AN APPRAISAL OF

SOCIAL SERVICES DELIVERY FOR CHILDREN

IN PAKISTAN

By

Mukhtar Aziz Kansi

IPF Fellow 2002-2003
TABLE OF CONTENTS

Abstract_________________________________________________________________________ 3

1. Country Context______________________________________________________________ 4

2. The new set-up under Local Government Ordinance 2001____________________________ 6

The Local Govt. structure at a glance_______________________________________________ 7

The Devolution process__________________________________________________________ 9

3. Evaluating the National Policy for Children______________________________________ 10

National Commission for Child Welfare & Development_______________________________ 10

Implementation of CRC__________________________________________________________________ 10

National Project for Rehabilitation of Child Labour______________________________________________ 11

Redesigning / Revival of District Based Monitoring System (DBMS)________________________________ 11

National Council of Social Welfare (NSCW)__________________________________________ 12

4. The Health Situation in Pakistan_______________________________________________ 12

Health Services Infrastructure and Use_____________________________________________ 13

Main features of the National Health Policy__________________________________________ 13

Coverage and utilization of preventive Services affecting children._______________________ 14

Immunization Program.__________________________________________________________________ 14

Maternal and child health services;_________________________________________________________ 15

Family Planning._______________________________________________________________________ 15

5. Problems and National Policies on Education for children in Pakistan________________ 16

Focus on the Girl Child: Tracing specific causes Of Low Enrolment______________________ 18

Pakistan's Educational Policy_____________________________________________________ 18

Early Childhood Care and Development:_____________________________________________________ 19

Primary Education______________________________________________________________________ 19

Madrassah Education___________________________________________________________________ 20

Female Education______________________________________________________________________ 20

6. Cross-Cutting Issues_________________________________________________________ 21

Building on Pakistan's Social Action Program Experience______________________________ 21

Fiscal decentralization and resource allocation for social services delivery_________________ 22

Children with special needs______________________________________________________ 22

7. Role of the Non- Governmental Sector___________________________________________ 23

NGOs________________________________________________________________________ 23

Citizen Community Boards_______________________________________________________ 24

Role of Religious Institutions_____________________________________________________ 24

Role of Mass Media____________________________________________________________ 24

Abstract

In Pakistan, the unfolding of devolution paradigm in August 2001 and subsequent switching over to decentralized functioning has posed challenges on many fronts including the question of whether the local governments would be able to efficiently deliver social services, especially those concerning children. This paper provides a back ground of the overall scenario of children and development in Pakistan, introducing the recent local government framework and discussing the new and existing problems that will confront the policy makers concerned with child welfare. An analysis of the health and education sector has been made along with an elaboration of the evolving role of the civil society in the context of post devolution realities.

It is certainly too early to comment on the overall impact of the devolution plan but as the Local Government social services delivery system takes root, it is an opportunity for integrating all the essential services concerning child welfare and protection in to elaborate institutional roles with well defined parameters of resource allocation, efficiency monitoring and achievement of positive outputs. Any coherent strategy for the restructuring of the children services sector would have to address all these broad areas, and seek to introduce reforms that are seen and appreciated as a long-term effort in this regard. The policy paper has been written with a view to synthesize and assess a number of ideas and suggestions for social sector reforms enabling children to grow up protected from poverty and ill health and in receipt of an education that maximize their potential. The ideas originate from a variety of sources, advocating for placing children in high priority at all levels of development planning.

1. Country Context

Pakistan is a federal state, comprising four provinces; Punjab, Sindh, North West Frontier Province (NWFP) and Balochistan, and some federal units which include District Islamabad, Federally Administered Tribal Area (FATA) and Northern Areas (FANA). The population density of the country is estimated at 156 per square kilometer. The country borders Iran on the West, India in the East ,Afghanistan in the north and north-west and the People's Republic of China in the north-west to north-east.

Pakistan's population growth rate of around 3 per cent is considered the highest in the South Asian region and poses multiple challenges, problems and threats to the country's limited resources and economic and social development. Thirty per cent of the country's populations live below the poverty line. Pakistan's GNP per capita in 1996 was US$ 490, but income is not equally distributed. The over-all literacy rate is estimated at 38.9 per cent: 50 per cent for men and 27 per cent for women. Pakistan spends 0.7 per cent of the GNP on health and 2.6 per cent of the GNP on education. Despite steady urbanization (37%), the economy is still dominated by agriculture, which accounts for about 25-27% of GDP and is the largest source of employment.

Children constitute 52% of the total population in Pakistan. Presently, there are 36 million children between the age group of 5 to 15 years in the country. Out of this, an estimated 11 million do not have access to schools, and of the total enrolled, 12 million dropout before completing the primary school. Accordingly there are 23 million children who either dropped out or are left out. As per UNICEF and WHO reports, it is predicted that with a population of 152.311 million (WHO) and fertility rate of 5.0 (UNICEF), Pakistan in the next few years is going to be the seventh most populous country in the world. The UFMR (Under-Five Mortality Rate) is used as the best indicator of progress and its impact on the well-being of children. In 1999, it was 117 per 1,000 live births that placed Pakistan at number 39 from the bottom in the international ranking, below Bangladesh's 53 and India's 49. Unless Pakistan could put the agenda for children welfare in the forefront of its national efforts the situation is not likely to improve.

It can be seen that inadequate physical facilities and infrastructure in view of a high population growth rate ; resources constraint, low participation and high drop out rates; female illiteracy; disparities and imbalances in gender and area; socio-cultural inhibitions and taboos against female have seriously undermined progress in the education sector as well. Feudalism, uneven development and official apathy towards social issues can all be seen as contributing factors to this scenario.

