Is Pakistan's Social Sector Making Progress?

If you read Pakistan media headlines and donation-seeking NGOs and activists' reports these days, you'd conclude that the social sector situation is entirely hopeless. However, if you look at children's education and health trend lines based on data from credible international sources, you would feel a sense of optimism. This exercise gives new meaning to what former US President Bill Clinton has said: Follow the trend lines, not the headlines. Unlike the alarming headlines, the trend lines in Pakistan show rising school enrollment rates and declining infant mortality rates.

Key Social Indicators:
The quickest way to assess Pakistan's social sector progress is to look at two key indicators:  School enrollment rates and infant mortality. These basic social indicators capture the state of schooling, nutrition and health care. Pakistan is continuing to make slow but steady progress on both of these indicators. Anything that can be done to accelerate the pace will help Pakistan move up to higher levels as proposed by Dr. Hans Rosling and adopted by the United Nations.
Pakistan Children 5-16 In-Out of School. Source: Pak Alliance For M...


Rising Primary Enrollment:
Gross enrollment in Pakistani primary schools exceeded 97% in 2016, up from 92% ten years ago. Gross enrollment rate (GER) is different from net enrollment rate (NER). The former refers to primary enrollment of all students of all ages while the latter counts enrolled students as percentage of students in the official primary age bracket. The primary NER in Pakistan is significantly lower but the higher GER indicates many of these kids eventually enroll in primary schools albeit at older ages. 
Source: World Bank Education Statistics
Declining Infant Mortality Rate: 
The infant mortality rate (IMR), defined as the number of deaths in children under 1 year of age per 1000 live births in the same year, is universally regarded as a highly sensitive (proxy) measure of population health.  A declining rate is an indication of improving health. IMR in Pakistan has declined from 86 in 1990-91 to 74 in 2012-13 and 62 in the latest survey in 2017-18.

Pakistan Child Mortality Rates. Source: PDHS 2017-18

During the 5 years immediately preceding the survey, the infant mortality rate (IMR) was 62 deaths per 1,000 live births. The child mortality rate was 13 deaths per 1,000 children surviving to age 12 months, while the overall under-5 mortality rate was 74 deaths per 1,000 live births. Eighty-four percent of all deaths among children under age 5 in Pakistan take place before a child’s first birthday, with 57% occurring during the first month of life (42 deaths per 1,000 live births).

Pakistan Human Development Trajectory 1990-2018.Source: Pakistan HD...

Human Development Ranking:

It appears that improvements in education and health care indicators in Pakistan are slower than other countries in South Asia region. Pakistan's human development ranking plunged to 150 in 2018, down from 149 in 2017.

Expected Years of Schooling in Pakistan by Province 


There was a noticeable acceleration of human development in #Pakistan during Musharraf years. Pakistan HDI rose faster in 2000-2008 than in periods before and after. Pakistanis' income, education and life expectancy also rose faster than Bangladeshis' and Indians' in 2000-2008.

Now Pakistan is worse than Bangladesh at 136, India at 130 and Nepal at 149. The decade of democracy under Pakistan People's Party and Pakistan Muslim League (Nawaz) has produced the slowest annual human development growth rate in the last 30 years. The fastest growth in Pakistan human development was seen in 2000-2010, a decade dominated by President Musharraf's rule, according to the latest Human Development Report 2018.

UNDP’s Human Development Index (HDI) represents human progress in one indicator that combines information on people’s health, education and income.

Pakistan's Human Development Growth Rate By Decades. Source: HDR 2018

Pakistan saw average annual HDI (Human Development Index) growth rate of 1.08% in 1990-2000, 1.57% in 2000-2010 and 0.95% in 2010-2017, according to Human Development Indices and Indicators 2018 Statistical Update.  The fastest growth in Pakistan human development was seen in 2000-2010, a decade dominated by President Musharraf's rule, according to the latest Human Development Report 2018.

Pakistan Human Development Growth 1990-2018. Source: Pakistan HDR 2019


Pakistan@100: Shaping the Future:

Pakistani leaders should heed the recommendations of a recent report by the World Bank titled "Pakistan@100: Shaping the Future" regarding investments in the people. Here's a key excerpt of the World Bank report:

"Pakistan’s greatest asset is its people – a young population of 208 million. This large population can transform into a demographic dividend that drives economic growth. To achieve that, Pakistan must act fast and strategically to: i) manage population growth and improve maternal health, ii) improve early childhood development, focusing on nutrition and health, and iii) boost spending on education and skills for all, according to the report".
Pakistani Children 5-16 Currently Enrolled. Source: Pak Alliance Fo...


