Investment in education, health and infrastructure to usher in new era

June 12 - 18, 2006

The priority level of education, healthcare and infrastructure development can be gauged simply by looking at the allocations for these heads in the federal budget for 2006-07. Of the total outlay of Rs 1,315 billion only Rs 435 billion have been allocated for developmental expenditures. Out of total PSDP of Rs 270 billion Rs 119.5 billion will be spent on physical structure Rs 119 billion on social sector. With in infrastructure development, water and power, including village electrification will get Rs 70.6 billion and communication (including NHA, Shipping and Railways) will get Rs 37.6 billion. With social sector development, allocation to the health and population sectors amounts to Rs 15.4 billion and allocation to education including HEC to Rs 22.9 billion and allocations to Science and Technology is Rs 4.4 billion.

The government says access to basic education is the right of every citizen of any country. It is the most important instrument used for enhancing human capabilities and achieving the key objective, economic development. Education enables individuals to make informed decisions, improve their mind set and take part in the crucial decision making process. Education is often used for nation-building process, through which a nation passes on its values and cultural heritage to the next generation. At the national level, education means strong economic growth through use of productive and skilled labor force. At the individual level, education is strongly correlated to higher earning and a more informed and aware existence. The emerging global scenario offers immense opportunities and challenges, only those nations can benefit from it which can acquire the required knowledge base and skills.

Pakistan is committed to various international declarations for providing basic education to all of its citizens. It is one of the signatories of Millennium Development Goals (MDGs) as well as the Dakar World Education Forum 2000. The Government of Pakistan has taken several policy initiatives to achieve these international goals. The National Plan of Action for Education for All was initiated in response to the commitment made at Dakar for World Summit. The Education Reform Action Plan (ESR), built upon the National Education Policy 1998-2010 is a long term plan. The ESR addresses the development of the overall education sector through investment in rehabilitation of schools, improving the curriculum and assessment reform system, an adult literacy campaign, mainstreaming the Madrassas, a pilot school nutrition program and technical stream in secondary schools.

The Poverty Reduction Strategy Paper (PRSP) emphasizes education as a strong policy tool in bringing down poverty level in the country. Three main objectives of all of the programs and initiatives include 1) universal access to primary education by increasing the net enrollment and higher rate of survival of children till grade 5, 2) increase in the adult literacy rate and 3) to attain gender equality at all levels.

Currently, adult literacy rate is 53%, net enrollment at the primary level is 52%, retention rate for 2004-05 was noted as 61% and significant gender gaps at all levels especially in the rural areas persist. Public spending on education as a percentage of GDP is around 2% and has approximately increased by less than one percentage point since 2000-01. Pakistan has previously neglected investment in human capital and thus fosters a persistently high population, deceleration of growth and overruling poverty. In education, the problems are low level of enrollments not only at the primary, but also at the middle, secondary, and higher education levels along with poor quality of public education. Pakistan still has to go a long way to achieve the desired targets and until and unless education is given the top priority (in terms of priority in the policy framework and allocation of financial resources) this sector will continue to show weak performance in the coming years.

The President's Education Sector Reforms (ESR) envisages creating awareness about improving literacy, institutionalizing literacy efforts through more efficient and effective organizational structure at all tiers of the government. Under ESR, 6,953 literacy centers have been established throughout the country. So far, 0.278 million youth have been made literate. National Commission for Human Development has also established 6602 Adult Literacy Centers and 160,533 neo-literates have graduated from these centers. USAID assistance has also led to opening of approximately 4000 Adult Literacy Centers in Sindh and Balochistan and 7543 adults have so far passed the literacy program. National literacy guidelines have also been developed. UN Decade Strategies for literacy program have also been developed in close co-operation with UNESCO. President's Program emphasizes provision of education for all school age children and it proposes to achieve 76% net primary enrolment by 2006. Recently, the government has decided to provide at least one primary school to every village along with other initiatives like provision of free text books, free education up to matriculation and grants and stipend to girl students.