Pakistan signed the Convention on the Rights of the Child (CRC) some ten years ago. There are a few encouraging steps that can be cited as examples of positive developments like the enactment of legislation for protecting working children and youthful offenders. Also, there are many programmes in the government as well in the private sector with the assistance of international donor agencies that directly target issue of immediate concern. i.e. the ILO’s IPEC programme on child labour. The federal cabinet has recently discussed and gave serious consideration to enforce the National Plan of Action on the Elimination of Child Labour. Pakistan’s Constitution also enshrines a national policy for promoting the interests of the child. Article 35 of the Constitution binds the State to “protect…. the mother and the child” and Article 37 lays down commitments for promoting social justice and eradication of social evils. This includes removing “illiteracy and providing free and compulsory secondary education” and “… ensuring that children and women are not employed in vocations unsuited to their age or sex….”

The welfare of Children anywhere in the world depends a lot on the effectiveness of state policies for poverty eradication and economic stability. However, realistically speaking, Pakistan's performance with regard to social development has so far been disappointing. During the 1990s, Pakistan was faced with growing macroeconomic imbalances, declining economic growth, and rising poverty. The events following 11 September had a major adverse impact on Pakistan's fiscal and external balances that threatened to jeopardize the progress made in stabilization and structural reform. While the recent progress of reforms has been encouraging, much needs to be done to bring Pakistan's social indicators on par with other countries with similar levels of per capita income. In the early nineties, Pakistan launched the Social Action Program (SAP), with broad-based external support, to address its poor social indicators. However because of weak governance and declining public expenditures, the SAP failed to achieve the targeted improvements in the social indicators.

Due to similar experiences, effective and participatory Governance had clearly emerged as Pakistan's foremost Development concern. The present Government has committed to ongoing reforms in the form of a new local government framework introduced in 2001 (to be elaborated later in this paper) to restore the legitimacy and performance of all institutions concerned with political, administrative, judicial, and social services delivery. The Government's governance reform agenda covers three key areas:

(i) Improving the public financial management system, public accounting and auditing functions, civil service, and tax administration;

(ii) Enhancing effectiveness of delivery of basic public services through a comprehensive devolution plan; providing access to justice, and reducing vulnerability of poor through legal, judicial, and police reforms; and

(iii) Tackling corruption by reducing incentives for it through privatization, deregulation, tariff reduction, and tax system reforms; and establishing an effective anticorruption agency as a deterrent.

However these reforms have been opposed by powerful status quo vested interests; the severe fiscal constraint puts additional restraints on the reform agenda. Despite this, the current trend in national policy making suggests readiness to confront the issues that eluded the country since independence.

2. The new set-up under Local Government Ordinance 2001

On 23 March 2000, the Government of Pakistan announced far-reaching reforms in the area of decentralization. This far-reaching Political Devolution and administrative Decentralization Plan is seen as one of the boldest governance reforms ever undertaken by a developing country, the Program involves the restructuring of federal, provincial, and local governmental relations.

Subsequently, local bodies elections were held in all provinces, and the new local government system is now in place for more then an year.. This system is based on devolution of political power, decentralisation of administrative authority, de-concentration of management functions and diffusion of the power authority nexus aimed at ensuring the safeguard of the genuine rights of the citizens. Efforts have been made under the new system to create an enabling environment for the public to participate in determining their own destiny.

The District has been selected as the main pillar of the new system of local governments. This political decentralization has given district administration a certain degree of autonomy by measures of fiscal decentralization. In this regard certain functions of the Provincial government have been decentralised to the lower levels of District, Tehsil and Union Council and these Councils have been assigned new roles and responsibilities.

The most significant change that LGO2001 brings to governance in Pakistan is placing the elected Nazim as the administrative manager of a local body. Never before in Pakistan’s history have elected local representatives been given the authority to direct the activities of government bureaucrats. In the past the key government representative at the local level, the Deputy Commissioner (DC), was the de facto head of the local councils. He was also the chief magistrate and the controller of the police. The police now report to the elected leader and a Public Safety Commission will be created for oversight. LGO2001 is actually replete with checks and balances operating at many levels. Nazims can request the removal of DCOs and Police chiefs. Councils can vote for the removal of Nazims. A Chief Minister can suspend a Nazim and remove him completely with a majority of the Assembly. The system appears cumbersome, and possibly fraught with potential for misuse, but it is a far cry from the old systems where whomever got to the top ruled the pile without question—until he was knocked off. This will be an interesting aspect of the process to observe, especially with regards to women and children’s protection.

Numerous other innovations have been included in this one policy, as follows:

(i) Removal of the district administration system, one of the last holdouts of the colonial order;

(ii) Placing locally elected leaders in charge of out-posted bureaucrats;

(iii) Providing local councils with the right to obtain information on departmental operations and to sanction non-performance;

(iv) Allowing properly registered citizen groups to gain direct access to a proportion of the local councils’ development budgets;

(v) Creating a ‘municipal’ entity responsible for maintenance and development of basic municipal services such as water, sanitation, streets, lighting, parks, and business regulation.

(vi) Enhancing effectiveness of delivery of basic public services through a comprehensive devolution plan

The Local Govt. structure at a glance

 The local government structure is now composed of 97 Districts. Each District has been divided into Tehsils which are further divided into Unions. The number of Unions in a District is a function of population. Certain Districts have been classed as City Districts where certain population density and development criteria are met. Initially, however, only the provincial capitals have been classed as City Districts, with others to be named later.

Districts

The District Government has a District Chairman as its executive head. The District Chairman are assisted by provincially appointed District Coordination Officer and a District Police Officer. The DCO is the replacement of the District administrator. This post does not have any of the executive authority of the latter. The District Administration has been divided into a maximum of 12 groups of district departments and offices

District Council

The District Council is comprised of the Union Chairmen of the entire district. It is convened by the Vice Chairman of the District, his sole function. One of the interesting new roles of the Council is that members of the Council are to sit on district monitoring committees for each department to evaluate its performance.

