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Making Pakistan more equitable for all

Silvia Redaelli's picture
Between 2001 and 2015, approximately 32 million people were lifted out of poverty
Photo: World Bank

This blog is part of a series that discusses findings from the [email protected]: Shaping the Future report, which identifies the changes necessary for Pakistan to become a strong upper middle-income country by the time it turns 100 years old in 2047. 

In recent years, Pakistan has made remarkable progress in reducing poverty. Estimates based on the national poverty line, which was set at Rs3,030.3 per adult equivalent per month based on 2013-14 prices, show a consistent decline over the past two decades.
 
Between 2001 and 2015, approximately 32 million people were lifted out of poverty and the poverty rate was more than halved, going from 64 percent in 2001 to 24pc in 2015. However, a lot is yet to be done.

Not only because 2015 estimates show that approximately one in four Pakistani still does not have enough money to satisfy basic needs, but – even more alarming – progress has been far from equal when looking across the provinces, districts, cities, and rural areas.
 
While poverty declined at a fast pace in Khyber Pakhtunkhwa and, to a lesser extent, in Punjab, progress was less positive in Sindh and Balochistan.
 
Within provinces, poverty has remained stubbornly high in Southern Punjab and Northern Sindh. Similarly, the pace of poverty reduction has been slower in rural areas compared to cities, where the risk of poverty is less than half compared to rural areas.

Inequalities in poverty levels and poverty reduction performance are compounded by substantial inequalities in access to and quality of basic services such as health, education, electricity, water, and sanitation.
 
Being born in one of the country’s lagging areas and/or in a poor family largely predetermines a child’s chances of escaping deprivation and realizing his or her full human capital potential in life.

The dos and don’ts of boosting Pakistan’s human capital

Tazeen Fasih's picture
Photo: World Bank

This blog is part of a series that discusses findings from the [email protected]: Shaping the Future report, which identifies the changes necessary for Pakistan to become a strong upper middle-income country by the time it turns 100 years old in 2047. 

My parents’ gardener has six children – all aged 8 or younger. While his wife is busy taking care of the youngest ones, barely 15 months and 2 months old, he brings the other kids along with him so they don’t wander in the streets.

As I look at the supposedly 8-year-old girl with a dupatta wrapped around her head, looking tiny, probably stunted, suddenly I realize how pervasive all the statistics Yoon and I have been working are – right there, staring at us in our face.

The 38 percent stunting rate for the population, the fertility rate of 3.6 births per woman, the 22.6 million children out of school, the dismal learning outcomes for students, these are all here manifested in this family and its future.

What kind of future is awaiting these children? Will they be able to reach their full productive potential? According to the World Bank’s Human Capital Project, Pakistan’s children born today can achieve only 39 percent of their full potential – productivity they could have achieved if they were able to enjoy complete education and full health.

With over 60 percent of Pakistan’s national wealth (measured as the sum of produced capital such as factories and infrastructure; 19 types of natural capital such as oil, minerals, land, and forests; human capital; and net foreign assets) estimated to be coming from Human Capital Wealth, a failure to nurture and utilize this wealth to its full potential can be fatal.

Nonetheless, successive governments have failed to address the human capital challenge. A careful review of policies in Pakistan on human development reveals a myriad of policies over the 70 years of the country – many strategies appearing sound and well-intentioned, some, of course, appearing to be prompted by geopolitical situations of specific eras of the country.

In this context, we highlight some principles in human capital policies.

Ways for Sri Lanka to fix its healthcare

Deepika Attygalle's picture
Ways for Sri Lanka to fix its healthcare
Nurses in Sri Lanka. Photo: World Bank

Today on World Health Day, we can say with confidence that Sri Lanka’s healthcare system has delivered on many of its promises.

This year’s focus on universal health care is a timely reminder that Sri Lanka is still reaping the benefits of far-thinking health policies implemented as early as the 1800s.  

Many of these measures were designed to address what were then considered the key challenges of previous centuries, such as high maternal and child mortality rates and infectious diseases that claimed the health and lives of thousands.
 
Successes in lowering maternal and child mortality rates and introducing effective vaccination programs have made Sri Lanka’s low-cost model one worth emulating in the rest of South Asia.  
 
Sri Lanka’s healthcare faces new challenges
 
However, we can no longer afford to rest on our laurels. Our policies and systems must now evolve to address the country’s urgent concerns.
 
The island must also now contend with a worrying rise in non-communicable diseases such as cardiovascular diseases (CVD), ischemic heart disease and stroke, cancers, diabetes, and respiratory conditions such as asthma.
 
Fertility decline and increasing longevity have resulted in a demographic transition in Sri Lanka and this is taking place while the country is aspiring to become an upper middle-income country. 

Population projections show that the proportion of Sri Lankans above the age of 60 years will increase from 14 percent in 2017 to 22 percent by the year 2037.
 
With such a rapidly aging population in Sri Lanka, it is imperative for policymakers to ensure that social and economic institutions in the country are ready to face the health challenges and social consequences ahead.
 
