Low public spending equals low levels of health and education development - report

Pakistan's low spending on education and health is a leading contributor to the country's low human development which places it 142nd out of 177 countries on the Human Development Index, an official report says. UNESCO has recommended that developing countries set aside a minimum of four percent of their gross national product for education. But State Bank of Pakistan's annual report says the country is spending only 1.8 percent of its GNP on education. Urban males in Sindh have the highest literacy rate in Pakistan at 64 percent, while the lowest rate is the 16 percent among rural women in Balochistan, the government statistics show. There are vast gender and regional disparities between the provinces. While the overall literacy rate in Sindh is 56 percent, it is only 36 percent in Balochistan, says the bank's report, released over the weekend. Substantial disparities also exist at the district level within the same province. For Sindh it varies from 68.2 percent in Karachi to 18.3 percent for Tharparkar. In Punjab province, the literacy rate varies from 70 percent for Rawalpindi to 19.6 percent for Hafizabad. Pakistan's overall literacy rate is estimated at 54 percent in 2004, a figure achieved largely due to an increased emphasis on basic education in the country to achieve the millennium development goal of universal primary education, the report says. However, 68.4 million Pakistanis are illiterate, while the literacy profile depicts a substantial gender specific and rural-urban disparity. The gross primary enrolment rate has not been very encouraging, marginally increasing from 70 percent to 72 percent between 1999 and 2002. Pakistanis make up 2.5 percent of the world's population. It is the sixth most populous country in the world and its population growth rate is still among the highest in the region. The total fertility rate in Pakistan has declined from 4.8 children per woman in fiscal year 2000 to 4.1 children per woman in 2003-2004. The reduction is significant but the rate is still well above 2.1 children per woman, the long-term target of the population policy. Due to the persistent low level of primary enrolment and high population growth, 5.8 million children in the five-to-nine age group are still out of school. More than half of them are girls. The report says that while most low-income countries spend three to four percent of gross domestic product (GDP) on health, this is even lower in Pakistan where private sector spending accounts for 65 percent to 75 percent of total health expenditure. Almost 45 percent of women 45 years of age and above of the low income group in rural areas suffer from poor health, while 60 percent of men in the same group suffer from poor to fair health. Pakistan's infant mortality rate has dropped from 105 deaths per 1,000 two decades ago to 85 now, but this is still the highest in the region. Life expectancy has improved from 55 years in 1980-81 to 64 years in 2002-03, against the 64.4 years that is the average for developing countries. However, there is only one doctor per 1,466 people and one hospital bed per 1,517 people. The private sector provides services through a network of 21,000 clinics, 450 diagnostic laboratories and 520 small to medium size hospitals. But this sector works for the maximisation of its own benefit and ignores the aspect of welfare, the report says. "About 17 percent of the urban and 47 percent of the rural population do not have access to clean drinking water, which contributes to 30 percent of hospital cases and 60 percent of recorded infant deaths." "This situation is contributing to the worsening of social indicators in the country. The adverse impact of high population growth is compounded by the neglect of the social sector, in particular health and education, keeping the productivity of country's large labour pool low," the report says. The government should focus on policies which encourage medical staff to work in areas where the quality of life is low and the need for their services is highest, the State Bank suggests. "Competition in the private sector will improve the quality of services and government regulation may minimise the effects of inequality. Not-for-profit and non-government organisations (NGOs) that are involved in intensive healthcare work should also be given full support and encouragement," it says.