Is Pakistan's Social Sector Making Progress?

[Riaz Haq]

If you read Pakistan media headlines and donation-seeking NGOs and activists' reports these days, you'd conclude that the social sector situation is entirely hopeless. However, if you look at children's education and health trend lines based on data from credible international sources, you would feel a sense of optimism. This exercise gives new meaning to what former US President Bill Clinton has said: Follow the trend lines, not the headlines. Unlike the alarming headlines, the trend lines in Pakistan show rising school enrollment rates and declining infant mortality rates.

Key Social Indicators:

The quickest way to assess Pakistan's social sector progress is to look at two key indicators:  School enrollment rates and infant mortality. These basic social indicators capture the state of schooling, nutrition and health care. Pakistan is continuing to make slow but steady progress on both of these indicators. Anything that can be done to accelerate the pace will help Pakistan move up to higher levels as proposed by Dr. Hans Rosling and adopted by the United Nations.

Pakistan Children 5-16 In-Out of School. Source: Pak Alliance For M...

Rising Primary Enrollment:

Gross enrollment in Pakistani primary schools exceeded 97% in 2016, up from 92% ten years ago. Gross enrollment rate (GER) is different from net enrollment rate (NER). The former refers to primary enrollment of all students of all ages while the latter counts enrolled students as percentage of students in the official primary age bracket. The primary NER in Pakistan is significantly lower but the higher GER indicates many of these kids eventually enroll in primary schools albeit at older ages. 

Source: World Bank Education Statistics

Declining Infant Mortality Rate: 

The infant mortality rate (IMR), defined as the number of deaths in children under 1 year of age per 1000 live births in the same year, is universally regarded as a highly sensitive (proxy) measure of population health.  A declining rate is an indication of improving health. IMR in Pakistan has declined from 86 in 1990-91 to 74 in 2012-13 and 62 in the latest survey in 2017-18.

Pakistan Child Mortality Rates. Source: PDHS 2017-18

During the 5 years immediately preceding the survey, the infant mortality rate (IMR) was 62 deaths per 1,000 live births. The child mortality rate was 13 deaths per 1,000 children surviving to age 12 months, while the overall under-5 mortality rate was 74 deaths per 1,000 live births. Eighty-four percent of all deaths among children under age 5 in Pakistan take place before a child’s first birthday, with 57% occurring during the first month of life (42 deaths per 1,000 live births).

Pakistan Human Development Trajectory 1990-2018.Source: Pakistan HD...

Human Development Ranking:

It appears that improvements in education and health care indicators in Pakistan are slower than other countries in South Asia region. Pakistan's human development ranking plunged to 150 in 2018, down from 149 in 2017.

Expected Years of Schooling in Pakistan by Province

There was a noticeable acceleration of human development in #Pakistan during Musharraf years. Pakistan HDI rose faster in 2000-2008 than in periods before and after. Pakistanis' income, education and life expectancy also rose faster than Bangladeshis' and Indians' in 2000-2008.

Now Pakistan is worse than Bangladesh at 136, India at 130 and Nepal at 149. The decade of democracy under Pakistan People's Party and Pakistan Muslim League (Nawaz) has produced the slowest annual human development growth rate in the last 30 years. The fastest growth in Pakistan human development was seen in 2000-2010, a decade dominated by President Musharraf's rule, according to the latest Human Development Report 2018.

UNDP’s Human Development Index (HDI) represents human progress in one indicator that combines information on people’s health, education and income.

Pakistan's Human Development Growth Rate By Decades. Source: HDR 2018

Pakistan saw average annual HDI (Human Development Index) growth rate of 1.08% in 1990-2000, 1.57% in 2000-2010 and 0.95% in 2010-2017, according to Human Development Indices and Indicators 2018 Statistical Update.  The fastest growth in Pakistan human development was seen in 2000-2010, a decade dominated by President Musharraf's rule, according to the latest Human Development Report 2018.