In response, Sri Lanka is undertaking an ambitious agenda that will strengthen and expand primary healthcare services from the ground up. Documented in Re-Organizing Primary Healthcare in Sri Lanka, preserving our progress preparing our future”   this approach is backed by strong evidence.

The report captures the findings of wide-ranging conversations among hundreds of stakeholders from every level of the country’s healthcare system.

Facilitated by the Ministry of Health, Nutrition and Indigenous Medicine, and supported by the World Bank, the report makes a case for why, and how, Sri Lanka must re-imagine its primary healthcare systems in order to attain the goals of universal healthcare. 

Visualizing Nepal's health progress

Ravi Kumar's picture
Photo: World Bank

Over the last few decades, Nepal has considerably improved the health and wellbeing of its people.

As we mark World Health Day today, here’s an overview of how much health progress Nepal has made in its efforts to meet the Sustainable Development Goals (SDGs), especially the SDG 3 indicators, which focus on healthy lives and wellbeing for all at all ages.

Shaping a brighter future for Pakistan

Illango Patchamuthu's picture
Pakistan needs to think big on investing in its people
Pakistani girls attending a primary school. Photo: World Bank
This blog is part of a series that discusses findings from the [email protected]: Shaping the Future report, which identifies the changes necessary for Pakistan to become a strong upper middle-income country by the time it turns 100 years old in 2047. 
 
In 28 years, Pakistan will turn 100 years old. The children born this year will be adults then.

I wonder what they will see when they look around. Will they see a country teeming with opportunity? Or will they be in a country that does not offer enough jobs and does not provide the needed skills to compete?

Some of them may well be new parents at 28. Will they be able to look at their own children, and see a brighter future for them?

Pakistan has some important decisions to make if it wants to give its children the future they deserve.

If the country can make the right decisions now, Pakistan can accelerate and sustain growth to become a confident upper middle-income by the time it turns 100. It’s ambitious but possible.

Other countries –South Korea, China, and Malaysia – have transformed their economies within a generation, and there is no reason why Pakistan cannot achieve the same.

The alternative is not inspiring. If the country fails to accelerate and sustain growth as well as control population growth, by 2047 income levels will be close to where they are today and with challenges similar to what they are today.

I like to imagine another Pakistan, in which stunting and malnutrition are gone, in which family background does not determine what job you can get, women compete equally with men, businesses thrive, and Pakistan competes with the likes of Shanghai or Singapore as a trading hub.

Last month we launched a report, [email protected]: Shaping the Future, which looks at some of the reforms needed to accelerate and sustain growth and transform Pakistan’s economy.

Now is the time to come together and see what needs to be done to achieve this goal. A growth narrative for Pakistan needs to rest on these four elements: investing in people; using resources more efficiently; caring for the environment; and finally, improving how Pakistan is run to support growth and the implementation of difficult reforms.

Pakistan needs to think big on investing in its people.

In Bangladesh, new latrines meet a tested business model

Shilpa Banerji's picture
Shamila Hakim outside her home in Gazipur district's Shinglab village, Dhaka
Shamela Hakeem outside her home in Gazipur district's Shinglab village, Dhaka. Photo: World Bank

In a tiny hamlet called Shinglab in Gazipur district, around 2 hours from Dhaka, you can see a cluster of homes made of varying materials depending on the household income.

Shamela Hakeem, 40, lives in a functional mud hut with a tin roof. A widow with no children, she makes around BDT 300 ($3.50) daily as a sweeper at a local factory.

Last year, she decided to upgrade her sanitation facilities and purchased a BDT 10,000 ($118) toilet from a local entrepreneur. She is due to pay off her final installment within the next month.

But why did she decide to invest in a toilet?
                                                                                                                                                                                      
A three-way street

Bangladesh has nearly eliminated the practice of open defecation, but many latrines are poorly constructed and unhygienic, which can be harm­ful to the environment and the user.

Only 32 percent of the rural population have access to a safely managed sanitation service.  The government is helping rural households shift to better sanitation. However, many poor rural households are often discouraged by the upfront cost.

The country also has a history of micro-finance institutions (MFIs) who have effectively worked with rural households. But MFIs have had little experience in investing in non-productive assets such as toilets.

In 2016, a $3 million World Bank grant helped scale up MFIs lending for improved rural sanitation in Bangladesh. An additional $23.7 million in seed money was mobilized from MFIs for the installation of latrines.

Small-scale sanitation entrepreneurs received technical assistance to build good quality, affordable models of hygienic latrines for low-income households. Finally, an agreement was reached with the Palli Karma-Sahayak Foundation (PKSF) to work with retail MFIs and local entrepreneurs (LEs).

Interest-free loans were extended to households using their own capital ($22) of PKSF and their MFI partners plus business loans to entrepreneurs with market rate interest. Across 42 districts, household borrowers could choose from a range of standard design ‘set price’ latrines installed by LEs. Another arrangement was reached between MFIs, LEs, and customers who accessed the sanitation loan from MFIs and placed an order with LEs to construct the latrine.