The role of the private sector in primary education has increased over time. Out of the total primary-level GER of 86% in 2004-05, the government school GER has been computed at 62%. The private school GER increased by 33% during 2001-02 to 2004-05 as compared to only 15% increase in the government school GER. This means that while new enrollment has taken place in both schools, relatively more increase in the private school GER suggests some shifting of children from public to private schools. Approximately, half of the enrollment in urban areas at primary level is currently in private schools, and it has marginally declined. In rural areas, where poverty is predominant, private school enrollment increased from 15% to 18% during this period suggesting that the public schools still remain the main source for primary education.

An important area to evaluate the individual's well-being is "Health". According to the 1948 Universal Declaration of Human Rights "Everyone has the right to a standard of living adequate to the health and well -being of him/her and his/her family." Human Development is a basic right of every individual and "Health" is regarded one of the prerequisite for development. Beside the importance of the Health for measurement of the Welfare of an individual, poor health can directly influence an individual's opportunities -his or her earning capacity, performance at school, ability to care for children, participation in community activities etc. Such an important role of health implies that the inequalities and the deficiencies in the health can be translated into other inequalities and deficiencies of life and so can affect the well -being of an individual and welfare of a society as a whole.

A healthy population contributes positively to the economic and social development of a country. The reflection of this can be seen from the importance accorded to the health issues in the United Nations Millennium Development Goals. These goals have emerged from the UN Millennium Declaration of September 2000 with specific measurable targets. These include reducing the extreme poverty that still grips more than one billion people. Three out of the eight goals (MDGs) are directly related to Health sector. These are: reducing Child mortality; improving maternal health; and combating HIV/ AIDS, TB, Malaria and other diseases.

The poor conditions in the health sector can be attributed to a product of various factors like poverty, malnutrition, unequal distribution of health facilities, inadequate allocation for health, high population growth and infant mortality. To address all these problems and to take care of these deficiencies a National Health Policy was announced in June 2001. This policy focuses on health sector investment as part of poverty alleviation and accords priority to primary and secondary health care services. The key objectives of the policy targets ten specific areas for reforms. These include: reducing the wide spread prevalence of communicable diseases; addressing inadequacies in primary/secondary health care services; promoting gender equity; correcting urban biases; bridging basic nutritional gaps; improved regulation of private health sector; removals of professional and managerial deficiencies in districts health sector; capacity building for health policy monitoring; creating mass awareness in public health matter and improving the drug sector to ensure the availability, affordability and quality of drugs.

Two measures of immunization coverage are already in practice. Based on Mother's recall, at least one immunization has increased. The measure that includes mother's recall as well as record of immunizations given to child shows a rise in the proportion of one year old, who are fully immunized. There has been an increase in the proportion of children under five suffering from diarrhea but Sindh has shown significant increase. The increase may be attributed to shortage of clean water availability in many districts in the recent past.

According to the latest Economic Survey, Pakistan enjoys a vast network of health care facilities. These health care facilities include 946 hospitals, 4554 dispensaries, 5290 Basic Health Units and sub health centers, 907 Mother and Child Health Centers, 552 Rural Health Centers and 289 TB Centers primarily run by provincial governments. The human resource available for health care have gradually increased over the years and according to Pakistan Medical and Dental Council (PMDC) there were 100,131 doctors registered until 28th February 2006. There are also 18,029 doctors registered as specialists making the total number of available doctors as 118,160. The dental surgeons registered in the country include 6,374 as general practitioners and 387 as specialists making a total of 6,761. Though there is annual output of around 5,000 medical graduates from both private and public medical colleges the current ratio of one doctor per 1,310 persons is below the recommended ratio of one doctor per 1000 persons.