Pakistan Human Development Growth 1990-2018. Source: Pakistan HDR 2019

Pakistan@100: Shaping the Future:

Pakistani leaders should heed the recommendations of a recent report by the World Bank titled "Pakistan@100: Shaping the Future" regarding investments in the people. Here's a key excerpt of the World Bank report:

"Pakistan’s greatest asset is its people – a young population of 208 million. This large population can transform into a demographic dividend that drives economic growth. To achieve that, Pakistan must act fast and strategically to: i) manage population growth and improve maternal health, ii) improve early childhood development, focusing on nutrition and health, and iii) boost spending on education and skills for all, according to the report".

Pakistani Children 5-16 Currently Enrolled. Source: Pak Alliance Fo...

Summary: 

The state of Pakistan's social sector is not as dire as the headlines suggest. There's reason for optimism. Key indicators show that education and health care in Pakistan are improving but such improvements are slower than in other countries in South Asia region. Pakistan's human development ranking plunged to 150 in 2018, down from 149 in 2017. It is worse than Bangladesh at 136, India at 130 and Nepal at 149. The decade of democracy under Pakistan People's Party and Pakistan Muslim League (Nawaz) has produced the slowest annual human development growth rate in the last 30 years. The fastest growth in Pakistan human development was seen in 2000-2010, a decade dominated by President Musharraf's rule, according to the latest Human Development Report 2018. One of the biggest challenges facing the PTI government led by Prime Minister Imran Khan is to significantly accelerate human development rates in Pakistan.

Related Links:

Haq's Musings

South Asia Investor Review

Pakistan's Expected Demographic Dividend

Can Imran Khan Lead Pakistan to the Next Level?

Democracy vs Dictatorship in Pakistan

Pakistan Child Health Indicators

Pakistan's Balance of Payments Crisis

Panama Leaks in Pakistan

Conspiracy Theories About Pakistan Elections"

PTI Triumphs Over Corrupt Dynastic Political Parties

Strikingly Similar Narratives of Donald Trump and Nawaz Sharif

Nawaz Sharif's Report Card

Riaz Haq's Youtube Channel

PakAlumni Social Network

[Riaz Haq]

Good news about what is going right in the world is hard sell today.
But look at the trend lines; more than a billion people have been lifted out of extreme poverty since 1990. We have dramatically reduced people dying of tuberculosis and malaria on all continents. Infant mortality is going down.

https://youtu.be/SQZ6JmpFrfs

[Riaz Haq]

Indonesia to provide 2.5m metric tons of #palm #oil to #Pakistan on urgent basis. First ship carrying 30,000 metric tons of oil from Indonesia left for Pakistan on Tuesday. #edibleoil #cookingoil #palmoil

ISLAMABAD (Dunya News) - Ten ships of edible oil will arrive in Pakistan in the next two weeks from Indonesia and Malaysia.

After successful negotiations of Pakistani delegation that visited Indonesia, it was agreed between the two countries that Indonesia will provide 2.5 million metric tons of edible oil to Pakistan on urgent basis.

According to a statement released today by Prime Minister’s Office, the delegation visited Indonesia on the directions of Prime Minister Shehbaz Sharif. Earlier, the Prime Minister talked to the Indonesian President Joko Widodo in this regard.

The first ship carrying 30,000 metric tons of edible oil from Indonesia will leave for Pakistan on Tuesday.

https://dunyanews.tv/en/Business/655987-Indonesia-provide-2-5m-metr...

[Riaz Haq]

Maternal Mortality Rate (MMR)

Country Name Per 100K Live Births
India 145.00
Timor-Leste 142.00
Pakistan 140.00

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Pakistan Maternal Mortality Rate 2000-2022

https://www.macrotrends.net/countries/PAK/pakistan/maternal-mortali...

