District Pakpattan Human Development Report Addressing Vulnerabilities in Education and Health: Responding to Out-Of-School Children and Out-Of-Pocket Costs
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D i s t r i c t P a k p a tt a n H u m a n D e v e l o p m e n t R e p o r t District Pakpattan Human Development Report Addressing Vulnerabilities in Education and Health: Responding to Out-of-School Children and Out-of-Pocket Costs Faisal Buzdar AAWAZ Copyrights AAWAZ Programme @2015 AAWAZ Programme is funded by the UKAid through the Department for International Development (DFID), AAWAZ was conceived initially as a five-year programme, from 2012 to 2017. Development Alternatives Inc. (DAI) is the Management Organisation (MO) for implementing the AAWAZ programme, while Pakistan’s prime civil society organisations: Aurat Foundation (AF), South-Asia Partnership Pakistan (SAP-PK), Strengthening Participatory Organisation (SPO) and Sungi Development Foundation (SF) form the implementation consortium responsible for directly working with communities. All publications by AAWAZ are copyrighted, however, can be cited with reference. 2 D i s t r i c t P a k p a tt a n H u m a n D e v e l o p m e n t R e p o r t Table of Contents Executive Summary ........................................................................................................................5 Chapter 1: Putting Human Development and Human Development Reports into Perspective ........7 1.1: Enlarging Choices: The Case for Human Development ........................................................7 1.2: Human Development Reports: An Overview ......................................................................8 1.3: Key Indicators ....................................................................................................................9 1.4: Key Themes .....................................................................................................................10 1.5: Methodology ...................................................................................................................13 Chapter 2: Human Development in Pakpattan: What Key Indicators Tell Us .................................14 2.1: Human Development in Punjab: A Cursory Glance ...........................................................14 2.2: District Pakpattan ............................................................................................................14 2.3: Education in District Pakpattan ........................................................................................15 2.4: Health in District Pakpattan .............................................................................................19 Chapter 3: Out-of-School Children and Out-of-Pocket Costs in District Pakpattan: What Qualitative Data Tell Us .......................................................................................................22 3.1: Out-of-School Children in District Pakpattan ....................................................................22 3.2: Out-of-Pocket Health Costs ..............................................................................................30 Chapter 4: Conclusions and Recommendations .............................................................................35 4.1: Education ........................................................................................................................35 4.2: Health .............................................................................................................................39 Annex A: FGD Guide for AAWAZ District Forum ............................................................................44 Annex B: FGD Guide for AAWAZ Village Forum .............................................................................46 3 AAWAZ Acronyms BHU Basic Health Unit NER Net Enrolment Rate CPR Contraceptive Prevalence Rate PEF Punjab Education Foundation CDS Comprehensive Development PSLM Pakistan Social and Living Standards Strategy Measurement DFID Department for International PPP Public Private Partnership Development PRSP Punjab Rural Support Programme DHQH District Headquarter Hospital PTC Parents Teachers Council DMO District Monitoring Officer RHC Rural Health Center EFA Education for All SAP Structural Adjustment Programs FAS Foundation Assisted Schools SDGs Sustainable Development Goals FGD Focus Group Discussion SMC School Management Committee GDP Gross Domestic Product SPO Strengthening Participatory HDR Human Development Report Organisation IMR Infant Mortality Rate THQH Tehsil Headquarter Hospital LHV Lady Health Visitor UC Union Council LHW Lady Health Worker WHO World Health Organisation MCH Maternal and Child Health MDGs Millennium Development Goals MEA Monitoring and Evaluation Assistants MICS Multiple Indicator Cluster Survey MMR Maternal Mortality Rate 4 D i s t r i c t P a k p a tt a n H u m a n D e v e l o p m e n t R e p o r t Executive Summary Human development emerged in the context of for the people. According to the Health System growing frustration with traditional models of Financing Profile released by the World Health development that were based on a belief in the Organisation (WHO) in 2013, Pakistan spent 6.8 annual growth of income per capita alone. It gave billion dollars on health in one year, 55% of which primacy to people’s wellbeing and turned focus was spent by households. The problem of health to enlarging their choices. At the heart of human related private costs is intimately linked to the development lies a pressing concern for providing state’s priorities, as public spending on health equal life chances for all. This report draws on constituted only 2.7% of the GDP. The report at the basic elements of human development hand undertakes to discuss and highlight the and presents a commentary on the state of key scale of out-of-pocket costs and vulnerabilities social indicators in District Pakpattan. Concerned associated with them. It does so by examining with addressing vulnerabilities in education and the key issues of public and private healthcare, health, and relying on qualitative data, it further access, poverty, and gender. reflects on the themes of ‘out-of-school children’ The state of key education indicators in Pakpattan and ‘out-of-pocket health costs’ in the context of is far from being satisfactory. Enrolment, literacy, the district and highlights issues characterising and school completion rates are quite low. Pupil- them. Despite numerous achievements globally teacher ratio is high and a number of primary in the domain of education since the inception schools have only one or two rooms. The scale of the Millennium Development Goals (MDGs), of missing facilities is also considerable as 18% of the problem of out-of-school children remains; the schools in the district do not have electricity fifty-eight million children of primary school age and 16% are without toilets. Correspondingly, (normally between six and eleven years) are still the number of out-of-children in the district is out of school around the world. This phenomenon high. According to an estimate, 18.9% children has a strong gender dimension as well, as thirty- of school going age are out of school. This can one million of the fifty-eight million children are be ascribed to a range of factors such as lack girls. The number of out-of-school children in of quality and access, poor infrastructure, and Pakistan is estimated to be twenty-five million. misplaced priorities. Poverty, child labour, gender This report seeks to build a holistic analysis of the discrimination, and disability also serve as issue and discusses a range of variables central barriers to education. Getting children into school to it, viz.: access, quality, poverty, gender, and requires evolving an integrated strategy taking disability. Low investments in health result in into account both supply and demand factors. increased risks and enhanced out-of-pocket costs 5 AAWAZ This may involve building schools, providing for services – including tests, treatment, medicines, missing facilities, upgrading teachers’ skills base, and consultation fees – are largely unregulated eradicating political interference, and offering and have considerably high values attached broad-based social protection programmes. In to them. Dramatically reducing out-of-pocket addition, special measures need to be undertaken costs calls for developing a new policy regime, to end gender discrimination in education and prioritising universal healthcare, and allocation of promote female literacy. Disability is exclusion resources for the health sector. Resources should at its worst. In Pakpattan, children with special be generated and directed towards creating and needs remain very much marginalised. Steps strengthening health facilities at the grassroots, should be taken to fulfill their learning needs and tehsil, and district levels to provide a range of bring them into the mainstream. What actually is services and reduce the frequency of referrals to required to give a boost to education is a sense other cities. Reproductive health related services of ownership on the part of all the stakeholders, should be easily available to the population across including the government, civil society, political the district if the wellbeing of the community is to parties, donor organisations, and media. This will be ensured. Investments in public infrastructure clarify the assumptions, synthesise efforts, and will shorten the distances and address the issue create the synergy required to bring children into of access. Moreover, the private health sector school. should be regulated transparently and through citizen health committees to end