Tehsil/Town

The Tehsil is headed by a Chairman who has been selected by all the Union councilors of the Tehsil. The Tehsil administration does not have independent offices for most of the local government services. With few exceptions, these are implemented as district functions through out-posted Deputy District Officers. However, there are four significant functions that fall under the Tehsil’s responsibility :

(i) Municipal services

(ii) Municipal infrastructure

(iii) Sewerage, drainage, solid waste management, roads and street, street lighting, parks

(iv) Rural-urban planning/land use and building control

Importantly, all water and sanitation agencies have been placed under the control of tehsil/town municipal administration. Never before has water supply be managed by a local entity, accountable to local leadership.

Tehsil Council

Monitoring committees for the specific Tehsil functions are to be formed by the Tehsil Council. The council is made up of the Vice Chairmen of the Unions of the Tehsil and is convened by the Vice Chair of the Tehsil.

Unions

The Union Chairman is the only directly elected leader in the local government structure. This makes this position potentially important for donors that choose to focus on strengthening participatory local governance.

Much of the purpose of the Union Municipal administration appears to be to manage the inter-village municipal infrastructure. The drafters of the law have been careful not to place too great an administrative burden on the lower administrative levels. However, they are expected to identify gaps in delivery of services by the higher authorities and to make recommendations. In order to build greater linkages into the system, the Union is specifically required to cooperate with public, private or voluntary organizations engaged in activities similar to those of the Union.

Citizen Community Boards

These are totally new entities in civil society that can access government resources. Once established they can be empowered by law to:

·               Monitor a service provision facility

·               Develop a new project or existing facility

·               Manage a service providing facility

·               Monitor a specific elected institution of local government

On paper at least, the Citizen Community Boards appear to be excellent entry points for enhancing citizen ‘voice’ in governance. The Monitoring Committees of each Council will be made up exclusively of Councilors. The CCB, on the other hand, have the potential to be truly citizen watchdog committees. To date, only a few CCBs have been formed, but the Government is in the process of creating a supportive mechanism to assist in their development.

The Devolution process

 The devolution policy is fundamentally based on the principle of subsidiarity. The Government leadership has stated this clearly and repeatedly. This concept simply means that the local authorities will have the authority and responsibility to address all problems that are, in their determination, within their ability to solve. They may, of course, request assistance from the Government, if necessary. In recent years many governments around the world have initiated devolution plans, but few have elected to undertake such a radical and immediate power shift. The Government of Pakistan appears certain that such a move is required to break the country out of the long-term deterioration of public services and quality of life.

The current devolution experiment has perhaps the greatest potential for introducing systemic change into Pakistan’s governance framework. The Government's ambitious governance reform agenda is at the core of its strategy for reviving growth, reducing poverty, and accelerating social development. In some areas, such as devolution, public expenditure management, anticorruption etc. appreciable progress has been made. In others, such as tax administration, the justice system, the police, and the civil service, the process is at a relatively early stage. However, for the success of the proposed development agenda to succeed, the need to consolidate the reforms in the first category is critical as is accelerating the process in the second.

At the present time, it is impossible to predict what the long-term impact of devolution will be on the delivery of social services. Despite the radical shift in political philosophy at the top, the districts will still be staffed by personnel from the provincial cadre and will receive the bulk of their financial resources from the provincial treasury. However, unless either the new local politicians try to capture all public goods for their personal gain or the provincial bureaucracy attempts to totally subvert the process, one should not expect to witness a further deterioration in the quality of public goods and services delivered at the local level in most local jurisdictions.

3. Evaluating the National Policy for Children

In order to understand the various initiatives taken by the state in Pakistan to promote the interest of the child, we will look at the structure and scope of functioning of two institutions of significance that deal with the formulation and implementation of child related policies in Pakistan. It may be noted that these institutions have not came up with any innovative strategies so far to match up with the devolution process. However, the description on their scope of functioning and priorities would give a clearer idea on the policy direction of the state on child welfare.

National Commission for Child Welfare & Development

On 16th December 1980, the Government established National Commission for Child Welfare and Development (NCCWD) to pursue the following objectives:

1. To formulate a National Policy for Child Welfare and Development in the Country
2. Promotion and integrate social welfare and child protection in the programmes of relevant Government departments.
3. Facilitate and encourage participation of civil society - organizations in social welfare programmes to share responsibility with the Government
4. To assess the impact of the constitutional, legal and administrative provisions having bearing on welfare and development of children and suggest measures to provide full opportunities for their complete growth.
5. To formulate legislation to deter the child abuse in all its forms, including physical violence, child mutilation, exposure to drugs, child labour and protection to children who are handicapped (mentally or physically) or otherwise in need of social protection and services.

A number of programmes have also been initiated by the NCCWD in order to facilitate child's well being. Some of them are as follows:

Implementation of CRC

Pakistan ratified the Convention on the Rights of the Child (CRC) in November 1990. In this regard the National Commission for Child Welfare and Development (NCCWD) undertook various activities in collaboration with Provincial commissions for Child Welfare and Development (PCCWDs) and NGOs. After ratification, the objectives of NCCWD were revised to ensure implementation of various provisions of UN CRC. The NCCWD initiated the following processes for effective implementation of the CRC in the country.