Maternal mortality ratio is the number of women who die from pregnancy-related causes while pregnant or within 42 days of pregnancy termination per 100,000 live births. The data are estimated with a regression model using information on the proportion of maternal deaths among non-AIDS deaths in women ages 15-49, fertility, birth attendants, and GDP.
Pakistan maternal mortality rate for 2017 was 140.00, a 2.1% decline from 2016.
Pakistan maternal mortality rate for 2016 was 143.00, a 7.14% decline from 2015.
Pakistan maternal mortality rate for 2015 was 154.00, a 4.35% decline from 2014.
Pakistan maternal mortality rate for 2014 was 161.00, a 3.01% decline from 2013.

[Riaz Haq]

The average expected years of schooling in Pakistan is 8.5 years. In comparison it is 11.2 years in Bangladesh and 12.3 years in India. Pakistan has performed poorly even on inequality adjusted human development, as well as gender development and equality compared with the regional countries.

https://www.dawn.com/news/1522407#:~:text=The%20average%20expected%....

[Riaz Haq]

What is the status of food security in Pakistan?

Pakistan is presently self-sufficient in major staples – ranked at 8th in producing wheat, 10th in rice, 5th in sugarcane, and 4th in milk production. Despite that, only 63.1 percent of the country's households are “food secure”, according to the Ministry of Health and Unicef's National Nutritional Survey 2018.

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More worryingly, almost half of the children under 5 years are stunted (low-height-for-age) and one in ten has been suffering from wasting (low-weight-forheight) in the country. Incorporating these factors, Pakistan was ranked 106th
among 119 countries surveyed for the Global Hunger Index, and has been
characterized as facing a “serious” level of hunger (Figure S2.2). In fact, Pakistan
is among those seven countries that cumulatively account for two-thirds of the world’s under-nourished population (along with Bangladesh, China, Congo,
Ethiopia, India and Indonesia)

https://www.sbp.org.pk/reports/quarterly/fy19/Third/Special-Section...

[Riaz Haq]

Senator Dr Sania Nishtar
@SaniaNishtar
Pakistan's first ever end-to-end digital targeted subsidies program #Ehsaas Rashan Riayat (implementation of which was underway) has been closed down, which means 20 million eligible families will not have access to 30% monthly subsidy on 3 grocery items. https://bit.ly/3zawG1M

https://twitter.com/SaniaNishtar/status/1548000577803563008?s=20&am...

Each year, Pakistan spends billions of rupees in untargeted federal and provincial subsidies across sectors. Much of these government transfers are subject to elite capture, subsidizing producers, corporations, and middlemen instead of reaching the poorest households.

Earlier this year, Ehsaas sought to address this issue by launching the first-of-its-kind, end-to-end-digitized targeted commodity subsidy programme, called Ehsaas Rashan Riayat. The programme established infrastructure to deliver government subsidies directly to millions of deserving households.

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Unfortunately, the current government has decided to end the programme as of July 1, 2022, and instead committed Rs16 billion in untargeted subsidy to be disbursed through Utility Stores. Utility Stores are meant to provide subsidized ‘rashan’ without any digital targeting or verification. This will open avenues for collusion and elite capture. Given fiscal constraints and double-digit inflation, which is placing a disproportionate burden on the poor, I would urge the federal government to reconsider its decision and use the Ehsaas Rashan Riayat mechanism, instead.

Ehsaas Rashan Riayat was launched after extensive stakeholder consultations and has several features, which can be a gamechanger to target support to poor households while minimizing likelihood of corruption or elite capture. To make sure that public money is targeted, the programme created objective criteria for beneficiary eligibility, based on socioeconomic conditions drawing on data infrastructure of the 2021 National Socioeconomic Registry.

The backbone of the programme is the nationwide network of kiryana, Utility, and CSD stores, which were leveraged for disbursing the subsidy, instead of creating new distribution channels. Through an extensive process of engagement with merchant unions, visits to multiple cities, social mobilization, and grassroots awareness campaigns, the programme achieved a retail outlet footprint in 84 per cent of districts across Pakistan, to develop a network of 15,000+ merchants. This helped us reach the poorest families by mobilizing distribution channels wherever they lived. The plan was to reach more than 50,000 merchants by the end of the 2022 calendar year.

