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.

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[Riaz Haq]

Ahmed Jamal Pirzada
@ajpirzada
Doesn't look good for Pak: the human capital index has stayed flat since 2005. While "avg years of schooling" has increased from 4 years in 2000 to 6 years in 2015 (Barro-Lee dataset), the quality has not improved. Worse, the gap with regional countries has increased since 80s.

https://twitter.com/ajpirzada/status/1583239244168200193?s=20&t...

[Riaz Haq]

The HDI is a summary measure for assessing long-term progress in three basic dimensions of human development: a long and healthy life, access to knowledge and a decent standard of living. Pakistan's HDI value for 2021 is 0.544— which put the country in the Low human development category—positioning it at 161 out of 191 countries and territories.

Between 1990 and 2021, Pakistan's HDI value changed from 0.400 to 0.544, an change of 36.0 percent.

Between 1990 and 2021, Pakistan's life expectancy at birth changed by 6.0 years, mean years of schooling changed by 2.2 years and expected years of schooling changed by 4.0 years. Pakistan's GNI per capita changed by about 62.7 percent between 1990 and 2021.

https://hdr.undp.org/data-center/specific-country-data#/countries/PAK

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Pakistan has dropped seven places in the Human Development Index, ranking 161 out of 192 countries in the 2021-2022 HDI, according to the UNDP report released on Thursday.

https://www.thenews.com.pk/print/989724-pakistan-down-on-human-deve...

In the previous year, Pakistan had stood at 154 out of 189 countries.

As per the report, Pakistan’s life expectancy at birth is 66.1 years and expected years of schooling are 8. The country’s gross per capita national income is $4,624. The report has identified that different climate shocks are affecting world order, pushing back the growth that was achieved in the past few years. While doing so, it has categorised the floods in Pakistan as “an example of the climate shocks seen around the world.”

Switzerland leads the way on the latest HDI while Norway and Iceland enjoy second and third positions. Among the nine South Asian countries -- Afghanistan, Bangladesh, Bhutan, India, Islamic Republic of Iran, Maldives, Nepal, Pakistan, Sri Lanka -- only Pakistan and Afghanistan (180th position) are in the low human development category.

Bhutan (127), Bangladesh (129), India (132) and Nepal (143) are in the medium human development category. And crisis-riddled Sri Lanka has managed to improve its position by 9 points, reaching the 73rd position on the index, finding itself in the high human development category. Iran is three positions behind at 76; the next is Maldives at the 90th position.

The report, titled ‘Uncertain Times, Unsettled Lives: Shaping our Future in a Transforming World’ has found out that around 90 per cent of countries have seen “reversals in human development” in the year of the survey, pointing to a world stuck in a never-ending cycle of crisis after crisis, causing global disruptions. Per the report, the two major factors responsible for these disruptions were the Covid-19 pandemic and the Russia-Ukraine war.

The Human Development Index is a measure of countries’ standard of living, health and education. This is the first time in the last 30 years that human development in a majority of countries has gone in reverse for two consecutive years.

This has pushed human development to its 2016 levels, a huge blow to the progress made on the Sustainable Development Goals (SDGs) that were meant to be completed by 2030. For the year 2021, the UN had projected an HDI value of 0.75 -- the actual value has come out to be 0.732.

The report adds that the world is in a “new uncertainty complex”. Such uncertainty is created by the two years of Covid-19 which saw a series of the lethal waves of the virus.

Even though the world took quick steps to defeat the virus, the report notes, and developed vaccines to counter the threats, unequal distribution of the vaccines has created more problems in a number of low-income countries.

The pandemic-induced lockdowns and school closures also took a toll on people’s mental wellbeing across the world. The report has found out that mental distress among male minority groups in the UK saw the largest increase, and men from Bangladesh, India and Pakistan were the most affected by the disruptions caused by the pandemic.

[Riaz Haq]

INTERGENERATIONAL ECONOMIC MOBILITY: THE CASE OF NORTH-
WESTERN PAKISTAN
Ansa Javed Khan1, Sajjad Ahmad Jan2, Jawad Rahim Afridi3*, Arshia Hashmi4, Muhammad Azeem Ahmed5 1Assistant Director, P&D, Bacha Khan University, Charsadda, Pakistan; 2Assistant Professor, Department of Economics, University of Peshawar, Peshawar, Pakistan; 3*Lecturer, Department of Economics, Sarhad University of Science & IT, Peshawar, Pakistan; 4Assistant Professor, The University of Faisalabad, Department of Management Studies, Faisalabad, Pakistan; 5Associate Professor, Barani Institute of Sciences, Pakistan.
Email: 1*[e-mail], [e-mail], 3*[e-mail], [e-mail], [e-mail]
Article History: Received on 19th June 2021, Revised on 26th June 2021, Published on 29th June 2021


