Public health sector: Pakistan needs to spend 1pc of GDP every year: World Bank

LAHORE: World Bank has estimated that Pakistan needed to spend one percent of current GDP, i.e. $4 billion, per year on public health sector to reduce stunting rates in children by half in a decade or so, said Regional Vice President for South Asia Martin Raiser on Friday.

He was speaking at the Lahore University of Management Sciences (LUMS) Lahore in connection with the launch of the ‘final policy notes’ on reforms for a brighter future for Pakistan. Ghazala Mansuri, Lead Economist, World Bank, made a presentation on the status of stunted growth in Pakistan while Ali Cheema, Vice-Chancellor, LUMS moderated the question answer session. The event was attended by a good number of academicians, economists, social scientists and the University students.

Raiser told the audience in his welcome remarks that the World Bank would focus on the country’s high child stunting rates, a major public health challenge that, World Bank believe, has had insufficient attention for too long. He termed it part of a “silent” human capital crisis hurting Pakistan, which rarely makes the headlines, even if it affects the majority of the population today, and undermines Pakistan’s future potential.

According to him, 40% of children under five in Pakistan suffer from stunted growth. The rates exceed fifty percent in some of the poorest districts of Punjab, and even sixty percent in rural Sindh, he added.

“A large part of the country’s population is not reaching their physical and cognitive potential,” he said, adding that the root causes lie in lack of access to clean water and sanitation, lack of birth spacing, poor nutrition and insufficient access to health services. Many mothers and children in the first 1000 days from conception exposed to unclean environment and unhygienic living conditions, which are a major cause of high stunting growth.

Sadly, said Martin, the impacts of stunting continues through a person’s life, limiting cognitive abilities and increasing susceptibility to disease. And the disadvantage is intergenerational. Mothers who are stunted are at much higher risk of giving birth to children who are stunted.

He pointed out that recent research shows that despite a dramatic decline in poverty between 2000 and 2018, stunting rates have stayed pretty much the same. It also explains why they have not even declined in urban areas, where people are on average better off. Nutrition is important but it is clearly not sufficient, he stressed.

He said the multi-sectoral nature of the issue suggests that it should be dealt with a different approach covering right from water and sanitation infrastructure, health and nutrition facilities, and behavioural change. It requires political mobilization across all levels of governments, especially at the local level, in each Tehsil. It also requires coordinating interventions in sectors that rarely work together. This is not easy, but countries like Indonesia, Peru and others have shown that rapid progress is possible, he maintained.

“A detailed analysis of Pakistan’s tax and spending policies tells that just tax exemptions and the losses of state-owned enterprises consume public resources four times higher than what would be needed to address stunting.”

He said World Bank is now starting to implement this new approach, with the Government of Punjab, bringing all required interventions together at the Tehsil level.

The Vice President said the human capital shortcomings, combined with stunting, mean that the productivity of Pakistan’s large and growing workforce is only 41 percent of what it could be, were Pakistan’s youth, and especially girls, to reach their full potential. If the country just caught up in human capital with its peers, its GDP per capita could be one third higher by 2047. Pakistan’s high fertility rate – related to girls dropping out of school early – means Pakistan has not yet benefited from the demographic window of opportunity, he added.

He said World Bank finance alone is never going to be more than a small part of the solution. To address Pakistan’s human development crisis, we need a national effort to at least double spending on health and education to around 5 percent of GDP. Some commentators have suggested the World Bank should make all its programmes conditional on the government committing to this. But the conditionality ultimately only works if there is ownership – and that comes from people asking for change.

Copyright Business Recorder, 2023