AN
APPRAISAL OF
SOCIAL
SERVICES DELIVERY FOR CHILDREN
IN
PAKISTAN
By
IPF Fellow
2002-2003
Background
The structure of Pakistan devolution
experience does provide significant changes from the past but it will be a bit
early to draw any conclusions about its performance. At present, the devolved system is nascent and in need of capacity development. There are chances that either fiscal
decentralization may not make headway or re-centralization of functions may occur
in some sectors. There are indications
for both already. Largely, this is due
to the efforts of the provincial bureaucracies, attuned to administrative
control as the sole option for achieving policy integration. Lack of clear norms and standards,
mechanisms and options for intergovernmental relations are underlying causes
for this situation.
If the current devolution process succeeds in Pakistan, it is foreseen that services delivery for children will no longer regarded as the sole responsibility of central government, even though over-reliance on the state is likely to persist. Much is desired to see the continuity of commitment of the present government to the devolution process. Even with a powerful pro-devolution president in place, the future of this program remains a question, unless there are solid guarantees like providing constitutional cover to the on going reform process.
It is clear that the original goals of
Pakistan’s devolution agenda – to raise the standard of living for everyone and
to develop a humane and democratic society – now need to be re-affirmed. The
political goals of the devolution should be seen as tools to achieve these
greater human goals. In reality, the ultimate success of the devolution process
will depend on improvements in social conditions and the promotion of a humane
culture for children to grow. Among the major durable strategies to bring about
this change is to bring about certain reforms in both the public and private
sector. Around the world, states pursue policies of
encouraging and assisting local governments as well as non-governmental
organizations, the private sector and civic groups, to prepare their own
programmes. These exercises have helped fuel local demand for coordinated
social development, and for more coherent approaches to social service
provision, especially at the point of delivery. They have also helped reinforce
a sense of social responsibility for children. . In many cases, the National
Plans for Action (NPAs) were incorporated into national development plans,
social policies and sectoral programmes. Similraly a National action for
children can be pursued in Pakistan’s newly devolved governance system through
child-focused social policies and budgets. Action plans for children can form part
of state or district development plans and programmes.
If an analysis of similar experiences is seen globally, four key qualities have been present in many of the successful experiences. The same can be enumerated as expectations for child related policies from Pakistan’s ambitious decentralization programme.
1. Sustained levels of political commitment.
2. Broad participation in preparation, monitoring and evaluation of plans.
3. Initial or eventual mainstreaming of child-focused goals, priorities and strategies into wider national framework for development planning, resource allocation and implementation.
4. High-level coordination and monitoring of policies and strategies for children, with technical and administrative support from clearly identified agencies.
In the light of this understanding, following are some general as well as sector specific policy recommendations for operationalizing reforms in major areas of child welfare concern in Pakistan:
1. Local governments play a key role in the implementation of welfare policies. Being in the frontline, they are logically positioned to deliver basic services to the people. In this context, it is important that the process of decentralization of management to the district level and below already initiated within provincial Departments should be deepened. It should encompass all three phases of management i.e. planning, implementation and monitoring. As management is increasingly decentralized, a transparent formula is needed where funding is decentralized, central governments must ensure that adequate systems of transfers from the centre are in place to allow poorer local authorities to do their job. Ensuring timely compliance with processes like clarity on allocation of fiscal resources and formulating a sphere of power for local govt. officials can help sustain and strengthen the devolution processes. Delaying or obstructing the grass root management can form a reason for non-implementation, and even failure, of the reform interventions for better services delivery.
2. Sustaining and strengthening broad-based access to health care system and schooling, including gender equity, must be part of a general strategy to combat inequalities amongst children’s of various social classes in terms of access to services.
3. It is important to identify the scope of functioning for ministries and state institutions that will be coordinating the implementation of any welfare initiative or national policy with the District governments. Further to this, District officials with responsibility for education, social welfare, the environment, and finance, as well as health, need to work with each other – as well as with the general public – to further the cause of efficient social services availability to children.
4. There is also a need for diversification of the financial resource base of child welfare programmes by encouraging active involvement of the community and international assistance agencies.
5. Decentralization and devolution strategies for social services delivery must be accompanied by serious capacity building efforts. It is important to realize that human resource development plays the most fundamental role in a nation’s material advancement and quality of life improvement. In Pakistan, the new system of decentralized functioning has highlighted a genuine need for capacity building of state functionaries and elected representatives. It remains a fact that a wide array of local actors have been put on board with challenging roles and responsibilities for which they do lack skills and capacity. It should therefore be a priority policy concern to equip the responsible actors in this framework with the capacity to play their roles effectively, through a process of trainings, awareness and expertise support.
6. In the context, the presence of a specific capacity building and training institution for both local and national government officials can be suggested. The effectiveness in bringing about reform ultimately depends on building adequate institutional capacity, assuring monitoring of the ongoing process and supported by a strategy for assessing the quality of service. What can be done is to develop a comprehensive capacity building program with specific modules aimed at developing specific skills of the participants. Such An initiative, however, should take cognizance of the challenges (protecting interests of children in this case) in the country, and in their implementation, locate the capacity building interventions to the overall social services delivery framework and elaborating on the roles of the various sectors (government, private, civil society, business, donor institutions, etc.)