https://www.sciencegate.app/document/10.18510/hssr.2021.93141


Access to Education and Intergenerational Economic Mobility
The following table 1 shows the change in educational status which has taken place between the parents and children’s generations for the overall sample as well as for the sub-groups (Majority and Minority Tribes). The absolute numbers (outside parentheses) and the percentage (within parentheses) in different cells of the table show the people who are illiterate or at different levels of education. The table on one hand shows the intergenerational mobility of people up and down the education ladder and on the other hand reveals the wide and persistent educational gap between the majority and minority tribes. The table shows that 26 % of the respondents in the kids’ generation do not have any education versus 46 % in the parents’ generation. The results affirm the government’s claims and the common perception that, on average, more people have become literate through time and therefore the people in the children’s generation are more likely to be educated than their parent's generation. Further, the college and university graduates in the children’s generation outnumber the school graduates while school graduates outnumber the higher two educational categories in the parents’ generation as most of the students in past used to drop out at both primary or high school levels and couldn’t manage to get into a college or university for higher studies.

The aggregate results for the whole sample are actually driven by the majority tribes as it shows identical trends from the parents’ generation to the children’s generation in all educational. The majority tribe has succeeded in decreasing the number of illiterates from 33% in the parents’ generation to 11% in the children’s generation. College and university graduates (total of 60%) outnumber the school graduates and the illiterate (total of 40%) in the children’s generation as compared to the parents’ generation in the majority tribe where the former is 26% and the latter is 73%. This indicates a visible upward movement of the educational ladder by the members of the majority tribe. The situation of education and literacy in the minority tribe is deplorable if the comparison is either made on basis of children’s and parents’ generations or if the educational attainment levels of the minority and majority tribes are compared. The illiterates outnumber all the other educational categories as in sharp contrast to the educational attainment levels of the majority tribe. The data further reveals that no or only a negligible improvement in the educational status of the people belonging to the minority tribe has taken place between the children’s and parents’ generations. This affirms our presumption that in the North-Western parts of Pakistan, the tribal affiliation of a person determines his or her access to education. The ease of access to education then further transforms into economic mobility or immobility of the people.

[Riaz Haq]

Pakistan Demographic Survey 2020


https://www.dawn.com/news/1721179


The latest figures showed that although the overall life expectancy has dropped, it rose among men from 64.3 to 64.5. For women, it fell from 66.5 to 65.5 but was still higher than for men.

Life expectancy also increased for the 1-4 age group to 71.3, including 70.6 for males and 72 for females.

The infant mortality rate has fallen to 56 deaths per 1,000 live births. It was 60 in PSLM 2018-19, and 62 in PDHS 2017-18.

While the general fertility rate was 124, the age-specific data shows the rate was highest in the 25-29 age group at 215, followed by 176 in the 20-24 age group, 164 in the 30-34 age group, and 94 in the 35-39 age group.

This last age group (35-39) also saw the most significant jump when compared with the PDHS figure of 79.

The general fertility rate was also quite higher in rural areas (138) compared to urban areas (102).

The PDS shows that the country’s population has reached from 207.6m in 2017 to 220.42m now, including 111.69m men and 108.73m women. Most people continue to live in rural areas (139.41m) compared to urban areas (81m).

https://www.pbs.gov.pk/sites/default/files/population/publications/...

[Riaz Haq]

Bilal I Gilani
@bilalgilani
Continuing with looking at the brighter side of our development

Burden of disease has declined from 70,086 disability-adjusted life years (DALYs)32 lost per 100,000
people in 1990 to 42,059 in 2019 due to decreases in CDs and improvements in maternal and
child health;

https://twitter.com/bilalgilani/status/1610718511369797655?s=20&...

[Riaz Haq]

TFR Fertility Trend in Pakistan:


Past
Forecasted
1990 2017 2100
Pakistan
6.1 3.4 1.3
South Asia
6.1 3.4 1.3
Global
3.1 2.4 1.7


https://www.healthdata.org/pakistan

[Riaz Haq]

Lancet Study: Non-infectious diseases cause early death in Pakistan
BY MUNIR AHMED, ASSOCIATED PRESS - 01/19/23 4:04 AM ET

https://thehill.com/homenews/ap/ap-health/ap-study-non-infectious-d...

Pakistan has considerable control over infectious diseases but now struggles against cardiovascular diseases, diabetes and cancer as causes of early deaths, according to a new study published Thursday.

The Lancet Global Health, a prestigious British-based medical journal, reported that five non-communicable diseases — ischaemic heart disease, stroke, congenital defects, cirrhosis, and chronic kidney disease — were among the 10 leading causes of early deaths in the impoverished Islamic nation.

However, the journal said some of Pakistan’s work has resulted in an increase in life expectancy from 61.1 years to 65.9 over the past three decades. The change is due, it said, “to the reduction in communicable, maternal, neonatal, and nutritional diseases.” That’s still 7.6 years lower than the global average life expectancy, which increased over 30 years by 8% in women and 7% in men.

