal, neonatal and child health in Pakistan: towards the MDGs by moving from desire to reality