District Swabi Human Development Report District Swabi Human Development Report District Swabi Human Development Report Addressing Vulnerabilities in Education and Health: Responding to Out-of-School Children and Out-of-Pocket Expenses 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 District Swabi Human Development Report 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 Swabi: What Key Indicators Tell Us ........................................14 2.1: Human Development in Khyber Pakhtunkhwa: A Cursory Glance ...........................................14 2.2: District Swabi .........................................................................................................................15 2.3: Education in District Swabi .....................................................................................................15 2.4: Health in District Swabi ..........................................................................................................19 Chapter 3: Out-of-School Children and Out-of-Pocket Costs in District Swabi: What Qualitative Data Tell Us .......................................................................................................24 3.1: Out-of-School Children in District Swabi .................................................................................24 3.2: Out-of-Pocket Health Costs ....................................................................................................29 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 NCHD National Commission for Human Development CPR Contraceptive Prevalence Rate NER Net Enrolment Rate CDS Comprehensive Development Strategy PPHI People’s Primary Healthcare Initiative DFID Department for International Development PSLM Pakistan Social and Living Standards Measurement DHQH District Headquarter Hospital PTC Parents Teachers Council EFA Education for All RHC Rural Health Center FGD Focus Group Discussion SAP Structural Adjustment Programs GDP Gross Domestic Product SDGs Sustainable Development Goals HDR Human Development Report SPO Strengthening Participatory IMR Infant Mortality Rate Organisation IDS Integrated Development Strategy THQH Tehsil Headquarter Hospital KPK Khyber Pakhtunkhwa UC Union Council LHV Lady Health Visitor WHO World Health Organisation LHW Lady Health Worker MCH Maternal and Child Health MDGs Millennium Development Goals MICS Multiple Indicator Cluster Survey MMR Maternal Mortality Rate 4 District Swabi Human Development Report 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 Swabi. 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 Swabi, and ‘out-of-pocket health costs’ in the context of though relatively better, is not very satisfactory. the district and highlights issues characterising Enrolment, literacy, and school completion rates them. Despite numerous achievements globally are low. Pupil-teacher ratio is high and many in the domain of education since the inception primary schools in rural areas lack basic facilities. of the Millennium Development Goals (MDGs), Correspondingly, the number of out-of-children the problem of out-of-school children remains; in the district is not negligible. According to an fifty-eight million children of primary school age estimate, 9.2% children of school going age are (normally between six and eleven years) are still out of school. This can be ascribed to a range out of school around the world. This phenomenon of factors such as lack of quality and access, has a strong gender dimension as well, as thirty- poor infrastructure, and misplaced priorities. one million of the fifty-eight million children are Poverty, child labour, gender discrimination, and girls. The number of out-of-school children in disability also serve as barriers to education. Pakistan is estimated to be twenty-five million. Getting children into school requires evolving This report seeks to build a holistic analysis of the an integrated strategy taking into account both issue and discusses a range of variables central supply and demand factors. This may involve to it, viz.: access, quality, poverty, gender, and building schools, providing for missing facilities, disability. Low investments in health result in upgrading teachers’ skills base, eradicating increased risks and enhanced out-of-pocket costs 5 AAWAZ political interference, and offering broad-based prioritising universal healthcare, and allocation of social protection programmes. In addition, resources for the health sector. Resources should special measures need to be undertaken to end be generated and directed towards creating and gender discrimination in education and promote strengthening health facilities at the grassroots, female literacy. Disability is exclusion at its worst. tehsil, and district levels to provide a range of In Swabi, children with special needs remain very services and reduce the frequency of referrals to much marginalised. Steps should be taken to other cities. Reproductive health related services fulfill their learning needs and bring them into should be easily available to the population across the mainstream. What actually is required to the district if the wellbeing of the community is to give a boost to education is a sense of ownership be ensured. Investments in public infrastructure on the part of all the stakeholders, including the will shorten the distances and address the issue government, civil society, political parties, donor of access. Moreover, the private health sector organisations, and media. This will clarify the should be regulated transparently and through assumptions, synthesise efforts, and create the citizen health committees to end malpractices synergy required to bring children into school. like monopolisation, commissioning, profiteering, and producing and selling spurious drugs. Indicators related to health also present a gloomy Addressing vulnerabilities in health will eventually picture. Contraceptive Prevalence Rate (CPR) require prioritising health as a sector and an area in the district is fairly low and the incidence of of intervention, and offering policy prescriptions reproductive health related problems