Poor Sanitation is Stunting Children in Pakistan

More than one in every three children born in Pakistan today is stunted. Child stunting, measured as low height for age, is associated with numerous health, cognition and productivity risks with potential intergenerational impacts. With a stunting rate of 38 percent (Demographic & Health Survey 2018), Pakistan is still among the group of countries with the highest rates of stunting globally and the pace of decline remains slow and uneven. In Sindh, for example, things have worsened over time, with one in two children now stunted!

The policy response to this enormous health crisis has been almost entirely centered on interventions at the household level—reducing open defecation (OD), improving household behaviors like child feeding and care practices and food intake.

A recent World Bank report, which I co-authored, suggests that a major shift is this policy focus is required for significant progress on child stunting. The report begins by showing that over the past 15 years Pakistan has made enormous progress in reducing extreme poverty, with the poverty rate falling from 64 percent to just under 25 percent in 2016. This has improved dietary diversity, even among the poorest, and increased household investment in a range of assets, including toilets within the home. This has, in turn, led to a major drop in OD, from 29 percent to just 13 percent. Curative care has also expanded, with the mainstreaming of basic health units and the lady health worker program.

Why has progress on all these fronts made virtually no dent in rates of diarrhea and stunting?

In the report we argue that to reconcile these apparently anomalous facts, we need to refocus attention on why arguments for ending OD were made in the first place. The intended benefit of ending OD was to ensure the safe removal of fecal waste away from human settlements and waterways, in order to contain the bacterial contamination of water, soil and food. The role of E. coli bacteria in diarrhea prevalence has been known for a long time. Now research has also shown the far more damaging impact of environmental enteropathy (EE), a process by which fecal pathogens like E. coli can permanently damage the intestinal villi of young children making it difficult for them to absorb nutrients even during periods when there are no signs of diarrhea. EE leads to both stunting and a compromised immune system, with lifelong health challenges.

So, what does the available evidence on E. coli contamination in Pakistan tell us? While there is no systematic testing of water or soil, the Pakistan Council for Research in Water Resources (PCRWR) has been conducting water quality tests in some locations. These tests almost invariably reveal high levels of E. coli. contamination.

Water tests done as part of a long-term study in rural Punjab and Sindh that is being conducted by me and my co-authors at the World Bank, show that more than one-third of the water samples drawn directly from hand and motorized pumps, as well as from piped water supply systems, in rural Punjab were contaminated with E. coli bacteria. This numbers are consistent with PCRWR (2011) for Punjab. What is more alarming is that the rate of bacterial contamination rises to 50 percent, when water storage devices within the home are tested. In Sindh, things were much worse. Close to 60 percent of ground water was contaminated at source, with contamination rates rising to 75 percent when water storage devices were tested.

Why is ground water in the most densely populated areas of rural Pakistan so contaminated? The answer lies in the way expansion in access to “improved” toilets and water supply has been achieved. There has been almost no public investment in water or sanitation systems in rural Pakistan. Instead, households have largely self-provided for both, and have done so in the absence of even a basic set of regulatory guidelines. The result has been devastating, especially in the poorest districts. In rural Sindh, for example, most toilets are of the leaching pit or open drain variety and are built in close proximity to water pumps. This sets the stage for the substrate contamination of ground water, especially where the aquifer is shallow. Open drain toilets further concentrate untreated fecal waste around human settlements and much of the waste flowing in open drains eventually enters surface water systems spreading the contamination. Fecal waste is also dumped in open trash heaps around villages, spreading more contamination to surface soil. It doesn’t end here. Untreated waste water is routinely mixed with ground and surface water for crop irrigation. This creates further downstream effects, contaminating the food grown and distributed for consumption in the major urban centers of the country, where it is consumed by the rich and the poor alike. Together this chain of contamination multiplies the channels through which the oral transmission of fecal bacteria can occur—food, flies, fingers, fields, and fluids.

The incidence of diarrhea in Sindh’s largest cities provides clear evidence of this. Even the richest households in cities like Karachi and Hyderabad report diarrhea rates among young children of close to 30 percent. In fact, as we show in the report, living in proximity to an area with poor quality sanitation provides roughly the same exposure to fecal pathogens as being poor.  Interestingly, the evidence also shows that areas with the highest levels of diarrhea and stunting engage in roughly similar or better health behaviors than areas with lower levels.