The Prime Minister program For Prevention and Control of Hepatitis in Pakistan (2005-2010) was launched on August 29, 2005 to substantially decrease the prevalence, morbidity and mortality due to hepatitis viral infections in the general population by utilizing the existing health infrastructure. The total cost of the program is Rs.2.59 billion for financial years 2005 till 2010. The total PSDP health sector allocation is Rs. 9.44 billion and release for this project is 300 million. The goals set under the program aims to achieve 50 percent reduction in hepatitis prevalence by 2010 through establishment of hepatitis Surveillance System, provision of drugs for hepatitis B & C patients, provision of hepatitis vaccination for high risk population, provision of essentials for ensuring safety of blood and blood products at all blood transfusion centers, proper disposal of invasive medical devices including syringes, hospital waste, prevention and control of Hepatitis A &E and actualizing the strategy for safe drinking water supply and sanitation provisions.

Specific goals of the program include: Establishing Screening / diagnosis, Counseling and Chronic liver disease treatment facilities at provincial, District and Tehsil level hospitals in a phased manner (121 Districts 425 Hospitals); Establishment of reference water quality control laboratories and purification plants at NIH, Provinces (7 units) and in rural setting (150 units); Improvement of health care providers knowledge for prevention of Hepatitis through focus on injection safety, safe blood transfusion practices (385 Blood Banks) and Hospital Waste Disposal (425 hospitals); Introduction of lab based surveillance system for evidence based policy decisions and creating opportunity for epidemiological research studies mainly community based and establishment of provincial satellite offices of the provincial Coordinator; Advocacy and behavior change communication (BCC) Strategy development and execution on persistent basis for prevention of Hepatitis by creating awareness among general masses for adoption of healthy practices ; Strengthening of routine immunization services of Hepatitis B vaccine for infants through provision of immunization against Hepatitis B in children below on year of age by using Expanded Program of immunization infrastructure and reduction of vulnerability to Hepatitis in medical staff of public sector and other risk groups.

Infrastructure has a central role in the development program and is a major contributor to growth, poverty reduction and achievements of the MDGs. Many studies show that the economic returns to infrastructure investment are high, and infrastructure services - especially those contributing to improve investment climate - can make significant contributions to the growth of an economy. Despite the high returns from infrastructure investment, fiscal stresses resulting in high level of public indebtedness rendered public sector investment in infrastructure rather difficult. The growing economic activities are placing increasing pressure on existing infrastructure.

A strong, efficient and affordable infrastructure is a pre-condition for sustained growth. Transport and Communications are important elements of infrastructure services. Transport and communication sector in Pakistan account for about 11% of GDP, 16% of fixed investment, 6% of employment and about 15% of the PSDP. Road transport is the backbone of Pakistan's transport system, accounting for 90% of national passenger traffic and 96% of freight movement. Over the past ten years, road traffic - both passenger and freight - has grown much faster than the country's economic growth. The 9,518 km long National Highway and Motorway network contributes 3.7% of the total road network and carries 90% of Pakistan's total traffic. Pakistan, with about 155 million people, has a reasonably developed transport system. However, when compared with other developed and developing countries, the road density of Pakistan is low. Road density indeed is the index of prosperity and development. With road density of 0.31 km/sq. km Pakistan intends to double it to 0.64 km/sq. km gradually over the next 10 years.

National Highway Authority (NHA) has successfully completed the rehabilitation of N-5, and the improvement of 757 Km of Indus Highway. The construction of the Makran Coastal Highway (N-10), and 424 Km of motorways via Lahore Islamabad (M-2) and Pindi Bhattian - Faisalabad (M 3), have also been accomplished. Motorways not only provide safe and efficient transport for commuters but also reduce the vehicle operating cost. On the whole, the motorway network aligned through the new corridor will hopefully instigate new areas of economic and social potential, whilst reducing the pressure on the existing infrastructure.

