The track record of social sector service delivery in Pakistan is so poor and tempting to assert that almost any reform in governance arrangements would produce better results.
In a joint study of Asian Development Bank, Department for International Development and Poverty Reduction and Economic Management Sector Unit, South Asia Region World Bank mentioned that in many reports, including the government's PRSP, pointed out that Pakistan's social indicators lag behind those of countries with comparable per capita incomes.
According to one estimate, Pakistan's gross female primary enrollment rate is 33 percentage points below and its infant mortality rate 20 per thousand above that of countries with the same per capita income.
As devolution began, Pakistan faced a double dilemma of long standing. Its public institutions for social service delivery were demonstrably failing, and the evidence suggested that neither economic growth nor increased public expenditures were likely to have significant remedial impact.
Cross-country comparisons illustrate that, in Pakistan, growth is associated with fewer improvements in key health and education outcomes than in comparable developing countries.
For example, the female-male literacy gap increased in Pakistan with growth while it declined in a sample of comparator countries; infant mortality declined by 56 percent in the comparator countries, compared to only 27 percent in Pakistan.
The link between increased funding and better education or health indicators is equally weak. The Social Action Programme has to date been the government of Pakistan's most concerted effort at improving its pro-poor social expenditures.
The programme aimed at increasing the physical availability and improving the quality and efficiency of services, especially for the poor and for women, in elementary education, basic health care, family planning and rural water supply and sanitation.
Outcomes were disappointing, particularly in education, which received roughly two-thirds of this allocation. Overall net enrolment rates declined from 46 percent in 1991/92 to 42 percent by 2001-02. There was some provincial variation around this declining national trend, the situation in Sindh, and especially in Balochistan, was particularly disturbing, while NWFP showed some moderate progress.
There were some positive achievements in health as indicated by a significant decline in the infant mortality rate, incidence of diarrhoea and modest improvement in prenatal care as measured by the immunisation rate of children from 12 to 23 months of age.
Though the programme failed to adequately prioritise institutional reform and did not tackle the thorny issues related to the incentives for staff to improve outcomes either at the policymaking level or at the service provider level.
Joint report noted, the existing institutional arrangements for social sector service delivery in Pakistan deliver ineffective services and neither growth nor additional investment expenditures offer a ready cure.
Devolution offers a new set of institutional arrangements that, arguably, can produce effective solutions. It is important to emphasise that government policy statements did not regard service delivery and responsiveness as ends in themselves. In some respects, the architects of policy saw the pitfalls of measuring the success or failure of devolution by a narrow emphasis on efficient service delivery.