A key feature of the programme was to digitize the entire network of participating stores. These stores were linked in real-time through a mobile app of the National Bank of Pakistan, which was used to conduct subsidy transactions, with the subsidy given as a digital voucher. This programme enabled small, often informal kiryana stores to become more technologically savvy. Additionally, by connecting these merchants in an online database and geotagging them, the programme started digitally documenting a previously undocumented part of the economy.

The programme improved financial inclusion for thousands of unbanked small merchants by facilitating the opening of bank accounts. These merchants were reimbursed for the subsidy disbursed, in near real-time, through an entirely digital payment mechanism. These small merchants were to get access to banking services, including saving, transacting, and using other financial instruments, which could help further scale their businesses.

[Riaz Haq]

Senator Dr Sania Nishtar
@SaniaNishtar
Pakistan's first ever end-to-end digital targeted subsidies program #Ehsaas Rashan Riayat (implementation of which was underway) has been closed down, which means 20 million eligible families will not have access to 30% monthly subsidy on 3 grocery items. https://bit.ly/3zawG1M

https://twitter.com/SaniaNishtar/status/1548000577803563008?s=20&am...


Ehsaas Rashan Riayat was also meant to provide an ecosystem where cash recipients of Ehsaas benefits could potentially transition into digital payment practices, thus eliminating pilferage and interplay of extractive middlemen.

The underlying digital ecosystem that was set up as part of this programme was agile and had immense potential to be scaled even further. Initially, we used a demand-based model in which people had to SMS a request. The next model was based on pre-qualification of all the eligible beta families, developing pools of CNICs and corresponding registered SIMS for each eligible beta family, allowing any family member to visit their nearest merchant with their phone and CNIC to avail of the subsidy, without the need to register or wait weeks for verification. Just before I left office, I convened a steering committee meeting to approve detailed modalities of the new registration model.

If the programme is continued, its infrastructure could also be utilized to expand the range of subsidized commodities. Other household food essentials – beyond wheat, pulses, and cooking oil – could be added with minor backend changes in the program’s infrastructure. The monthly subsidy amount can be increased. The plan was to use the system beyond groceries, for subsidies on fuel and outpatient healthcare assistance, which is not covered by health insurance.

Our country faces economically challenging times, where drastic measures will be needed to address the far-reaching effects of the rising fiscal deficit. Ehsaas Rashan Riayat provides an opportunity for the government to take the lead in exercising fiscal prudence and to phase out untargeted subsidies, in favour of targeted support to households that need it most while at the same time address corruption.

The government must reconsider its decision and continue the operation and expansion of Ehsaas Rashan Riayat in the public interest.

[Riaz Haq]

India, Pakistan tackle backslide in child immunizations

https://www.news-medical.net/news/20220727/India-Pakistan-tackle-ba...

While India and Pakistan topped the list of countries that saw the greatest increase in children not receiving a first dose of DTP between 2019 and 2020, they were also quick to bounce back.

Pakistan now figures among countries that successfully fought back declines to return to pre-pandemic levels of coverage "thanks to high-level government commitment and significant catch-up immunization efforts", UNICEF/WHO said.

In India, progress towards reducing the number of zero-dose children was impacted by the pandemic and the number of children who did not receive the first dose of the DTP vaccine was estimated to have increased to three million in 2020, up from 1.4 million in 2019, according to Mainak Chatterjee, health specialist at UNICEF India.

"Despite having the largest birth cohort in the world, India was able to prevent a further backslide through special drives such as the Intensified Mission Indradhanush, which enabled the country to bring down zero-dose to 2.7 million in 2021," Chatterjee told SciDev.Net.