Realizing the growing needs the NHA has initiated some major ongoing road projects. The urban area of Karachi has received some respite with diversion of substantial heavy port traffic to Karachi Northern Bypass. Lyari Expressway Projects shall be completed during the year 2007 and work on dualization of Karachi Northern Bypass is to commence soon. Karachi-Hyderabad Superhighway (M-9) is being upgraded to a 6-lane motorway. Work on Islamabad-Peshawar Motorway (M-1) is continuing. Islamabad-Burhan Section and Rashakai-Charsadda Section have been completed and the entire motorway will be opened to traffic in June 2007.

The NHA is also implementing major program for rehabilitation, up-gradation and preservation of N-5 in phases at a cost of Rs 17 billion. This includes reconstruction and widening of the Lahore-Gujranwala Section. Work on Satra Mile-Lower Topa and is scheduled for completion by June 2007. After completion of Mansehra-Naran-Jhalkhad Section, construction of Jhalkhad - Chillas Section has been undertaken. Construction of Lowari Rail Tunnel Project has also been undertaken. Work on D. G. Khan-Rajanpur Section is in progress and work on Sara-e-Gambila-Malana Section recently been awarded. Similarly, construction of many road links in Balochistan providing connectivity to Gwadar is under consideration. The 196 Km Gwadar-Turbat-Hoshab Road is nearing completion. Work on construction of Hoshab-Panjgur-Nag-Basima-Sorab Road is going to commence within the next few months. Construction of Kalat-Quetta-Chaman Road (247 Km) is already in progress.

Modern railway network is one of the major components of the transport system. Pakistan Railways plays a vital role in generating development opportunities. It has a definite and unmatchable edge over road for long and bulk haulage and mass scale traffic volume being safe, environmental friendly and most economical as compared to any mode of transportation.

During 1995-2006, the share of Railways, both in respect to passenger traffic and freight traffic has declined from a little less than 11% to 9.9%t and from 6% to 3.9%, respectively. However, Pakistan Railways has shown its good performance since 2000-01 in respect of passenger as well as freight traffic. During the last five years (2000-05), Pakistan Railways has been showing an increasing trend in both passenger and freight traffic, registering an average increase of 5.6% and 8.3% per annum, respectively. A positive growth of 5.2% and 3.6% has been recorded in passenger traffic and freight traffic, respectively during 2004-05. However, the passenger traffic carried by railways increased by a little above 9% during July-March 2005-06, whereas freight traffic declined by over 7% in this period due to transportation of oil through pipeline. The positive growth trend for five consecutive years (2000-05) can be attributed to the wide ranging improvements made by the Railways due to completion of a number of development projects and right direction in policy making toward the modernization of Railways. In addition, Pakistan Railways has improved the quality of services, timeliness and cleanliness.

At present, the network of Pakistan Railways has international connections to India and Iran, with great plans to improve its position as a transport provider. For a start, the feasibility studies for construction of Chaman to Kandhar have been completed and the one for Kandhar to Khushka (Turkmenistan) has also been planned. However, at the same time, rail construction work from Chaman to Spingbuldak will be executed in the first phase. The major development schemes in this regard, include the manufacturing and import of 18 locos and 38 passenger coaches in Risalpur, the decommissioning of 28 locos, procurement of 130 high sided and 64 covered freight wagons from China and lastly, the manufacture of 150 freight wagons locally. In addition, 80 passenger coaches will be rehabilitated and 78 km track will be doubled on Lodhran- Khanewal section. The work of doubling of track on Khanewal-Raiwind has been started during the current year. Track renewal of 115 km of rails and 290 km of sleepers; have been considered for the main line from Karachi Khanpur. Various other schemes include the replacement of broken down cranes, the strengthening of bridges, an underpass in Renald Khurd and lastly, the completion of the Sangla Hill. Mirpurkhas- Khokhropar has also been converted from meter gauge to broad gauge and is open for traffic to India.

Many critics may say that whatever amount is being spent on development is too meager but must not forget that in the past even smaller amounts were allocated. If the opponents of present regime are serious they must keep track of the developments and must also pinpoint misappropriations, if any.