1. Review of national laws and enforcement of CRC through legislations;
2. Monitoring the violation of child rights;
3. Reporting to the UN Committee on Rights of the Child on the implementation of the CRC;
4. Disseminating information on the CRC and educating public on the subject.
5. Review of National Laws and Enforcement of CRC through Legislation

National Project for Rehabilitation of Child Labour

Child Labour is essentially an outcome of poverty, which persists due to social and economic stratification. It is nationally viewed, as a scourge for children. It is estimated that approximately 3.3 million children are working. Steps have been taken to initiate comprehensive programmes to retrieve children from early labour/ work in collaboration with international cooperation agencies and NGOs and Successful bilateral projects in the private sector have been undertaken under the auspices of IPEC, like soccer ball project in Sialkot. Also, various other administrative measures to provide child with basic educational training, health care, recreation and financial incentive to the family of a working child to combat poverty and economic exploitation of the child.

One such achievement is the establishment of National Project for Rehabilitation of Child Labour by Pakistan Bait-ul-Mal. In this project 51 Centres for rehabilitation of child labour have been established in the areas where child labour concentrates. Recently the Government has also approved a National Policy and Plan of Action to Combat Child Labour. The primary concern of this plan is to promote basic education, skill development and concentrate on personality building of all children. The main theme of this plan is the strategic approach the focuses on rehabilitation activities, child care and child development. The NCCWD developed NGOs statement regarding policy and action plan to combat child labour for incorporation in the national document. In this regard NCCWD organized divisional, provincial and National Consultative workshop in which about 700 NGOs were participated.

Redesigning / Revival of District Based Monitoring System (DBMS)

It was felt that government's efforts were not reflected in true spirit due to lack of coordination between Federal and Provincial Departments. The policy initiatives taken by the Government either at Federal and Provincial levels required a bridge for consolidation and compilation of all material and information at grassroots level. Various solutions to this problem were raised on different forums. The DBMS was launched with a view to fulfill the standards expressed in provisions of the CRC.

The system has been developed with an objective to collecting information from the grass root at the district and community levels from all Districts of Pakistan. On the basis of this experience the NCCWD is revamping the DBMS in collaboration with the new district governments. In this regard a revised methodology of the system is under consideration, to keep up with the new scope of functioning for a national institution in the post devolution era. In this context, the NCCWD plans to initiate the service delivery system at the grass roots level for welfare and development of children including play grounds, juvenile courts, and child care centres and children libraries.

National Council of Social Welfare (NSCW)

The National Council of Social Welfare (NCSW) consists of official and non-official members i.e. Public Representatives, Public Servants and NGOs. The underlying idea of the establishment of the NCSW is to take into consideration the heavy demands on the limited sources of the Government and to meet the pressing needs of the Socio-economic development of the country by motivating and mobilizing the the private/voluntary sector through a financial and technical assistance programme.

The scope of functioning of the NCSW includes:-

· To render advice to the Federal Government on all social welfare matters such as formulation of social welfare policy social welfare planning, social legislation, social work education and training, youth welfare family and child welfare and to review on going social welfare programmes to submit reports to the Federal Government.

· To stimulate the work of voluntary social welfare agencies and to render financial and technical assistance to deserving registered voluntary social welfare agencies.

· To coordinate with the Provincial Social Welfare Councils and Punjab Social Services Board at Nations level in the development of the voluntary social welfare programmes in the country.

· Training of NGOs in capacity building, institutional strengthening and Community Development / Women Development.

· To create social awareness about social policies, social problem/evils social welfare activities in the country by holding seminars, workshops, conferences and through other mass communication media.

4. The Health Situation in Pakistan

The health of the population in Pakistan has improved in the past three decades, but the pace of improvement has not been satisfactory. Today, Pakistan lags well behind the averages for low-income countries in key indicators, including infant and child mortality and the total fertility rate. Thus Pakistan is still at an early stage in the epidemiological transition, with basically preventable or readily treatable diseases affecting primarily young children and women of reproductive age accounting for a dominant share of mortality and morbidity. Poor health status is in part explained by poverty, low levels of education, the low status of women in large segments of society, and inadequate sanitation and potable water facilities. But it is also related to serious deficiencies in health services, both public and private.

Health Services Infrastructure and Use

The health services delivery system in Pakistan is a mix of public and private providers. In the public sector, provincial, federal and some local governments operate tertiary care hospitals in the larger urban areas. In rural areas and smaller towns and the provincial governments operate an extensive infrastructure of first-level care facilities and secondary care hospitals, supported by several federal programs. The government is by far the major provider of hospital care in rural areas, and it is also the main provider of preventive care throughout the country. The Ministry of Population Welfare operates its own network of family welfare centers for the provision of family planning services.

The private health services sector is dominated by more than 20,000 "clinics", the small, office-based practices of general practitioners. Other private sector facilities such as dispensaries, maternity homes and laboratories also tend to be small. There are also more than 500 small and medium-size private hospitals with about 30 beds per hospital on average. NGOs working in the health sector are small in number and, for the most part, in size, and that they are heavily concentrated in urban areas. A notable exception is the Aga Khan Health Services program, which has been successful in implementing its community-oriented primary health care model in two districts of the Northern Areas. There is also a low levels of utilization for Basic Health Units, Rural Health Centers, Tehsil Headquarters Hospitals, and District Headquarters Hospitals.

Main features of the National Health Policy

The National Health Policy places strong emphasis on:

1. Decentralization and the development of district health systems;
2. The establishment of district health authorities, with broad representation from government, health professionals and community leaders, to supervise the district health management teams and decide on resource allocation within their districts;
3. The promotion of active community involvement in supervising and assisting government health facilities;
4. Bringing about better coordination between government health services and NGOs, and providing funding for selected NGOs and community-based organizations for the provision of health services;
5. Granting a much greater degree of autonomy to district headquarters hospitals;
6. Further reducing gender imbalances in staffing;
7. Broadening the system of health insurance;
8. And introducing a mechanism for the accreditation of private hospitals and clinics.