If anything, stunting, diarrhea and other types of morbidity could well have increased in Pakistan, were it not for the decline in poverty and improvements in diet and primary health care.  This is not to suggest that these factors do not need attention. They do! The problem is one of squarely confronting what is first order. Dietary, curative and behavioral improvements can serve as a temporary bulwark at best, unless the total fecal burden in the environment is reduced, the treatment of water is prioritized and the use of untreated waste water for crop irrigation is controlled.

Dr. Ghazala Mansuri is the Lead Economist at the World Bank.

Women’s Mobility and Labor Force Participation in Karachi: Some Preliminary Observations

Pakistan has the lowest female labor-force participation rates in South Asia and urban areas perform especially poorly . Distinct patriarchal norms interlinked with migrant status can affect women’s autonomy and thus labor-force participation in different ways. Recently the Collective for Social Science Research conducted fieldwork for the IGC supported project ‘Women’s Agency and Mobility in the mega-city of Karachi and their Labor-Force Participation’ at three ethnically purposive sites. Many female respondents mentioned instances, relative to patriarchal norms and structures of their communities, which informed their ability to work in the city. In this blog, we attempt to present a current snapshot of some of the diversity of women’s experiences with regards to labor force participation in relation to their community norms and migrant status in Karachi.

Lyari

Lyari is considered one of the oldest neighborhoods in Karachi, and pre-dominantly consists of Baloch and Katchi populations that have long assimilated here. Most young Baloch and Katchi women we interviewed preferred to work and complete their education.3 Two-thirds of younger women have at least completed Intermediate exams and nearly all aspired to hold undergraduate degrees if they didn’t already. In terms of mobility, our female Balochi respondents within Lyari did not report restrictions on mobility from patriarchal figures in the household or street harassment by strangers to the same degree as in other sites where this study was conducted. One respondent who works as a teacher noted that her community respected her a lot for her job, and that when she is walking to work, men actively move out of her way. The extent of mobility and the relative lack of restrictions described by some of the Balochi women around issues of respectability and safety, strictly in a comparative sense with other localities in Karachi, have been surprising for us to learn and are indicative of norms improving overtime, in conjunction with length of the migration period.

In terms of hindrance to employment, an issue most women noted was labor-market discrimination pertaining to ethnicity rather than gender. Nearly all of our respondents complained about rampant racism in the rest of the city against Lyari residents and its adverse effects on their employability. Being Baloch in addition to being a Lyari resident compounded the problem more so.

Baldia

Baldia was selected as a site because it consists of predominantly Pashtun migrants. For women, earning was considered disgraceful and dishonorable because it implied that the household was running on the woman’s income instead of the man’s and the sense of emasculation is a major cause of disrepute for the men in the community. Despite income issues, prospects of poverty still do not seem to mobilize women or let men from their household to relent and let them work or earn. The only instances women resorted to working were in the face of extreme destitution as a result of the absence of a male patriarchal figure and bread-winner in the household, at the expense of disrepute in the community. Older women also hardly held jobs – not even cleaning jobs in households, unlike the other two sites we investigated. Similarly, in terms of education households frequently stopped their daughter’s education after primary school or once they reached puberty, and cited ‘azaad mahol’ (permissive environment), which points towards future potential constraints to labor-force participation.

Korangi

Korangi was chosen due to the ethnically heterogeneous nature of the community and the prevalence of Urdu-speaking and Sindhi populations in the area.
In terms of employment, similar to Lyari, the long assimilated Urdu-speaking and Sindhi women did low-paying private school teaching jobs. If they had income issues they took up better paying, but far more demanding, company or factory jobs. Working in the nearby garment factories was commonly reported by some of the respondents. Older uneducated women usually took up work as cleaners in other households but this was not considered respectful work by them. In contrast, newer Sindhi migrant women were not allowed to work at all, especially if they were young, due to anxieties pertaining to the strangeness of the new and unfamiliar city.