[Riaz Haq]

#Pakistan managed to bounce back to its overall #child #vaccination rates in spite of disruptions due to the #COVID #pandemic. #health #immunization https://www.gavi.org/vaccineswork/pakistan-can-how-one-country-repa...

https://twitter.com/haqsmusings/status/1558266057206288384?s=20&...


“Pakistan can”: How one country repaired its routine immunisation safety net
As the COVID-19 pandemic hit in early 2020, Pakistan’s routine immunisation programme took a heavy hit. But while many countries continued to struggle to make up lost ground in 2021, Pakistan bounced back to pre-pandemic levels of protection. VaccinesWork spoke to country health leaders to find out what went right.

https://www.gavi.org/vaccineswork/pakistan-can-how-one-country-repa...


New data confirms what public health officials hoped was true: in 2021, Pakistan’s children were very nearly as well-protected against preventable diseases as they had been in 2019. That may not sound like a landmark triumph, but it is – and here’s why.

Like in most countries, routine immunisation in Pakistan suffered a gut-punch – if not quite a knockout blow – when the pandemic landed in early 2020. Mario Jimenez, who has worked on Gavi’s Pakistan programme since 2019, says, “The lockdowns started, and that led to the immediate stop of outreach activities, and a subsequent accumulation of children that were not being reached with routine immunisation.”

Even once the lockdowns lifted, recalls Dr Faisal Sultan, former Special Assistant to the Prime Minister on Health, fear of infection continued to inhibit contact between people and the health system. And even making it to the clinic didn’t always mean a child would get their jab: Pakistan struggled with periodic vaccine stock-outs as shipping and air travel stumbled to a halt globally.

“It really pushed the country and ourselves to reflect about how we can adapt to the situation, and what can be done to recover some of the losses that were taking place,” says Jimenez. These were urgent conversations: the real-world danger signalled by those losses was plain to everyone involved.

Pakistan has a massive birth cohort – more than 16,000 children are born each day. “In a matter of days,” Jimenez says, “we could have a very large number of unprotected unvaccinated children.” With the vaccine levee crumbling, every small disease outbreak risked becoming an epidemic flash-flood.

From July 2020, the health system kicked into high gear, beefing up outreach, and finding novel means to trace unvaccinated “zero-dose” children. Life-saving gains were made.

[Riaz Haq]

The headline multidimensional poverty (MPI) figures for Pakistan (0.198) are worse than for Bangladesh (0.104) and India (0.069). This is primarily due to the education deficit in Pakistan. UNDP's report titled "Unpacking Deprivation Bundle" shows that an average Pakistani still enjoys a better "standard of living" than his/her counterparts in Bangladesh and India. Below is an excerpt from it:

"The analysis first looks at the most common deprivation profiles across 111 developing countries (figure 1). The most common profile, affecting 3.9 percent of poor people, includes deprivations in exactly four indicators: nutrition, cooking fuel, sanitation and housing.7 More than 45.5 million poor people are deprived in only these four indicators.8 Of those people, 34.4 million live in India, 2.1 million in Bangladesh and 1.9 million in Pakistan—making this a predominantly South Asian profile "

https://hdr.undp.org/system/files/documents/hdp-document/2022mpirep...


Also note in this UNDP report that the income poverty (people living on $1.90 or less per day) in Pakistan is 3.6% while it is 22.5% in India and 14.3% in Bangladesh.

Living standards (Cooking fuel Sanitation Drinking water Electricity Housing Assets) of the poor in Pakistan (31.1%) are better than in Bangladesh (45.1%) and India (38.5%).

Pakistan fares worse in terms of education (41.3%) indicators relative to Bangladesh (37.6%) and India (28.2%).

In terms of health, Pakistan ( 27.6%) fares better than India (32.2%) but worse than Bangladesh (17.3%).

In terms of population vulnerable to poverty, Pakistan (12.9%) does better than Bangladesh (18.2%) and India (18.7%)