In the areas of basic health and welfare, the most significant aspect of the current policy is that of child survival and development. To follow this, the government has launched a number of programmes. The programmes include the Expanded Program of Immunization (EPI), Control of Diarrhoeal Diseases (CDD), training of lady health workers (LHWs) and traditional birth attendants (TBAs) and a comprehensive nutritional programme. Similarly legislative measures have been taken to provide better health care facilities. The Government has already passed a law on the use of iodized salt and expects shortly to enact legislation on breast feeding, maternity benefits [amendment bill], juvenile smoking and food fortification. Awareness campaigns on primary health care services and family planning are being carried out through print and electronic media.

Some of the other priority health programs in this context that are specified in the National Health Policy include the Expanded Program of Immunization, the Prime Minister's Program for Family Planning and Primary Health Care, Maternal and Child Health, Reproductive Health, Acute Respiratory Infections and Diarrhoeal Diseases Control Programs, Malaria Control Program, Tuberculosis Control Program, AIDS Control Program, Nutrition, Mental Health, Oral and Dental Health, Health Education, and School Health Programs.

Coverage and utilization of preventive Services affecting children.

Although the situation has improved in recent years, preventive services have had a low priority in Pakistan. An indication of this low priority is the fact that recurrent expenditures of preventive services are financed to a large extent from the Development budget rather than the Current budget. The main preventive programs in Pakistan include:

(1) Immunization;

(2) Maternal and child health services;

(3) Family planning; (in coordination with the Prime Minister's Program for Family Planning and Primary Health Care).

Immunization Program.

The expanded program of immunization (EPI) includes vaccination for young children against measles, diphtheria, tetanus, polio and tuberculosis. It also includes vaccination against tetanus for pregnant women. Vaccination in the public sector is provided through a combination of vaccination in static health facilities and outreach vaccinators (operating out of static facilities or in mobile teams). The most recent comprehensive estimates of immunization coverage for children are from the 1995/96 PIHS. Nationwide, according to this survey, 78 percent of children 5 years and younger have had at least one immunization (up from 70 percent in 1991, i.e., as compared with the 1991 PIHS). The percentage of children 5 years and younger who are fully immunized against the above listed six diseases was only 54 percent in 1995/96, however (up from 25 percent in 1991). Immunization coverage against tetanus toxoid of childbearing age women was only 14 percent in 1995 according to Ministry of Health estimates.

Maternal and child health services;

In addition to immunization, other preventive services for mothers and their children include prenatal care, supervised deliveries, growth monitoring, nutrition education, and health education (e.g., to teach mothers to recognize serious common diseases in young children). The government health sector still gives maternal and child health services much less priority than they deserve. Of 134 rural health facilities sampled, one-third did not have any female staff --a precondition for provision of effective maternal and child health services. An earlier survey of 89 randomly selected rural health facilities nationwide showed that, among other findings: (a) only 8 out of 89 facilities were doing growth monitoring of children; (b) nutrition education and demonstration sessions were reported in only 10 facilities; (c) 34 facilities were not providing any maternal and child services because of non appointment of a Lady Health Visitor; and (d) only 33 facilities maintained records of providing antenatal care.

Family Planning.

The government health sector has also failed to make family planning services widely available. As noted above, many rural health facilities do not have any female staff, which is a precondition for provision of family planning services. And the proportion of health facilities not yet providing family planning services is still high. Recent surveys also suggest considerable unmet demand for family planning. Availability of family planning services has improved in recent years with the deployment of the Lady Health Workers. The Government of Pakistan is a signatory of the Cairo Declaration which followed the International Conference on Population and Development (ICPD) of 1994. The ICPD program of action aims to ensure that all couples and individuals have access to an appropriate range of services to protect reproductive health. In line with its commitment to implement the ICPD program of action, the Government is in the process of planning and implementing a number of reforms.

A broad overview of the system of health services suggests that it suffers from many weaknesses that impair their efficiency, quality and impact. The most important include insufficient focus on preventive interventions. This is reflected in the unsatisfactory coverage of immunization, maternal and child health services, and family planning services. Health education programs are also poorly developed. Another weakness is excessive centralization of health services management in all of its phases (planning, implementation and monitoring) and aspects (personnel, finances, and supplies). Most managers have little control over resources and real management decision making rests far away from the delivery of services. This particular aspect is likely to be addressed as the new framework of decentralized governance is evolving, with an emphasis on improved social services delivery.

5. Problems and National Policies on Education for children in Pakistan

The country’s education system is among the most deficient in Asia, reflecting the traditional determination of feudal-dominated ruling elite to preserve its hegemony and, to a lesser extent, the two- decade-long mushrooming of Madrassahs (Islamic schools). With no school fees and free boarding and lodging, Islamic schools are particularly attractive for poor families. The official literacy rate of 46% breaks down into a male/female ratio of almost 2:1; and female illiteracy was at 71% in 1998. There are substantial urban and rural gaps, as well as gender gaps. To some extent these dismal results are due to insufficient public spending, but poor governance also played a major role.

Major issues and problems confronting basic education in Pakistan, which are yet to be resolved can be identified as:

(i) Inadequate physical facilities and infrastructure in view of high population growth rate of 2.6 percent;

(ii) Resource constraint, low participation and high dropout rates;

(iii) Adult illiteracy, especially female illiteracy; disparities and imbalances in gender and area,( females, rural children and children in urban slums being the most disadvantaged segment of population);

(iv) Socio-cultural inhibitions and taboos (though removed considerably yet still existing) against female education; economic barriers, such as, poverty and high opportunity cost;

(v) Insufficient political commitment in addition to persistent political instability;

(vi) Inconsistencies in education policies and programmes;

(vii) lack of teachers competency, low motivation and commitment;

(viii) Partly non-relevance of curricula to the needs of the learners and the community; Over centralization and inadequate level of local capacity to programme formulation, institutional management and evaluation;

(ix) Lack of integrated planning and coordination amongst organizations and institutions from different sectors of society;

(x) Ineffective assessment, monitoring and evaluation system especially for quality improvement.