Conclusion

There is indication that patriarchal arrangements relative to migrant status and cultural notions of respectability, determine the extent of women’s participation in the labor market. The relegation of women’s labor force participation only to certain acceptable occupations or by keeping women at home entirely, unquestioningly indicate that gender norms play a role in shaping women’s labor force participation in Pakistan. In an urban context, mobility is complicated by distinct norms pertaining to patriarchy within their communities, geographic and spatial anxieties due to migrant status, and histories of conflict within the city. Our preliminary findings suggest a differentiated employment strategy concerning women’s labor-force participation, underpinned by social-policy that is context-specific to communities within Karachi is needed.

 

Natasha Ansari is a Research Associate at Collective for Social Science Research.

Between a Rock and a Hard Place

Older residents of Lahore often proffer that in the last few decades the city has changed drastically, and not for the better. While some may dismiss these sentiments as mere nostalgia, the assertion remains empirically observable. It seems as if in the blink of an eye roads that were often deserted just a few years ago now play host to traffic jams that last hours. While the problems that have led to this situation are varied and complex, there is one aspect that demands immediate attention and redress: urban transport.

Among the many difficult decisions that the new PTI government must grapple with, the future of investments in Pakistan’s urban transport infrastructure, particularly in Punjab, will carry salience in the coming years. While the federal government must contend with a potential $8 billion IMF bailout program, and the austerity that is expected to accompany it, it may not sit well with the new Prime Minister’s campaign promises of improvements in human and physical capital, and an overarching promise to improve the quality of life for the country’s 200 million citizens.

One fundamental aspect of this quality of life is the manner in which people and goods move about. Any future story of Pakistan’s growth will be incomplete without an accompanying story of how it moved.

Currently, an estimated 36 percent of the population lives in urban settlements, with the vast majority relying on private means of motorized transport for their mobility needs. According to the National Transport Policy commissioned by the Ministry of Planning, Development and Reform in 2017, Pakistan’s population travels almost 400 billion passenger kilometers (pkm) each year, with an expected 5-fold increase to 2 trillion by 2050. Between 2006 and 2016, the number of registered motorcycles grew from less than 5 million to more than 12 million. This increasing dependency on private transport puts a strain on physical infrastructure that the country is not equipped to deal with. The lack of quality infrastructure results in growing congestion, environmental problems, and road accidents, in addition to the negative impacts on economic productivity. Simultaneously, and perhaps more severely, it also impacts citizens’ access to basic services such as healthcare, schooling, housing, and entertainment.

As it is, Lahore’s urban sprawl has become a severe hindrance to public service delivery. Poor service delivery within the center forces people to move out towards the suburbs. As the city expands, service delivery over greater distances becomes even more costly. And if the city continues to spread, it will become even more difficult to maintain connectivity. In addition to the more tangible effects, this has effects on the fabric of society as well. The sense of community, of self, of identity, become things of the past. People grow to become insular, disconnected from everything around them.

As the country’s urban population, continues to grow, the lack of an integrated transportation system will increasingly constrain any aspiration for economic growth. Nowhere will this be more apparent than in Lahore and Karachi, the two biggest urban centers

In the backdrop of the austerity measures that have been announced, the question of whether the country can delay investments in its urban transport infrastructure is an important one that must be answered. This is particularly salient in light of the demands that investments in the country’s human capital place on the budget. Will transport be kicked down the road and become someone else’s problem or will the current government play a more proactive role?

Why investments in Lahore’s public transport must continue

If there was any time for the government to be proactive viz a viz urban transport, it is now. As things stand, many of the high costs associated with the Green Line Metro Bus and the Orange Line Metro Train systems are the costs of bad planning in the past. Despite having a population of over 11 million people, Lahore still lacks an effective and integrated public transport system. While the Green Line has shown signs of success despite its various problems, it still largely operates in a silo. Similar concerns hold for the Orange line. Unless thousands of buses are deployed to operate in mixed-mode traffic, much more than the 1574 planned by the Punjab Mass Transit Authority, we will see no changes in congestion. By rough estimates, Lahore needs at least 9000 buses to meet public transport needs.

