February 26, 2007	Monday	Safar 8, 1428

IN Pakistan, as in any other developing countries, the government tends to formulate policies without considering its own implementation capacity. As a result, the gap between policy objectives and actual delivery of public goods has been widening over the years.

The official Annual Progress Report for 2005-2006 clearly indicates that more than 63 per cent people remain dissatisfied with the standards of basic health services and over 40 per cent have a negative perception about schooling.

Policy formation is the starting point and implementation a sequential process. Many unpredictable things occur in the process of carrying out the policy decisions as various special interests interact with each other, all pursuing their goals, which might or might not be compatible with the policy mandate. Thus the content of the policy as well as its impact may be substantially modified during the implementation stage, creating the ‘implementation gap’.

Another set of problems in efficient execution of policies includes over--centralisation of decision-making, lack of transparency, non-involvement of stakeholders (including civil society institutions, which are in a position to articulate the concerns of poor), and the absence of technical analysis of different policy options. As a consequence of such shortcomings, serious mistakes occur and continue to be made in the design, sequencing and implementation of major economic reforms. The administrative machinery of the government needs to be reformed. Capacity building needs to be theprimary target.

Since the independence, our social sector development strategy as been evolved under several five-year plans and other development policies. But none of the social sector objectives under these plans were implemented. The performance of the social sector is at first assessed here on the basis of “target-achievement’ criterion and then in terms of policy outcome and impact.

Health policy outcome: The successive plans have achieved significant improvement of health status by reducing infant, maternal, and the under-five child mortality rate, which is not sufficient.

Despite these achievements, most of the plans failed to achieve their targets. The shortfall of targets reveals that the degree of implementation of plans was very low. None of 5-year plan period could utilise 100 per cent of the allocated fund nor they could implement all the projects under progress. The fund utilisation rates also varied, indicating that all the money could not be absorbed as stipulated.

Yet the government does not recognise its priorities. According to World Health Organization, Pakistan's expenditure on health was 2.4 per cent of the GDP, of which the government's expenditure was a mere 27 per cent. Instead of combating the spread of infectious diseases, ensuring universal immunisation or improving primary (or neo- and post-natal) health services in rural areas, a 14-storey medical tower in Islamabad is being constructed at a cost of over Rs2 billion which includes state-of-the-art VIP and VVIP facilities complete with a "presidential suite". Meanwhile, the tower in Karachi, to be built within the premises of the Jinnah Postgraduate Medical Centre, will stand 13 storeys tall and is going to cost Rs3.4 billion.

For a country that spends less than two per cent of its gross domestic product on health, spending over Rs5 billion on building two so-called 'health towers' in cities that already have reasonable medical and patient facilities (compared to the rest of Pakistan) seems to suggest that the government needs to rethink its priorities to health spending.

Although on paper, it is the policy objective to provide health facilities, in practice, most of the people living below the poverty line remain deprived of both-- the public and private health care. This is because, in line with the policy goal, no specific pro-poor programme and strategy have been undertaken so far. As a result health service have failed to ensure equity.

Education policy outcome: One of the policies is to ensure ‘Education for all’, . and still a majority of the children do not have any access to primary education. In fact, the National Education Census reveals that 58.5 per cent of all institutions that were not functioning (7,442 out of a total of 12,737) were found in Sindh. Out of the 50,585 villages in the country that were included in the census, a total of 10,908 (over 21.5 per cent) did not have any educational institutions at all.

In addition to this, 56.4 per cent of all public-sector institutions had no electricity, 40.5 per cent no toilets, 37.8 per cent no boundary wall, 32.3 per cent no drinking water and 6.8 per cent no buildings. Who can forget the so-called ghost teachers scandal, where a government survey in 1997 discovered over 40,000 'ghost' teachers in Punjab alone -- i.e. teachers who were on the government payroll and regularly drew salaries but never showed up for their teaching duties.

Education policy needs an analysis of how equitably the educational policies are implemented, how accessible the service is and how far the service is meeting the literacy rate required by the state.

Equity and access: Equity in and access to education depend on the nature and extent of inputs or supply side of the policy. Access is concerned with the availability of service (i.e. school building, furniture, teachers) to the actual as well as potential users while equality refers to need-based and justified distribution of services irrespective of income, location and whatsoever. In this way equity can ensure optimum access.

Physical Accessibility: Physical accessibility refers to the distance of the facility or time needed to travel. The distance of academic institution is one of the important factors of inaccessibility in rural areas.

Economic accessibility: Economic accessibility refers to accessibility depending on the ability of the individual or the community to pay for services. Due to the overall poverty, inability to pay is one of the major causes of inaccessibility. Constitutionally and according to the national plans, education is considered as a fundamental right of the people. Due to cost involvement, accessibility to modern and quality educational system is restricted to the children of the rich.

Quality of service: Another criterion to analyze the impact of the educational policy is to examine the quality of the services and the level of satisfaction of the recipients. The overall quality of the sector is low and unsatisfactory. The relatively well- off section of the population can purchase quality service from the private sector but the majority of the students look towards government sector, where generally quality is very low, except few schools.

On the other hand, poor maintenance of the existing facilities has also been persistently worsening the quality of service. And the problem is not just the dilapidated or non-existent infrastructure, the quality of teaching, the soundness of the curriculum and syllabuses and the general level of education being imparted to students are all well below par.