The quality of public education is also very poor, and school leavers are often functionally illiterate. The main problems stem from poor quality of leadership, massive political interference in human resource management and school site selection, lack of local government accountability and demand responsiveness leading to teacher absenteeism, low operating budgets that resulted in poorly maintained physical facilities and lack of teaching materials. In this context, Underfunding is also a crucial problem. Households are bearing an increasing proportion of the costs of schooling, direct and indirect, legal and illegal. As a result, both equity of access and educational efficiency tend to be threatened. The decentralization and deconcentration of financing and governance of educational institutions may bring about unclear consequences for equity and efficiency. The surfacing of so-called "ghost" schools and teachers, which only exist on paper, is a one example. Budget flows were strictly top-down from central government to local government, while central government staff was seconded to line ministries. The education system has witnessed an expansion of private schools, which are now attended by about 40% of children living in urban areas.

Enrollment in private primary schools is now in the order of 28% of total enrollment (14% in 1991), and in secondary level private schools at 17% (8% in 1991). Educational enrolment and achievement in Pakistan were still at alarmingly low levels, there is a need for governments and donors to increase their commitment to primary education. Also, the effects of basic education on public health and fertility are particularly strong for girls. Because female education is in a much worse state than male education in Pakistan, the social returns to improvements in female education ought to be particularly high. A World Bank led international donor consortium helped the Government design and implement a two-phased Social Action Program in the 1990s, to improve social sector service delivery. Improvements were tracked in the early 1990s (enrollment increasing from 65% to 70%), but stagnated at 69% thereafter.

An analysis of the recent policy trends show that the government has recognized the importance to provide universal basic education to children. The new local government set-up in the post decentralization era must maintain its focus on the provision of basic education as an essential component of a comprehensive child welfare strategy. Basic education gives very high social returns: better public health, lower fertility, and higher productivity of the population. In this context, the government has resolved to eliminate illiteracy from the society and stands internationally committed to universalize Basic Education for all children, youth and adults under the Pakistan 2010 programme, which also focuses on basic education for all. Resources for primary education in the development budget have doubled, and these increases in development spending (strongly encouraged by donor funds) have led government to triple recurrent spending in real terms in 10 years. Enrolments have risen somewhat but still fall well below those in neighbouring countries, and the quality of education has emerged as a major problem. Many parents feel the effort of educating children is not worthwhile because quality is so poor. If quality could be improved, more children would attend school, their achievement would improve, and the system would function better and give a greater return on investment.

The government, backed by donor funds, have generally sought to increase inputs that are in short supply (such as teacher training and textbook development). The governments have also, to some extent, tried to enhance educational incentives for girls (by providing scholarship programs, free textbooks, and hostels for female teachers, for example). Large donors such as the World Bank, USAID, and the Asia Development Bank have also supported the construction of school buildings. A recent examination of the expenditure program found that, although government projects have increased the resources devoted to educational inputs, the composition of government's own expenditure program in education has not changed much in the past four decades. Expenditures have often been inefficient and supply-driven; educational outcomes and perceptions of beneficiaries about the services provided have received little attention.

Focus on the Girl Child: Tracing specific causes Of Low Enrolment

Some of the basic causes of low enrolments of girls at all levels of education and continuing large male-female differentials in literacy and participation rates, as identified by different research studies and groups of experts are as follows:-

(i) Poverty, illiteracy and conservatism of the parents generating negative attitudes against the education of girls.

(ii) Demand for separate girls schools and lack of adequate financial support.

(iii) Non-availability of qualified and experienced female school teachers and neglect of basic physical facilities for female schools.

(iv) Lack of incentives for girls to attend schools and teachers to take up teaching duties with commitment and devotion couples with apathy of the community and ineffective supervisory system.

(v) Inhibiting role of uneducated mothers and severe attitudinal barriers to girl’s education in the rural and tribal areas.

(vi) Non-existence of a girls primary school or availability of a school at an inaccessible distance.

(vii) Heavy population growth-rate and burden of house hold work in large families on the female children.

(viii) Poor impact of non-governmental organisations on the motivation of parents and girls.

Pakistan's Educational Policy

The Government has begun a major initiative to devolve power and responsibilities, including those related to social services, from the federal and provincial governments to elected district level authorities and local councils. Within this context, the Federal Minister of Education has been successful in building a partnership with provincial education ministers, in articulating reforms and strategies to implement them. The Government has formulated an Education Sector Reform Action Plan, to be implemented by provincial and district governments, which, however, often lack administrative and budget management capacities.

The New National Education Policy aims to double the literacy rate, universalize primary education, replicate the non-formal schools to reach the un-reached, widen the learning time by reducing school holidays, improve the assessment system through introduction of National Testing Service, and initiate the decentralization process through the formation of District Education Authorities.

An evaluation of some of the relevant policy targets is as follows:

Early Childhood Care and Development:

There is a growing realization in Pakistan regarding importance and significance of early childhood education and training. Even then neither any clear cut policy nor quantifiable goals and targets could be set in this area. In order to cater the educational/learning needs of 3-5 year age group children pre-primary education classes under different denominations such as Katchi Class, Nursury and Pre-nursury, Kindergarten I and II etc. are introduced and managed in some of the schools unofficially. 1992 Education policy is silent about pre-primary education. however, in the current education policy i.e a clear cut policy provision has been made saying that Katchi class will be introduced in formal schools but again no target/goals have been fixed.