Summary: 

The state of Pakistan's social sector is not as dire as the headlines suggest. There's reason for optimism. Key indicators show that education and health care in Pakistan are improving but such improvements are slower than in other countries in South Asia region. Pakistan's human development ranking plunged to 150 in 2018, down from 149 in 2017. It is worse than Bangladesh at 136, India at 130 and Nepal at 149. The decade of democracy under Pakistan People's Party and Pakistan Muslim League (Nawaz) has produced the slowest annual human development growth rate in the last 30 years. The fastest growth in Pakistan human development was seen in 2000-2010, a decade dominated by President Musharraf's rule, according to the latest Human Development Report 2018. One of the biggest challenges facing the PTI government led by Prime Minister Imran Khan is to significantly accelerate human development rates in Pakistan.
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Comment by Riaz Haq 8 hours ago

Benazir Nashonuma Programme: Delivering Breakthrough Results in Preventing Malnutrition - Pakistan | ReliefWeb

Operating under Pakistan’s Benazir Income Support Programme (BISP) – the country's flagship social protection programme – the Benazir Nashonuma Programme has become a cornerstone in the fight against malnutrition in Pakistan.

The final results of the cohort study of the Independent Impact Evaluation presented in May 2026 show some of the strongest results ever documented globally for a nutrition programme, with impact on stunting reduction and child survival. The evaluation is conducted by the Institute for Global Health & Development at Aga Khan University and funded by the Gates Foundation. It followed two groups from early pregnancy – Nashonuma participants and non-participants – both enrolled in BISP Kafaalat.

The evaluation has documented significant impact on maternal outcomes, including full coverage of antenatal care (at least once), improved pregnancy weight gain (+24 g/week), and 0.36 g/dL smaller decline in hemoglobin concentration among Nashonuma participants. It also showed lower adverse birth outcomes, including low birth weight reduced by 6%, preterm births by 11%, and small vulnerable newborns by 7%. For child health outcomes, stunting at 6 months was 22% lower among Nashonuma beneficiaries (equivalent to 9.4 percentage-points), especially reflecting improved maternal nutrition, and at 12 months, it was 18% lower (equivalent to 10.1 percentage-points). The evaluation also found reduced child anemia by 12%, increased full immunization coverage by 17%, while <25% of women achieved adequate dietary diversity.

Launched in 2020, the Benazir Nashonuma Programme targets pregnant and breastfeeding women and children under 2, focusing on the pivotal first 1,000 days. Through its integration with BISP, Nashonuma can reach the most vulnerable mothers and children. The programme is delivered through 578 facilitation and 169 stabilization centers and has reached 4.6 million women and children so far.

Nashonuma provides a comprehensive package of nutrition-specific and -sensitive interventions:

  1. Antenatal and postnatal care services, child growth monitoring and immunization.
  2. Awareness sessions, Social Behavior Change to foster positive maternal, infant and young child nutrition, health, hygiene, breastfeeding and complementary feeding practices.
  3. Conditional cash stipends provided by BISP.
  4. Provision of specialized nutritious food (SNF) and Multi-Micronutrient Supplements (MMS) for mothers and children. SNF consists of 75 and-50 grams of nutrient-packed paste to complement the diet by filling nutrient gaps.
  5. Screening and Management of Moderate and Severe Acute Malnutrition for children and mothers, including lifesaving treatment.

The Nashonuma Programme is managed by the Government of Pakistan under BISP. The World Food Programme (WFP), in close partnerships with Health Departments, supports the management of the 578 Facilitation Centers and the procurement and distribution of SNF to prevent stunting. The centres also screen for, and manage, acutely malnourished children and women. Severe cases with medical complications are referred to one of the 169 nutrition Stabilization Centres supported by the World Health Organization (WHO), which provide lifesaving medical treatment and therapeutic milk (F-75 and F-100), as well as Ready-to-Use Therapeutic Food (RUTF). UNICEF provides RUTF for the treatment of severe acute malnutrition, MMS for women’s micronutrient deficiencies, and manages Social Behavior Change Communication & community engagement.

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