7. Most aspects of services delivery structure for children remain
unclear and undefined due to the overlapping concerns of various public
services sectors i.e. health, education departments etc. For this reason, the
ongoing process of decentralization may be seen by some as devolution of powers
to the local governments, while others see it simply as deconcentrating powers
to lower level institutions. There is a need to create awareness through a
sensitized media about the benefits the new setup can bring about and how the
community itself can participate in deciding the scope of welfare services
provisions they desire on a priority basis.
8. The participation process should also seek to involve and respect
the voice of children themselves who are quite oblivious of the developmental
efforts and lack awareness. Observations gained through personal interaction
with children especially of the lesser income social classes should be taken
into account while programming future actions. It is also required to target
specifically on the value of the
girl-child in rural set-ups and responsible parenting in urban communities to
prevent school dropouts and reduce the numbers of urban street children.
9. Pakistan has around 100 districts and a few municipal/city governments today. These districts do not present a uniform scenario in terms of their capacity to generate revenues, availability of expertise and even the existence of basic services infrastructure. Indeed, there can be no such thing as a "universal model" of public sector reform for then, where a one-size fits all formula can be applied to similar situations around the country. What can be done is to facilitate the sharing of experiences among the various districts, and also learning from experiences of decentralization outside the country. Where appropriate, approaches to social sector reform and child protection can be adapted but it is likewise important to recognize that the experiences of the different countries are unique and have to be placed and appreciated within the proper historical, social, cultural, political and administrative contexts.
10. Information is widely accepted as the single most powerful and effective tool in promoting and upholding human rights, including the rights of children. To make informed decisions concerning children, policy makers, international bodies and civil society need to have access to current, reliable and relevant information from many disciplines and from many sources throughout the world. As one step in this direction, the district governments should have access to the updated, effective user-oriented children's rights information and data to have a realistic picture of child welfare situation in their jurisdiction and adjust their priorities accordingly. As a first step, such data can be collected by National Bureau of Statistics in collaboration with Provincial Government, local bodies and civil society organizations.
11. Modern concepts of good governance invoke as essential the elements of political accountability, freedom of association and participation, reliable and equitable legal framework and bureaucratic transparency. As already mentioned, Pakistan’s decentralization programme has stirred a radical overhaul for the system. The ‘remedy of decentralisation’ has been identified as the most appropriate vehicle for achieving the objective of empowering of civic society, which has certainly upset certain quarters like the (used to be) powerful bureaucracy and feudal/political elite. It is important for the success of any policy framework for social services delivery for children to remove these tensions, which have to be solved with time, preferable through a well defined institutional mechanism.
There is a broad consensus in Pakistan that the health sector is in need of fundamental reform in order to achieve a better impact on the health status of the population. The need for reform should be reflected in the inclusion of health as a priority concern in the ongoing decentralization process. At the moment, the reforms targeted pertain not to the sector as a whole but only to basic government services.
As grass root governance takes root, Pakistan’s national health strategy should evolve into a comprehensive approach that supports the supply and demand aspects of health within the context of decentralization. A health sector strategy targeted for the district governments should clearly define setting of priorities for the use of public revenues, identify the weaknesses in the management of health services and pave way for possible reforms alongside improving the effective utilization of the available services. While providing essential services at the district level, it is also very important to maintain a watchful eye on whether the system is (as yet) capable to meet the expectations and desired standards in terms of quality of minimum level of health coverage to children in the district constituencies. The ability to meet the health care needs, demands and expectations of the people will be critical in realizing the legitimacy and stability of the devolution process.
Focusing on child health in Pakistan, three categories of health services deserve top priority in terms of policy attention. These categories are:
1. Maternal and child health services including family planning, pre- and post-natal care, deliveries by trained health personnel, and management of the sick child, especially for diarrhea, acute respiratory infections and malnutrition should be an essential concern for formulating any local government initiative. Poor women and children face the greatest threats to their health and typically have the smallest voice in health care decision-making. High levels of malnutrition and micronutrient deficiencies threaten their survival and the intellectual development of an entire generation. It’s therefore essential to maintain commitment to family planning, maternal/child health and nutrition, and other primary health care services at the local level. Greater priority should be given to in rural areas, where trained private health care providers are often not available.
2. Emphasis on health education, in such areas as nutrition, creating greater awareness of the links between proper spacing of births and the health of mothers and babies, stressing the importance of immunization and other preventive interventions, teaching basic hygiene practices, informing about early childhood diseases, and producing better health educated families.
3. Strengthening capacity of NGOs and local governments to plan and manage programs serving the special needs of children and control of communicable infectious diseases. They can help in providing or arranging for the provision of health care services in districts not adequately served by the existing infrastructure, with a strong focus on communicable diseases and maternal and child health. Financing should be a combination of government subsidy and user charges, but the poor should be exempt.
4. Any remedial strategy for the restructuring of the health sector
must keep all these priorities in view and seek to ensure
that quality and informed choice are instituted as hallmarks of the health
programs, implemented within a framework of child welfare.