Primary Education

Primary Education shall be made compulsory and free so as to achieve universal enrolment by the end of the decade. Special measures will be adopted for improving the quality of education. The minimum norm will be two-room primary schools with five teachers. In due course of time, primary education will be transformed into basic education (elementary education extending to class VIII). Education Foundations will be established in each Province, and at the Federal level, for development of education in the private sector. The main purpose of these foundations will be to facilitate and encourage the private educational institutions especially rural schools through giving them grants and loans to fill the gaps in their educational budget both recurring and development. The foundations may also open and operate the schools in remote and rural areas where needed. They will also implement public-private partnership scheme. The foundation will be governed by the Board of Governors where members will be taken both from public and private sector. Managing Director to be appointed by the government will be the administrative head of the foundation. The reform of curricula and examinations, crucial for this purpose, still has a long way to go. Shortages of textbooks are still common, especially in the rural areas. Teachers are often in need of re-orientation. In general very few schools have computers, and and the involvement of parents in schools is low.

Madrassah Education

Madrassahs are religious educational institutions located in almost all the parts of the country both in rural and urban areas. Statistics on these institutions are presently not available. Madrassahs focus on Quranic education and Islamic Teachings. Some of these religious institutions give education in other than religious subjects and disciplines as well. Most of them are degree awarding institutions. However, at present there is no close link amongst Madrassahs and modern educational institutions. The National Education Policy also envisages to integrate both the systems of education by introducing uniform standards through registration, standardization of curricula and examination system, equivalence of qualifications etc.

Female Education

Female education has been assigned the top priority. A number of policy measures and programmes for basic education of females have been initiated which include introduction of mixed schools; provision of basic facilities and services in female primary schools in terms of boundary walls, lavatories, stipends, free books and uniforms and food; and reservation of 60% female seats in primary schools under SAP. Besides, in order to ensure availability of female teachers, 70% positions of primary school teachers have been reserved for females.

The Prime Minister's Literacy Commission (PMLC) has been entrusted the assignment of accomplishing task of promoting effective and non-formal basic education approach. As per the enhanced programme the PMLC would open 75,000 new non-formal basic education schools by the year 2002. Moreover, the "Compulsory Primary Education Act" will be slightly amended and enforced by the Provincial Governments in letter and spirit.

The Education Sector Reform is designed as a comprehensive sector-wide program that seeks to increase access, and enhance quality and equity at all levels of education. It focuses on devolution/ decentralization to improve governance, addresses quality and systemic issues such as curricula reform, resource allocation and mobilization including tying federal funds to education outcomes, teacher training, girls’ education, national education assessment, the setting and monitoring of national targets, mainstreaming Madrassahs, expansion of literacy programs as well as non-formal, and higher education programs. It also seeks to strengthen public-private partnerships in service delivery, and develop mechanisms to streamline school governance, citizens community boards, and School Management Committees, with the latter to be given responsibility for some elements of monitoring and supervision of teacher performance.

The real impact of the new policy needs to be seen in terms of the provisions which would be translated into actions; targets supported by correspondingly proportionate allocations in the annual budgets; implementation of the restructuring proposals and pledges through appropriate institutional mechanisms; and effective participation and involvement of local communities through decentralized management of schools by parents, local leaders, and ordinary citizens at the local district and village levels. As a key implementation benchmark, the federal government is to launch the National Assessment, where respective assessments are set for 2004.

6. Cross-Cutting Issues

Building on Pakistan's Social Action Program Experience

In 1993, the Government of Pakistan, acknowledging the poor social status of its citizens, initiated the Social Action Program (SAP) to improve basic social services-elementary education, primary health care, population welfare, and rural water supply and sanitation. An aid consortium including Asian Development Bank, Department for International Development, the Netherlands Government and the World Bank supported the first phase of the Social Action Plan (1993-1997), and were joined by European Union in the second phase (1997-2002). The first phase mainly aimed to increase sector financing and monitoring and evaluation, while the second phase, based on what was learned in the first phase, placed more emphasis on policy development, governance, and capacity building.

The SAP was successful in terms of putting the social sector on the priority agenda of the federal and provincial governments, building capacity at these levels, and improving planning and evaluation. The SAP helped increase girl's education, and health and family planning services, often in combination with private services. However, because of the growing macroeconomic crisis, public expenditure on education, health, and population after increasing to 2.7 percent of GDP in the mid-1990s, declined to 2.1 percent of GDP in FY2001. The Government and external assistance agencies did not fully anticipate the serious and entrenched neglect of public social services and how difficult it would be to improve implementation and efficiency. Social sector development requires a social transformation and a radical change in the way social services are managed, with full recognition of the roles of communities and the private sector.

As the new local government system takes root in Pakistan, it is an opportunity to utilize the good and bad experiences of the SAP in the services delivery sector. A more recent initiative is worth mentioning in this context. In Nov 2002, the Asian Development Bank (ADB) announced its support to Pakistan's devolution program, through a package of loans approved totaling US$300 million equivalent. The Decentralization Support Program will support the development of democratic, accountable, and the transparent delivery of local government services besides improving access to justice, political representation, and gender equity. It aims to achieve this through a series of policy, legal, technical, and fiscal reforms to improve accountability, efficiency, and delivery of central and local government services, especially in health and education.

Fiscal decentralization and resource allocation for social services delivery

Fiscal decentralization in the new local government set up is taking place at two levels. First, the National Finance Commission (NFC) must apportion the national revenues between the federal departments and the provinces, including a fixed allocation among the four provinces. As per NFC Award 1996, all federal taxes/excise duties were sharable between federation and provinces at the rate of 62.5% and 37.5% respectively. The provinces share (i.e. 37.5%) is distributable amongst the provinces on the basis of population (i.e. Punjab: 57.88%; Sind: 23.88%; NWFP: 13.54%; and Baluchistan: 5.30%). The direct tax constituted 31.8% (with income tax contributing major chunk to the extent of 31.6%) whereas the indirect taxes share was 68.2% (with sale tax being the major contributor at39.3%).

