THE survival of individuals and nations depends on their practical knowledge of emerging technologies and innovations, which is not possible without certain prerequisites including education and health. It is a good omen that from the outset, the current government diagnosed the core problem correctly and put human capital development on its priority agenda.
Global economists believe that for growth in developing countries, national governments must: (i) develop fundamental capabilities in the shape of human capital and institutions, and (ii) undertake a structural transformation (agriculture to industrialisation). It is a fact that the goal of human capital development prevails over other objectives.
There are some critical questions relevant to human capital development in Pakistan which must be debated before a strategy in this area is devised. Have welfare states around the world developed the fundamental capabilities of their people by entrusting this responsibility to the private sector? Does the private sector in countries like ours have the requisite capacity and the sincere intent to accomplish this significant task?
In the 1960s and 1970s, there were access issues in Pakistan’s public-sector education because of less spending on the expansion of schools. But the children of most government servants, senior lawyers, district surgeons, engineers and businessmen went to government schools. There were not too many private schools at that time, but a few elite ones did exist. Though the quality and standard of education in the latter was far better than in state-run schools, government school students were equally diligent and could compete with their counterparts studying at elite private schools. This was why students from humble backgrounds, who graduated from government schools, reached the zenith of their careers, whether in science and technology, medicine, engineering, the civil services, judiciary or the armed forces.
It is the government that must take the lead in developing human capital.
The bankruptcy of the state education system started gathering pace in the 1990s. This might have been due to the lack of interest on the part of the ruling elite as this system did not suit their class interests. Instead of reforming and expanding the state education system, they liberalised and deregulated educational policies on purpose to separate their children’s system of education from that of the lower middle class and the poor. This opportunity was availed by rent-seeking entrepreneurs who established a massive network of private schools. Today, education has become a huge business controlled by a powerful mafia. Figures show that in Punjab, there are around 60,500 private schools as compared to 53,000 government schools.
Due to the low quality of education in government schools, people have lost trust in the latter. To catch up with the privileged class in the job market, low-income families opt for affordable private schools. Government schools are left for the underdogs. Our prevailing education system is producing more heat than light because of its discriminatory face.
In the health sector, the government has decided to launch a universal health insurance programme across the country. This initiative aims to outsource health services, and poor families would be able to receive free health facilities from empanelled private hospitals. Reportedly, six million KP families have been enrolled at an annual premium cost of Rs18 billion. In Punjab, the target is to enrol 22m families by December 2021 at an approximate annual cost of Rs80bn.
The current financial year’s expenditure on the health sector in Punjab is about Rs284 billion. A vast network of government health facilities exists in the shape of tehsil headquarter hospitals, district headquarter hospitals, teaching hospitals, tertiary care hospitals, and specialised institutions. It is not clear what the use of the existing health infrastructure, which the government has established with one billion rupees of tax money, would be if by bearing the extra financial burden they shift millions of families to private hospitals for treatment. What special treatment would doctors offer to patients from poor households at private health facilities, which the same doctors cannot offer when they perform their duties at a government hospital?
It is a dilemma of our governance culture that instead of improving the existing system by introducing corrective measures, we bring a parallel system or agency to tackle a specific problem and increase the financial burden on already meagre state resources.
In 1998, the Punjab government, instead of overcoming the problems in the Boards of Intermediate and Secondary Education, introduced an entry test system for admission to medical and engineering universities. On the one hand, the entry test system has increased parents’ financial burden and heaped extra stress on the students; on the other hand, it has provided the private education mafia ample space in which to spread its tentacles. Recently, the Pakistan Medical Commission, with its new team, granted full liberty to private medical colleges to charge hefty donations from students who could not secure admission to government medical colleges.
Hotchpotch government policies and plans implemented by a plethora of agencies have worsened the health and education structure in the country. Already, the nexus between regulators and the private education mafia has become a hard nut to crack, and now there is going to be a new privatisation paradigm in the health sector.
There is no substitute for a national government. Adopting a market-like approach in the health and education sectors cannot develop a nation’s fundamental capabilities. The private sector could be our growth and development partner, but not in this field. There is a need to expand the network of schools and hospitals at the government level to improve public access to education and healthcare. The quality of these institutions can be enhanced by providing state-of-the-art facilities. Teachers and doctors are the lynchpin of the system and they must be recruited through a highly competitive process and paid handsomely. Above all, governance in this area must be improved through a stringent accountability mechanism.
The writer is a governance and development analyst.
Published in Dawn, February 26th, 2021