The emphasis, however, lies on integration. Public transport needs to become a staple of daily life. It needs to be safe, accessible, and of good quality. For example, people shouldn’t have to first take a rickshaw to the nearest market or town center to catch a bus.

In order for public transport to truly take center-stage in public discourse, we must reframe the narrative around it. Decreasing congestion or making it easier for the car-owning public to travel should not be the primary aims of public transport. It is important to think about public transport in terms of moving workers and goods. Lahore has a varied economic base with about 9000 industrial units and about 42 percent of its work force employed in finance, banking, real estate, community, cultural, and social services. The lack of an integrated public transport network increases both the costs that businesses incur in attracting workers and the costs that workers face in commuting to their places of work. As more and more commuters shift to public transport, it simultaneously becomes easier for goods to be transported within the city. And as it becomes easier to do business and for workers to move about, effects spill over into productivity and growth as well.

At the same time, this urban mass transit should be combined with improvements in intra-city transport networks as well. The World Bank’s Logistic Performance Index for 2018 ranked Pakistan at 122 among 160 countries for the quality of trade and transport infrastructure and quality of logistics service providers. A regular bus service, higher-order transit systems like the Green and Orange lines, and integration with high-quality intra-city rail networks would go a long way in making both the city and the wider region more mobile.

Effective public transit systems require both investments in physical infrastructure, and consistent and coherent policy clarity through land-use and town-planning authorities. While one can appreciate the fiscal constraints posed by a weakening economy, the importance of public transport cannot be understated. Given its long-term impact on economic productivity, it must remain a priority for the new government.

Bakhtiar Iqbal is a Research Assistant at Consortium for Development Policy Research (CDPR).

Third Tier Organisations (TTOs) in Pakistan: Filling Public Delivery Gaps at the Community Level

Third Tier Organisations (TTOs) are essentially volunteer organisations for community-driven development. They help provide representation to around 30,000 people within the Union Councils that they are located in, and help fill the gaps left by unaddressed community needs. For this reason, TTOs are also known as Local Support Organizations (LSOs). There are around 1,000 TTOs active across Pakistan in the spheres of health, education, microfinance, human rights, community infrastructure, and other sectors. These organisations do not typically generate revenues and thus require funds, either through private fund-raising mechanisms or provision of funds through donors, government, or their Partner Organisations (POs). Leading POs include the National Rural Support Programme (NRSP) that is engaged with 60% of the TTOs, followed by Sindh Rural Support Organization (SRSO) (11%), Sarhad Rural Support Programme (SRSP) (8%) and Agha Khan Rural Support Programme (AKRSP) (7%). In particular, POs are the primary support system for the TTOs as they closely monitor and support the aims of the TTOs under their purview to ensure that they operate with as much ease as possible.

Since POs look out for the interests of their TTOs, they provide monetary backing through direct and indirect funding, as well as non-monetary support by way of coordinating their activities across government and line departments. In addition to this, they also supply technical advice or staff trainings when needed.

Empowering and working directly with TTOs can help improve government outreach for public service delivery because TTOs have optimal proximity to the needs of the community for the delivery of innovative and tailored solutions.

Pakistan Poverty Alleviation Fund (PPAF), a not-for-profit organization, has been championing coordinated efforts to increase the institutional capacity of civil society organisations at the forefront of ending poverty from the grass root level. To this end, PPAF has secured government backing, as well as of the World Bank, in designing and implementing capacity-building development interventions targeting TTOs through their link with a large network of POs.

The workings of a Third Tier Organisation (TTO)

Improving access to health and education, and provision of legal support for attainment of human rights, are the main areas of cooperation between the TTOs and the citizens in Pakistan. To successfully execute the agendas for each TTO category, thorough coordination with the government is often crucial. However, sometimes it is not readily available and TTOs have to pressurize the government to get their support through sit-ins and meetings.

In general, TTOs require external funds in addition to locally-generated funds for catering to the demands of their community, especially for the provision of infrastructure and setting up of vocational training facilities. PO’s and external donor funds help improve the outreach of the particular TTO receiving it, but almost all TTOs continue carrying out local fund-raising in addition to the external financing they might or might not receive. In spite of the majority of TTOs not being beneficiaries of external financing, TTOs have continued to utilize whatever resources at their disposal for the avid pursuance of community development.