Subsequently, there is a fiscal transfer under the supervision of a Provincial Finance Commission to the districts. The Provincial Finance Commissions were only established in June 2002 and the allocations have recently been worked out for provinces but it will take sometime before a clearer formula comes through in this context. However, apart from this source, the possible measures available for enhanced resource mobilization in districts includes better tax management, review and reform in tax recovery system, broadening the tax base through revision of tax rate, exploring new tax avenues and elimination of tax exemptions/rebates. Under the new system, all tax collecting agencies were under the administrative control of the district government in the new set up. The districts need to computerize the tax record and monitor vigilantly the monthly tax recoveries to earn more revenues.

The Annual Development Programme made in coordination between the Tehsil and District governments, happens to be the key instrument/document for the implementation of development strategy and undertaking of public sector outlays. Participation is seen an essential cross cutting theme in the context of post-devolution scenario in Pakistan. It can be defined as a voluntary process by which people, including the disadvantaged, influence or control that affects them. The new era of decentralized financial management must conform to this approach as this provides families and communities an unprecedented opportunity to take responsibility for improving their own destiny. It will be encouraging to see an active role being played by the community organizations, women councillors and those sensitive to gender/children related concerns to promote their interests in the formulation of development plans as well as in the process resources allocation for education, health and nutrition services delivery – all effecting children directly.

Children with special needs

The UN Convention on the Rights of the Child calls for every mentally and physically disabled child to receive schooling “conducive to the child’s achieving fullest possible integration and individual development”.

The provision for education is not yet fulfilling the needs of the population.

Similarly, the provisions for special need children are also not sufficient, and a lot of development in the area of professional development, curriculum building, and team working has to be made. In Pakistan, special education is extended as a separate setup in special schools away from normal schools. Normal education institutions work separately while the special education institutions serve special needs children in a separate setting. Special education is an item of least priority of the Government. Because the economic conditions of the country does not allow which limits financial support for the provision. The children in cities are availing good educational provisions while the children in rural areas are hardly getting civic facilities of life. Educational provisions are being extended to these children but on a limited scenario.

Special Education support is almost non available for children in rural areas. The provision of inclusive education for the special needs children is also being popularized by the Government but it is not being welcomed by the professionals and the society. The set up of special education is mainly governed by the Non-Government organizations though Government of Pakistan ahs also established some special schools throughout the country.

The problem of disabled children in the country has also been brought to the forefront in some policy initiatives.. The Directorates of Special Education have been established at the federal and provincial levels with 49 institutions run by the federal government, 92 operated by provincial governments and 135 by NGOs. These are providing services to special children all over the country. There are also specialized institutes for early detection, prevention and rehabilitation of hearing impaired, mentally retarded, physically and visually challenged children. This is indeed impressive progress for a country which had only two schools for the blind at Independence in 1947.

7. Role of the Non- Governmental Sector

NGOs

Civil society has been attempting consistently to raise issues facing the children of Pakistan. During the last decade, it has succeeded in bringing to public debate several issues particularly those relating to child labour and juvenile justice. The NGOs have not only highlighted these questions but have also presented in many instances low-cost, workable and practical solutions and policies. In the recent past, NGOs have raised the issue of juvenile prisoners. In addition to this, a large number of NGOs are running non-formal basic education schools offering free primary education to children from low-income families who are otherwise not able to afford their education. They are participating in programmes for child education, rehabilitation of child workers and have secured the release of children and their families from bonded labour in many parts of the country. NGO’s role has also been instrumental in Sialkot Project under which at least 7,000 children have been removed from the soccer ball manufacturing and are being given education in NGO-run schools. NGOs have also raised the issue of child sexual abuse in the country. They are mainly working on raising awareness of parents and children themselves on how to guard against exploitation.

Citizen Community Boards

As mentioned earlier in this paper, it is encouraging to note that the Local government Ordinance has legitimized a formal role for citizen’s organizations. There is now a clear recognition that governance is a process of collaboration and conflict resolution, not command and control. Citizen Community Boards are a new form of CBO that will emerge from the devolution policy. CCBs are seen as the link between government and CBOs for preparing funding proposals and supervising government resource utilization. In addition to their development role, CCBs may, upon request, assist council committees in monitoring government activities. The exact procedures for facilitating this relationship are still being worked out. The CCBs are to be registered with the local social welfare department and cannot have members who are elected councilors or Nazims. The stated purpose of the CCB appears to be to support stakeholder groups in the preparation and submission of a proposal. However, some concerns have been expressed that the CCB could easily become a filter through which all community proposals must pass and thus could become a corrupting force if not carefully monitored.

Role of Religious Institutions

Pakistan is an Islamic State. As such it has a wide network of religious organizations which run schools providing religious education. Most of these boarding schools take care of children from poor families in rural and urban areas. Majority of the madrassahs also provides formal education at least up to primary levels. There are about four thousand religious institutions run by the private sector through philanthropic and self-help efforts. In addition to religious education, these institutions were imparting basic primary level education and providing full residential facilities to the non-local students along with free food and other basic need items. In addition to these, religious bodies also run orphanages to take care of children in difficult circumstances.

Role of Mass Media

Media in Pakistan has played a significant role in creating awareness on child rights issues and has been successful in bringing a change in public perception regarding the status of children. Print and electronic media allocates regular time and space to child rights issues including primary education, challenges like infant mortality, health and nutrition gaps and lack of equal opportunities among children. Media, during the last ten years has struck hard on the culture of indifference and neglect against children. Reporting incidents of child rights violations has sensitized readers and motivated them into becoming vocal and effective pressure groups. Electronic media has also brought about a massive change in public perception regarding child rights and has helped create an environment of care and concern for children.