Poor governance undermines equitable delivery of education, healthcare: Mahbub-ul-Haq 2012 report

Poor governance is the key impediment to improving public sector delivery of education and health for a vast majority of Pakistanis, according to a new Report by the Mahbub-ul-Haq Center. "Weak administrative structures, low budget allocations and even lower utilisation, poor quality and widespread inequities in access" - all stand in the way of empowering Pakistan's poor with education and health, the report says.
According to the report, Pakistan has seen some positive developments on the education front. The 18th Amendment has led to the recognition of education as a fundamental human right to be provided by the state. The country has also pledged to commit at least seven per cent of its GDP to achieve its international commitments for achieving universal primary education by 2015. Pakistan's leaders also declared the year 2011 to be Pakistan's year of education, signalling that across the board reforms would be implemented to improve access to education for all.
Yet, it is paradoxical that all these verbal commitments for reform, policy proposals and constitutional changes have not been implemented for the good of the common man. While the government in Pakistan has made some efforts to prioritise education in the policy agenda, public sector delivery for health is still waiting to be pushed up the policy ladder.
Pakistan is faced with a dual burden of communicable and non-communicable diseases on the one hand, and the challenge of increasing incidence of new diseases like HIV/AIDS on the other hand, the report adds. The report highlights the widening disparities in access to end quality of both education and health services based on regional, rural-urban, gender and income lines. The increase in income and wealth disparities over the last decade has further exacerbated these and resulted in a growing share of private, out of pocket financing for both education and health.
According to the report, the institutional machinery for the public sector delivery of education and health in Pakistan largely exists - the problem lies in efficiently delivering the services. For the education sector, weak management and lack of accountability have resulted in poor quality of inputs in the education system leading to poor outputs.
The number of functional schools and trained teachers has declined over the years, dropout and repetition rates are high and completion rates in primary education are low. Similarly, governance of the public health system suffers from parallel structures with overlapping responsibilities and authority, resulting in duplication, wastage of resources, and high administrative costs. There are weaknesses in monitoring, evaluation and accountability that have led to corruption at all levels in the health sector - from the regulatory, to the drug supply and registration system, and finally to the service delivery level where it directly affects the poor.
If men and women are not empowered with health and education, economic growth could not be sustained as there will not be enough healthy and productive labour force to refuel the growth process, the report adds. Further, Mahbub-ul-Haq Centre's 2012 report on Governance for People's Empowerment stresses on the need to go beyond traditional measures of poverty based on income to incorporate multiple deprivations suffered by the poor, such as lack of access to education and health when estimating the extent of poverty in Pakistan.
The last available official estimates for poverty released by the Government of Pakistan are more than 6 years old. According to these estimates, the proportion of people living below the calorie based income poverty line was 22.3 percent in 2005. This measure of poverty may be misleading as it ignores multiple deprivations suffered by the poor.
In broader terms, poverty is a denial of opportunities - the opportunity to have access to good quality education and health care facilities, and the opportunity to earn a decent living. It is the inequality in opportunity for poor people to develop their potential that is deemed more unfair than the inequality in income alone.
The report reveals the latest estimates for the Poverty of Opportunity Index (POPI), pioneered and developed by Dr Mahbub-ul-Haq in 1998 for Pakistan and a few other select South Asian countries. The POPI goes beyond what is captured by traditional measures of poverty to include poverty of opportunity in health and education, in addition to income poverty. In recent years, the United Nations and the World Bank have also developed indicators such as the Multidimensional Poverty Index and the Human Opportunity Index that aim to capture the multiple deprivations suffered by the poor across the world.
The incidence of poverty for Pakistan, as measured by POPI, is much higher at 29.2 percent compared to calorie-based national income poverty estimates at 22.3 percent. This shows that income based poverty line estimates only tell part of the story - individuals living above the income poverty line may still suffer deprivations in education, health and other living conditions.
It must be noted that since POPI estimates are based on latest available official data, which is more than 6 years old in Pakistan's case, the actual extent of deprivation experienced by the poor may be higher. Some estimates based on Asian Development Bank and World Bank data suggest that poverty has increased by an additional 18.9 percentage points since the government's last estimation in 2005-06.
According to these independent estimates, total poverty in the country may be as high as 41.2 percent, with more than 74 million people living below the poverty line. Comparing POPI estimates for Pakistan with other countries in the region also reveals interesting insights. Even though income-based poverty estimates in India is much higher than Pakistan, the former has a lower incidence of poverty as measured by POPI (27.8 per cent) because India's record is better in terms of providing education opportunities for its people.
The report suggests that a broader measure of poverty like POPI is useful for policy purposes as well. Policy makers need to understand that poverty alleviation efforts should not only focus on income transfers, but also on building the basic capabilities of the poor to earn a living.