AFZAL, who works in the city while his family lives in the village, has three daughters and one son. One of his daughters, now 10, still does not attend school. When she was two she started getting episodes of what appeared to be epilepsy.

Afzal took her to a number of maulvis, hakeems and pirs to have the ‘evil’ removed, but that did not work. He finally took her to a doctor when she was around six years of age, and the doctor confirmed that she did have epileptic episodes but thought that with some care and minimal medication these could easily be controlled.

Afzal did send his daughter to school during this time, but the teachers did not want to take the responsibility of having an epileptic episode in class and, in addition, they also thought that the child was ‘slow’, linking it to her epilepsy, and sent her home. According to the teachers, she could not follow what was going on in class very well.

It is only now, when the girl is 10, that Afzal has found out that while the epileptic episodes were indeed there, though they have been in control for years now, the child is not ‘slow’. She has weak eyes and could not see what was written on the board and hence could not follow the lesson being taught. And since she lacked confidence and was shy, partly due to her epilepsy, she did not really speak up in class either. Hence the teachers thought she was slow.

We now have a 10-year-old who has lost four to five years of schooling already. And this because of lack of timely but minimal interventions in early childhood. If the child had been taken to a doctor earlier for an eye examination, she would have developed in a different way. What we have now is an illiterate child with significant psychological issues to deal with.

There are other stories too. A few years ago while conducting household surveys in the rural areas of Punjab and Khyber Pakhtunkhwa, we came across a number of cases where malnutrition, poor hearing, poor eyesight and other relatively minor ailments that could easily have been detected in routine health examinations and easily corrected with minor interventions, had led to the isolation of a child. He or she was cast out of the mainstream and years later it was all but impossible to make up for lost time and opportunities.

And the problem seems to be growing. The latest health and nutrition surveys show that almost one half of the children born in Pakistan are, to one degree or another, malnourished. Is the future of this country not dependent on the children of today? If so, do we need justification for large and significant early childhood intervention programmes: programmes that ensure our children are well-fed, healthy, and provided an environment where they can develop optimally?

There is some evidence that Lady Health Worker/Visitor programmes, where they function, do have a significant impact on health and other outcomes of women and children of the area. Maybe we have a vehicle, if made effective, can be utilised for scaling up interventions quickly.

We are also finding, by design or default that children are being made to go to ‘school’ earlier as well. Parents start looking for schools at age three or so. And this trend is creeping from cities to rural areas and from higher income groups to middle and lower ones. Where both parents work, the demand for early enrolment is more of a demand for childcare than education, but that is not the whole story.

There are many parents who say that unless a child is enrolled in the right preschool and at the right age, his or her chances of making it to a good school stand compromised. There are major issues here, about child development and the right age for the right activity and the tendency to put too much pressure on our children too early in their lives that the society needs to think through.

But given the trend, for individual parents there might be little or no choice in the matter. And if private schools are offering preschool, the government has to think about doing the same in the public sector. We do not want children going to public schools being left behind or left out due to lack of instruction at preschool stage.

Article 25A of the Constitution gives the right to education to all five-to-16-year-olds in the country. We will need to revisit this at some point. If preschool becomes, de facto, a requirement, we need to make sure all children have access to it and some are not left behind for any reason whatsoever.

The demographic dividend, which we are hoping for, given our large and young population and our still significant fertility rates, will only work if our children are well-nourished, healthy and educated or skilled. But current nutrition and education surveys show a poor picture.

This requires a major rethink in our social-sector policies. We need to think about early childhood development and education programmes for the entire country. And we need to get them in place as early as possible: having millions of children malnourished or lacking basic health and educational facilities is not the road to a bright future.

The writer is senior adviser, Pakistan, at Open Society Foundations, associate professor of economics, LUMS, and a visiting fellow at IDEAS, Lahore.

fbari@osipak.org