Pakistan is a kaleidoscope of hope and despair, and obscurantism stymieing progress, frequently manifests in the courageous faces of young people who want change. Though there is a history with several periods of centralized and decentralized services delivery systems to mother and child, but in both times it was not easy to deliver health services to mothers, infants and children. There was not only financial crisis that the provincial management was facing but there was crisis of institutional management as well. High cost of health services energy deficiency, and rising population was major hurdles. After the 18th Constitutional Amendment to devolve education, health, the provinces have created an opportunity to reform governance and improve accountability in many sectors including health. Because of the huge challenges resulting from the differentials and inequities in Pakistan, the focus on universal health access should cover financial support and the achievement of equity for the country’s diverse population in terms of sex, ethnic origin, and Socio-Economic classes. We recommend six objectives for policy and action that the federation and the provinces should focus on over the next decade Supervisor:- Dr Atiya Yasmin Javid