Development Issues Poverty
One of the major issues of targeted area of DASE is poverty that is rarely mentioned, but is of increasing significance is that of the young. Over 50% of , Pakistan in general, the population is now under the age of 20 and it is estimated that in 25 years that number will be equal to today's total population. This segment of the population brings great possibility to the country; it also brings risks. Many countries, both rich and poor, that have experienced a similar 'youth bulge' have undergone serious social disruption.
The quality of public services
The linkages between poverty and human development are not only clear but also direct. Education, of course, is a central factor in determining a worker's wage earning prospective. New data also note a strong correlation between poverty and health. Poor health among primary wage earners keeps families poor or can cause a family to drop into poverty.
This perspective helps to focus attention on the impoverishment of human capacity, and the frustration of citizens who believe that they have lost an opportunity to progress because state institutions have not lived up to their responsibility to provide quality public services. While the government, and almost every donor in this room, invests heavily in the public education and health systems, the citizens of Pakistan are increasingly voicing their discontent with the quality of these same systems by choosing to avail of private services instead. This is the case in both education and health. What has led to this state of public service delivery? The reasons are complex and probably differ from sector to sector. It is clear that the yearly additional population increase exceeds the current capacity of the government to cope with demand. However, it must be a concern to us that at the same time that public service quality has deteriorated, recurrent expenditures have increased dramatically when compared to development expenditures.
Education
There is probably no sector that most of us here would give more importance to today in Pakistan than basic education. Yet there has been virtually no improvement in primary school net enrolment in Pakistan since 1970, despite the huge investments made by donors and government. These figures do not even take into account what is recognized as the often-poor quality of the learning among those that do complete primary school. Many attempts at reducing dropout and repetition and improving student competencies have focused on raising the quality of teachers and the classroom environment. These efforts have met with some success, but the improvements have not yet been widespread enough.
Perhaps improving the health and nutrition of the young as a means of improving school performance could be an important complement to more traditional education strategies. Let's look at what is currently happening in those areas.
Health and Nutrition
While it has long been recognized that brain development is strongly affected by early health and nutrition levels, the situation of nutrition in the country has not improved for more than a decade. Chronic malnutrition, or stunting, has shown a steadily worsening trend, according to the latest data from PIDE, reaching 60% of all children under five. In addition, the number of Pakistani children suffering from severe undernourishment, or wasting, has remained at 10% since 1987 without improvement, while only 6% of the children of new-arrived Afghan refugees measured recently evidenced similar conditions.
How do Pakistani children get to be so poorly nourished? First of all, one-quarter of all babies born in Pakistan have low birth weight. This is a reflection of the nutritional status of mothers, and the poor nutritional status of girls leads to undernourished mothers. Women born with low birth weight are themselves likely to give birth to children with low birth weights. The only way to break this intergenerational malnutrition will be to address the nutritional and educational status of girls. There are several useful new initiatives focusing on enhancing the status of women in the family and in the society; we should all be contributing to their success. A similar trend can be seen in the percentage of fully immunized children in Pakistan, where there has been no appreciable increase over the past decade. Despite a heavy focus on child immunization since the 1980s, the coverage of fully immunized children has not gone beyond 50%. Although the absolute number of immunized children increases each year, so does the number of those who have been left out. Deaths and illness from these easily preventable diseases should also be a concern of all of us. The extremely high maternal mortality rate is also an indicator of how much improvement is required in reproductive health, in women's status, and in gender equality. Fortunately, HIV/AIDS has not yet been added to those health issues, which are significant in Pakistan, and there is a possibility that the attention now being given to this scourge in Pakistan will prevent the human and economic impacts that this disease has caused in other countries. Linkages of health and education
It is important when we are discussing health and nutrition to include water supply and sanitation in our concerns. Although government statistics show a significant increase in the availability of drinking water during the past decade, almost every Union Nazim in the country says their constituents' primary demand is for improvements in water supply and drainage. The discrepancy, once again, relates to both quantity and to quality.
Diarrheal disease is one of the most prevalent health threats in Pakistan. When children consume food and water that is contaminated, they get sick and cannot retain the nourishment. Although the rates for child death have been declining, survival alone does not ensure that the child grows up to reach his or her full potential. Recent research found children who suffered from persistent diarrhea were far more likely to repeat a grade and the links with impaired learning ability were clearly evident. In fact, persistent diarrhea early in life accounted for more variation in school performance than any other variable studied.
Political Space
Although we spoke earlier on governance issues in Pakistan, there is need to re-iterate a point here. The current reforms underway in Pakistan offer DASE an opportunity to recognize that many of the human development problems in the country stem not from a lack of technical competence, but from institutional constraints that prevent us from addressing these problems in a holistic manner.
The new devolution policy, which has established the District as the governance unit responsible for the human development sectors, provides a unique opportunity for civil society to come to grips with these interconnected problems. Further, the creation of the tehsil municipal administration is a radical, and long necessary, step. The provision of basic services like clean water, clean markets, controlled sewerage and regulating food storage and processing - all identified as critical factors in public health maintenance - have now all been placed under the authority of the towns and tehsils of the country if community is mobilized and politically awakened.
Unfortunately, the importance of the tehsil has not yet been evident to many people and civil society. Perhaps it is because the tehsil is responsible for public goods and services that are so mundane that all take them for granted. However, the more the poor need to struggle to obtain clean food and water, the less time they have to be productive. The on-going devolution process in Pakistan has allows DASE to see that there is needs to be a much stronger focus on strengthening local capacity to get the services delivered to all the population of marginalized areas. The tremendous variations across the country related to almost every development issue suggests that human development issues in Pakistan are essentially local. Devolution has given civil society the institutional framework necessary to address these local development issues in an integrated manner.
Civil society must challenge itself to recognize this and to develop the tools necessary to support the reform process that Pakistan has initiated. Perhaps civil society needs to begin to re-think some of its approaches to human development in Pakistan, focusing on the importance of the youth bulge and its implications, and on four other factors mentioned here: the politically dormant masses, quality of public service delivery, the interlink ages among sectors, peace and harmony, the treatment of girls and women, and the potential of local management of public services. Pakistan today is focusing on many long-neglected areas. Our collective efforts to address these areas today are both indispensable and encouraging.