The study says “despite periods of political and economic turbulence since 1990, Pakistan has made positive strides in improving overall health outcomes at the population level and continues to seek innovative solutions to challenging health and health policy problems.”

The study, which was based on Pakistan’s health data from 1990 to 2019, has warned that non-communicable diseases will be the leading causes of death in Pakistan by 2040.

It said Pakistan will also continue to face infectious diseases.

“Pakistan urgently needs a single national nutrition policy, especially as climate change and the increased severity of drought, flood, and pestilence threatens food security,” said Dr. Zainab Samad, Professor and Chair of the Department of Medicine at Aga Khan University, one of the authors of the report.

“What these findings tell us is that Pakistan’s baseline before being hit by extreme flooding was already at some of the lowest levels around the globe,” said Dr. Ali Mokdad, Professor of Health Metrics Sciences at IHME. “Pakistan is in critical need of a more equitable investment in its health system and policy interventions to save lives and improve people’s health.”

The study said with a population approaching 225 million, “Pakistan is prone to the calamitous effects of climate change and natural disasters, including the 2005 Kashmir earthquake and catastrophic floods in 2010 and 2022, all of which have impacted major health policies and reform.”

It said the country’s major health challenges were compounded by the ongoing COVID-19 pandemic and last summer’s devastating flooding that killed 1,739 people and affected 33 million.

Researchers ask Pakistan to “address the burden of infectious disease and curb rising rates of non-communicable diseases.” Such priorities, they wrote, will help Pakistan move toward universal health coverage.”

The journal, considered one of the most prestigious scientific publications in the world, reported on Pakistan’s fragile healthcare system with the Institute for Health Metrics and Evaluation at the University of Washington’s School of Medicine. The study was a collaboration with a Karachi-based prestigious Aga Khan University and Pakistan’s health ministry.

The study also mentioned increasing pollution as one of the leading contributors to the overall disease burden in recent years. Pakistan’s cultural capital of Lahore was in the grip of smog on Thursday, causing respiratory diseases and infection in the eyes. Usually in winter, a thick cloud of smog envelops Lahore, which in 2021 earned it the title of the world’s most polluted city.

[Riaz Haq]

Library thrives in Pakistan’s ‘wild west’ gun market town
‘Men look beautiful with jewel of knowledge, beauty lies not in arms but in education’

https://gulfnews.com/world/asia/pakistan/library-thrives-in-pakista...

DARRA ADAMKHEL, Pakistan: When the din of Pakistan’s most notorious weapons market becomes overwhelming, arms dealer Mohammad Jahanzeb slinks away from his stall, past colleagues test-firing machine guns, to read in the hush of the local library.

“It’s my hobby, my favourite hobby, so sometimes I sneak off,” the 28-year-old told AFP after showing off his inventory of vintage rifles, forged assault weapons and a menacing array of burnished flick-knives.

“I’ve always wished that we would have a library here, and my wish has come true.”

The town of Darra Adamkhel is part of the deeply conservative tribal belt where decades of militancy and drug-running in the surrounding mountains earned it a reputation as a “wild west” waypoint between Pakistan and Afghanistan.

It has long been known for its black market bazaars stocked with forged American rifles, replica revolvers and rip-off AK-47s.


But a short walk away a town library is thriving by offering titles including Virginia Woolf’s classic “Mrs Dalloway”, instalments in the teenage vampire romance series “Twilight”, and “Life, Speeches and Letters” by Abraham Lincoln.

“Initially we were discouraged. People asked, ‘What is the use of books in a place like Darra Adamkhel? Who would ever read here?’” recalled 36-year-old founder Raj Mohammad.

“We now have more than 500 members.”

Tribal transformation
Literacy rates in the tribal areas, which were semi-autonomous until 2018 when they merged with the neighbouring province of Khyber Pakhtunkhwa, are among the lowest in Pakistan as a result of poverty, patriarchal values, inter-clan conflicts and a lack of schools.


But attitudes are slowing changing, believes soft-spoken 33-year-old volunteer librarian Shafiullah Afridi: “Especially among the younger generation who are now interested in education instead of weapons.”

“When people see young people in their neighbourhood becoming doctors and engineers, others also start sending their children to school,” said Afridi, who has curated a ledger of 4,000 titles in three languages - English, Urdu and Pashto.

Despite the background noise of gunsmiths testing weapons and hammering bullets into dusty patches of earth nearby, the atmosphere is genteel as readers sip endless rounds of green tea while they muse over texts.

However, Afridi struggles to strictly enforce a “no weapons allowed” policy during his shift.

One young arms dealer saunters up to the pristinely painted salmon-coloured library, leaving his AK-47 at the door but keeping his sidearm strapped on his waist, and joins a gaggle of bookworms browsing the shelves.

