PESHAWAR, Dec 22: The NWFP health department has conceded that because of lack of resources, management capacity, motivation and accountability of employees, it seems unlikely that the province will achieve the millennium development goals.

"On an average 18 patients visit basic health unit per day, with the overall performance of the healthcare outlets is mediocre, which needs to be improved", wrote secretary health, Abdul Samad Khan in response to a letter sent to him by Dr Benjamin Loevinsohn, Washington-based Senior Public Health specialist of the World Bank.

The letter was sent to the health secretary last month, asking him to prepare a health report for the NWFP and also mention weaknesses and suggest measures to bring about improvement.

In his reply the World Bank, the health secretary said that like the rest of the country, the NWFP was not on course to achieve the health millennium development goals (MDGs).

Citing a recent survey which, he said, had indicated that under-5 mortality and malnutrition rates showed that the province was unlikely to achieve the MDGs in health sector.

The NWFP's poor health outcomes and high fertility rates would slow down its economic growth and contribute significantly to continuing poverty. It said that the countrywide, public expenditure on health constituted 0.5 per cent of the GDP, which was among the lowest in the world.

"However, recent work in Pakistan and other countries suggests that increased resources alone will not be sufficient to improve health service delivery without serious reforms", said the letter.

The devolution of responsibility for the health delivery to the districts could lead to improved service delivery, but could also worsen existing inequalities, it said.

According to the secretary's letter, the NWFP health sector had made some gains in the last decade but still there was much room for improvement. For instance, it said that the immunisation coverage had increased from 39 per cent in 1995-96 to 57 per cent in 2001-2.

"However, 57 per cent full immunization coverage will not limit the spread of vaccine preventable diseases", the letter added. The available data points to large and possibly worsening, geographic inequity-district immunisation coverage rates vary from 30 per cent to 85 per cent, it added.

It says that the public sector in the province was small compared to private sector but still provides much of the most important preventive services (roughly 90 per cent of immunization coverage and more than half of the contraceptive prevalence are accounted for public sector).

The private sector is little studied, unregulated and provides an unknown quality of care, although it was widely being used by all classes of the society, it said. The private sector provides few of the services that could contribute to the achieving of the MDGs, the letter said.

While suggesting strategies, the letter says that it was certainly possible for the Frontier province to make dramatic progress in the next five years in ensuring that all citizens have access to a basic package of health, nutrition and population services.