1. It is difficult to make entirely applicable policy recommendations as no visible framework of a district educational strategy exists at the moment. However, it is undeniable that a resolute political leadership has to prioritise services for children like health and education and carry through whatever policy changes are appropriate to the present situation. Along these lines, some of the policy recommendations for improving a child’s access to better education are as follows;
2. The principle of universal, compulsory, high-quality basic education needs to be re-established and defended. However, Universal primary education in Pakistan is contingent on several factors, such as the existence of cost-effective schools, better curricula, and awareness among parents, especially in rural areas, of the importance of education. All of these issues need to be dealt with in the best possible manner while focusing on the aforesaid policy objective.
3. Another important reform is providing better support to, supervision of, and coordination of the school system at the district and provincial level. By making the district the key level for planning and management, state-level and central education bodies can focus more on policy-making, resource management and regulation. One way to do this is by promoting good principals and teachers at the school level to enhance the institutional capacity of district level organizations. The lack of sufficient manpower is the most serious problem at the district and sub-district level.
4. The balance between the genders in educational enrolment needs to be kept under review. At all levels the concern should be to ensure a commensurate share for females. The girl child has been the most effected by cultural norms/economic limitations, resulting in the educational deprivation of a large section of Pakistan’ female population.
5. Forging a link between education and development strategies should be the long tern view adopted. However, this can only be done through effective planning and management of educational policies at all levels. One component of such a strategy can be shifting the focus of the Curricula from disciplines to basic learning needs in specific communities. This approach should be realistically based in the light of the needs at the districts as well as the available resources.
6. It is necessary to encourage decision-making be based on educational, not political, considerations. At present, politicians hand out teaching jobs as patronage appointments. Federal and provincial funds provided for education sometimes remain unused, especially in rural areas, since feudal landowners are opposed to educating "their" people.
7. Pre-school programmes for children under 5 years of age will allow more attention can be focussed on children who are very vulnerable to the general effects of poverty. Pre-school registration can also bring along the benefit of direct social responsibility of the district government for their welfare. Introduction of the such programmes is also likely to improve the achievement of pupils at the primary school level.
8.
Implementation of special programmes
aimed at the indigenous sectors in the rural areas and according higher
priority in the provision of basic education to the out-of-school children,
females, rural population, inhabitants of tribal settlements and special
children. A more determined effort to get away from the institutional approach to
the education of disabled children is needed.
9.
The final necessary reform is to
expand the information and research base of education in Pakistan. Effective
management and administration of the education system depends on the quality of
the information system. Without reliable information, decision-makers cannot
improve education policy and programs at the national, district and school
levels. One way of collecting reliable information about the state of education
is to conduct standardized testing that measures student performance against
national curriculum goals. These can be used to compare learning achievement
across schools, districts and regions over time.
The involvement of representatives of civil society in a managerial or advisory role would help to ensure the relevance of local governments to the needs of society and the economy. This can be done by strengthening the participatory dimension as part of a strategy towards maximization of the roles of the family, schools, community, non-governmental organizations and the media in the provision of basic services.
The establishment of the Village and Neighbourhood Councils and the Citizen Community Boards is a distinct feature of the new local government set-up in Pakistan. However, it will take some time before they can be seen as fully operational. Their effectiveness depends, to a certain degree, on the existence of well functioning local administrations. Thus, interaction between civil society organizations and local governments will evolve over time. Local councillors will have to play a crucial role in the Mobilizing and organizing local communities.
In terms of services delivery, NGOs and civil society organizations tend not to suffer from the same performance problems as the public sector because of their smaller size and different organizational culture. Thus, in many instances, NGOs can be a very cost-effective channel for provision of government-financed social services. The government need not provide all it finances but networking between Government and civil society organizations is also important in the context of long term and especially donor supported programmes. Such networking may also bridge the vacuum which may be seen at some places due to the lack of capacity in district administrations. Also, genuine civil society organizations can be a useful support for playing the role of monitoring and evaluating institutions.
The civil society organizations should strive to function as a catalyst for change by introducing new ideas and new ways of doing things in the society. Some of the expectations from their role in the present set-up can be seen as follows:
1. Monitor arrangements to ensure that policies and programs for children are successfully carried out.
2. Undertake research, analysis and investigation into issues relating to children and disseminate widely the findings of such research.
3. Lobby for legislation, advocate the rights of the child and formulate specific legal provisions to solve child-related issues.
4. Take-up children’s issues with the concerned authorities, and urge them to take appropriate timely actions.
5. Encourage the government to set minimum ages for employment and regulate working conditions and protect every child from work that threatens his or her health, education or development.
6. Lobby the governments to make primary education free and compulsory and help establish and develop education institutions.
7. Mobilize public opinion for the rights of the child by influencing the mass media to disseminate information beneficial to the child.
The provision of all services related to children would be rendered more responsive and effective if community participation could be made an integral part of the functioning of the local governments. However, achieving sustained grass-roots community participation is difficult, it may be best to try different approaches through pilot projects first. It is recommended that the government expand its efforts to support the development of non-formal sector by encouraging those organizations that are capable of contributing to delivery of social services for children. .