Alongside tattered Tom Clancy, Stephen King and Michael Crichton paperbacks, there are more weighty tomes detailing the history of Pakistan and India and guides for civil service entrance exams, as well as a wide selection of Islamic teachings.

‘Education not arms’
Libraries are rare in Pakistan’s rural areas, and the few that exist in urban centres are often poorly stocked and infrequently used.

In Darra Adamkhel, it began as a solitary reading room in 2018 stocked with Mohammad’s personal collection, above one of the hundreds of gun shops in the central bazaar.

“You could say we planted the library on a pile of weapons,” said Mohammad - a prominent local academic, poet and teacher hailing from a long line of gunsmiths.

[Riaz Haq]

Library thrives in Pakistan’s ‘wild west’ gun market town
‘Men look beautiful with jewel of knowledge, beauty lies not in arms but in education’

https://gulfnews.com/world/asia/pakistan/library-thrives-in-pakista...


Mohammad paid 2,500 rupees ($11) for the monthly rent, but bibliophiles struggled to concentrate amidst the whirring of lathes and hammering of metal as bootleg armourers plied their trade downstairs.

The project swiftly outgrew the confines of a single room and was shifted a year later to a purpose-built single-storey building funded by the local community on donated land.

“There was once a time when our young men adorned themselves with weapons like a kind of jewellery,” said Irfanullah Khan, 65, patriarch of the family who gifted the plot.

“But men look beautiful with the jewel of knowledge, beauty lies not in arms but in education,” said Khan, who also donates his time alongside his son Afridi.

For the general public a library card costs Rs150 rupees ($0.66) a year, while students enjoy a discount rate of 100 rupees ($0.44), and youngsters flit in and out of the library even during school breaks.

One in 10 members are female - a figure remarkably high for the tribal areas - though once they reach their teenage years and are sequestered in the home male family members collect books on their behalf.

Nevertheless, on their mid-morning break schoolgirls Manahil Jahangir, nine, and Hareem Saeed, five, join the men towering over them as they pore over books.

“My mother’s dream is for me to become a doctor,” Saeed says shyly. “If I study here I can make her dream come true.”

[Riaz Haq]

Bearing gifts: the camels bringing books to Pakistan’s poorest children
The mobile library services are an education lifeline for students in Balochistan, where schools have closed during the pandemic

https://www.theguardian.com/global-development/2021/apr/26/bearing-...


Sharatoon had wanted to continue her studies, but she had to leave school and her beloved books when she got married aged 15.

Now 27, Sharatoon is happy reading again, as every Friday a camel visits her small town, his saddle panniers full of books.

She has four children, the eldest is 11, the youngest 18 months, and she reads to them all, as well as to other children in the town.

Every week, when Roshan the camel comes to her home in Mand, about 12 miles from the border with Iran, in Pakistan’s Balochistan province, Sharatoon exchanges the books she borrowed for new ones.

“When the camel came to our area for the first time, the kids were very happy and excited. Schools have long been closed in our area due to Covid and we do not have any libraries, so this was welcomed by all the kids,” says Sharatoon, who uses only one name.

Balochistan is Pakistan’s most impoverished province, blighted by a separatist insurgency for the past two decades. With a 24% female literacy rate, one of the lowest in the world, compared with a male literacy rate of 56%, it also has the highest percentage of children out of school in the country.


Roshan visits four villages, staying in each at the home of a “mobiliser” such as Sharatoon, where all the district children aged four to 16 can come to read, borrow and exchange books with one another.

“Parents and kids are excited. It is giving hope to many that they can read, and the staff members also work on mobilisation so more outreach can be done,” says Fazul Bashir, a coordinator for the library.

When Covid closed the schools across Balochistan, two women in Mand – Zubaida Jalal, a federal minister in the Pakistan government, and her sister Rahima Jalal, headteacher of a local high school – came up with the idea of a camel.

“Actually, the idea of using camels comes from Mongolia and Ethiopia,” says Rahima. “It suits our desolate, distant and rough terrains. We have received an enormous response that we were not expecting.”

The trial of the camel library has gone well and it is about to begin its next three months of rounds.

Sharatoon says: “Kids are eagerly waiting; they want to read books and keep asking me [about it]. There should be more science-related books so our kids can learn by experimentation.”


The Jalal sisters say there has been a lot of interest in the scheme from other areas, and they have just started a library in the city district of Gwadar, Balochistan, with a camel called Chirag.

Anas Syed Mohammad is a 10-year-old 4th-grade student in the town of Abdul Rahim Bazar, about 30 miles from the city of Gwadar.

Since the camel library started visiting three weeks ago, Mohammad has read a different book each time. “I loved reading Khazane Ki Talaash (In Search of Treasure). I discuss these books with my friends,” he says.