How education levels of TTO management impact outcomes and perceptions

TTOs with less educated Executive Body (EB) members are considered to be less mature and are therefore visited more frequently by social mobilizers so that the PO can oversee their activities from afar, in addition to directly visiting them. Further, TTOs with less educated Executive Body (EB) Members apply for less funding than their counterparts run by more educated members, whereas TTOs with a higher proportion of educated members are perceived to be making more progress in their community-driven objectives as reflected in citizen feedback. This might be unfair because even less educated EB members are extremely proactive in their philanthropic pursuits.

EB positions are not always held by educated members alone. All the major EB offices, including that of president and secretary are held by EB members with average education of 10 years. This is an encouraging observation showing that a lack of education is not a barrier to participatory civic engagement.

TTOs work in tandem with their POs through actively reporting to them, either verbally or by submitted progress reports on the criteria identified by the POs. It is quite promising to note that TTOs across all regions reported regularly to their POs. More specifically, it was noted that TTOs with a predominance of higher educated members were found to report less frequently to their POs and Punjab is second to Sindh in terms of having a high proportion of less educated TTO members. Punjab has recorded the highest frequency of reporting to their POs, which might have to do with the lower education levels across its TTOs. EB members in all the other provinces are on average twice as educated as the EB members of Sindh.

POs provide training for improving financial management of TTOs followed by Union Council (UC) plan development with PO respondents reporting that generally participants in these trainings understand the material well. Encouragingly, PO respondents rated around 52% of TTOs performing for the benefit of the people.  TTOs perceived to be the worst performing are located in KP and Balochistan.

Further, there is a direct correlation between the level of activity of the TTO and PO’s contribution in their affairs. This shows that POs either reward TTOs for being more active by providing their all-out support or PO support led to the increased activity of the sponsored TTO.

Where TTO capacity currently stands and the way forward

The most encouraging finding from the base line survey of TTOs across Pakistan is that TTOs are sustainable irrespective of external funding. This suggests that TTOs remain afloat for the purpose of genuine service delivery and are keen to learn through PO trainings and fully utilize all the support they can get. TTOs in KP and Gilgit are most active, with Gilgit generating the highest amount of annual income of 650,000 PKR while TTOs in Balochistan are least active, and also generating the lowest annual income of around 34,000 PKR. Regions such as Gilgit and Punjab receive much higher international donations, in addition to the high involvement of POs in their TTOs’ development. As a result, TTOs in Gilgit also have the highest accumulation of assets, but it cannot be discounted that these TTOs were among the earliest formed in the country. TTOs in Balochistan have also grown significantly as reflected in their growth of financial assets, but in absolute terms are still lagging behind other regions.

Government funding is not significant enough to account for the growth of TTOs probably because government funding is not based on ground-realities of where funds are crucially needed. This is an area where PPAF can help the government make informed decisions for redirecting its funds to resource-strapped TTOs in the poorest regions of the country. Hence, TTO development is largely neglected by the government and needs to be promoted.

This blog post is based on the International Growth Centre’s (IGC) study, “Outsourcing state capacity: A field experiment in Pakistan“.

Sharmin Arif is the Communications Associate at Consortium for Development Policy Research (CDPR).

Mapping Civil Society Spaces in Pakistan: A Preliminary Foray into CSOs Working on Child Abuse