Households could pay off the loan over a period of 50 weeks without interest. “We started off with 143 latrines in 2017, but now the market is more developed, and entrepreneurs are motivated,” said Gazi Md. Salahuddin, general manager of Resource Integration Centre, an MFI based in Narayanganj district.

Technology is transforming governance in Pakistan

Irum Touqeer's picture
Punjab Excise and Taxation Service Center
Punjab Excise and Taxation Service Center. Photo: World Bank

Technology is changing our world faster than ever before.

And Pakistan, home to more than 64 million internet users and 62 million people connected to mobile data, is no exception.

As they’ve become more digital-savvy, Pakistanis are now expecting better digital services from their government.

To meet these demands, the Government of Punjab has been working to modernize over the last decade.

As part of the government’s governance reforms, and learning from earlier pilot programs in education and health, the Punjab Public Management Reform Program (PPMRP) has aimed to transform citizens’ experience, improve access to administrative services, and boost public employee performance and the management of public resources.

Before that, Punjab authorities were facing several challenges in delivering public services. This, in turn, impacted social outcomes in the province: the health sector’ performance was affected by the absenteeism of vaccinators, resulting in a low immunization rate in Punjab (49% in 2014).

The education and agriculture departments faced similar absenteeism issues with teachers, students, and agriculture workers in the field.

Overall, citizens were dissatisfied with these public services.

Undernutrition in South Asia: Persistent and emerging challenges

Ashi Kathuria's picture
Indian Bengali tribal mother is feeding her baby on her lap in a rural background. Indian rural lifestyle
Indian Bengali tribal mother is feeding her baby on her lap in a rural background. Credit: Abir Bhattacharya/ Shutterstock

Childhood stunting—or being too short for one’s age—is one of the most significant barriers to human development and affects about 162 million children under five across the world.

The good news is that several countries in the region, Nepal, India and Sri Lanka, are progressing towards meeting the 2025 World Health Assembly target of reducing the number of stunted children.

But overall, South Asia remains home to about 62 million stunted children.

In this context, it’s critical to confront failures that impede progress toward better health and nutrition in the region. Even more so since some undernutrition challenges persist, and new ones are emerging.

One persistent challenge is the inadequate diets young children receive, especially in their first two years.

This starts early in a child’s life as breastfeeding rates remain low. Though early initiation of breastfeeding has more than doubled to 40 percent between 2000 and 2016, more than 20 million infants are still not being breastfed within the first hour of birth.

Progress is also uneven across the region: breastfeeding initiation ranges from 18 percent in Pakistan to about 90 percent in Sri Lanka.

Also worrisome is that exclusive breastfeeding in the first six months of life has improved by a mere five percentage points to 52 percent across South Asia.

Further to that, the diets of infants over six months continue to be one of South Asia’s biggest and most persistent challenges.  

Only 12 percent of South Asian children receive the minimally acceptable diet they need to grow healthy.

Sri Lanka’s women want to work—and thrive in the workplace

Idah Z. Pswarayi-Riddihough's picture
A woman hand painting fabric in a local Batik fabric factory
A Sri Lankan woman is hand painting fabric in a local Batik fabric factory. Matale, Sri Lanka. Credit: Shutterstock. January 3, 2017.

It’s International Women’s Day today, and there is a lot to celebrate in Sri Lanka and beyond.

Being a woman, mother, sister, aunt – name it, it’s something women wake up to daily and they love it.  None of them question about being enumerated for these roles.  We marvel and revel in the roles. 

But make no mistake. Women are also very capable breadwinners, contributors to the economies, innovators and entrepreneurs amongst many other roles.

Women want to work, and they want to stay in the workplace. 

What they seek is balance: a gender-balanced workplace, a gender-balanced management, and more gender-balance in sharing wealth and prosperity. 

In that sense, it’s heartening to see some of the proposals put forth in the government of Sri Lanka’s budget: more daycare centers, flexible work hours, and incentives to promote maternity leave. 

These are very welcome changes to think equal, build smart, innovate for change—the 2019 International Women's Day campaign theme—and we encourage those with jobs to implement these policy changes. 

This year, let me share with you a quick analysis of five laws that Sri Lankan women and their advocates have identified as constraining for joining the workforce and staying there! 

Applauding the women leaders in South Asia

Hartwig Schafer's picture

I just ended my first round of country visits as the World Bank’s Vice President for the South Asia Region.  Over and above all, I have been immensely impressed by the resilience, determination, commitment and innovation of the women leaders that I had the privilege to meet during my visits.

These women are succeeding in a region where it is hard for women to realize their career dreams. In South Asia, only 28 percent of women ages 15+ are employed, compared to 48 percent worldwide.

What better opportunity than International Women’s Day to give a huge shout-out and applaud those women who are role models, entrepreneurs, and leaders in the eight countries of South Asia.

Neha Sharma, the district magistrate in Baghai village and Hart Schafer in India
Baghai village in Firozabad district, Uttar Pradesh, India. Photo: World Bank

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