In January 2018, when the abduction, rape and murder of Zainab Ansari, a 7-year-old girl in Kasur – the latest at the time in a series of brutal instances of sexual abuse of minors in the area – led to a public furor[i], we set out to map civil society organizations (“CSOs”) in Pakistan working in the field of child abuse. At the outset, we decided to spread the net wide and to reach out to CSOs whose work we identified at face value as relating broadly to child rights and child protection (“CRCP”).[ii] Our working assumptions were that CSOs working directly on child abuse were likely to be small in number, and that even within this sample CSOs were likely to integrate their work on child abuse within a larger agenda on CRCP. The objective of this mapping exercise at the time was threefold: firstly, to simply document the credible CSOs that were actively involved in some way or to some extent in CRCP, and to get a sense of how inclusive these CRCP agendas were of issues related to child abuse, in particular sex abuse, issues; secondly, to observe whether and how CSOs mobilize around specific incidents or events (presently, the highly publicized case of Zainab); and thirdly, to explore the quality of voluntary linkages between different CSOs or amongst clusters of CSOs working on CRCP. The latter objective was motivated by our curiosity to learn more about how thick and overlapping the CSO network is in relation to child abuse issues. In other words, what is the nature of connections between CSOs and to what extent are these connections based on mutual relations of trust and reciprocity (thick); and how many CSOs are involved in the same or similar kind of activity (overlapping). These kinds of questions about voluntary association between CSOs have implications for evolving a broader consensus on a given issue or set of issues, openness to information transfer and resource pooling, and capacity for collective action and mobilization.

Below we present a list of CSOs we identified and mapped (i.e. interviewed in person or over the phone) between January and March 2018. This is by no means an exhaustive list. Because of paucity of both time and access to information, we limited ourselves to 13 CSOs that had a visible presence online and responded to our request for a candid conversation on their organizational structure, nature of work, funding sources, partnerships, general perceptions about other CSOs and government departments working in the same field, and sphere of work particularly in relation to child abuse (with a particular focus on sex abuse). We categorize these 13 CSOs according to a typology based on three ideal types of core CSO activity: “service providers,” “capacity builders,” and “advocacy organizations.” The combinations we have identified on the basis of this typology are: service providers, service providers & capacity builders, service providers & advocacy organizations, capacity builders & advocacy organizations, service providers, capacity builders & advocacy organizations, and advocacy organizations.[iii] We hope to add to this list over the course of the coming months and to expand our inquiry to issues beyond child abuse in order to further develop our working hypotheses on the nature and organization of civil society spaces in Pakistan. We end with some early observations from our mapping exercise.

SERVICE PROVIDERS

(1)                Bali Memorial Trust

Bali is a Lahore-based CSO that provides “holistic services to the underprivileged,” including education, health, old people’s sanctuaries, girls’ shelters and orphanages, a women’s crisis center, and a general helpline center. Bali’s mantra is that its services are “broad and inclusive” and “cater to the needs of the community.” The first point of contact at Bali is through its weekly “walk-in days” where anyone in need of assistance can simply drop by. Bali aims to deal with all facets of a crisis, providing some services themselves and outsourcing others through a referral system. Services include medical help, school stipends, psychological help, speech therapy for children, and sanctuaries and shelters.

Rabia Usman – the Program Manager at Bali – explains that child abuse is seldom reported directly. Recognition of such issues usually arises during conversations with women approaching Bali in crisis situations. Abused children who need psychological help along with temporary shelter can stay at an in-house crisis center that Bali runs from its office premises. Importantly, this crisis center attempts to plug a major loophole in the existing legal framework in Punjab: it offers shelter to boys in the 16-18 “transitional” age group who have been left out of the protective cover provided by the Child Protection Bureau.

(2)                Idara Aaghosh

Aaghosh is a Lahore-based CSO that works in the field of CRCP, with a focus on the emotional well-being of abused, exploited and neglected children on the street, runaway children, and those involved in child labor, delinquent or criminal activity, or sex trade. The core services provided by Aaghosh have shifted in the past few years due to various constraints, including funding problems and governmental pressures.

Naseer Ahmed – the founder of and General Secretary at Aaghosh – shares that in the early 2000s, Aaghosh focused on rehabilitating abused children through education. It set up a charitable school network across Punjab (comprising 36 schools) known as the Aaghosh Schools System. At its peak, this System had a total enrolment of 2,000 children. A change in government policies, however, compelled the System to shut down, causing Aaghosh to transfer all its students to government schools while continuing to help and liaison with the children’s families. Many children dropped out of school during this transition. After the closure of the Aaghosh Schools, Aaghosh began community building work in Sargodha, including renovation of baithaks or community centers, vocational training for women, and sensitization of Imams at local mosques to mobilize communities to enroll out-of-school children in school. Through this work, Aaghosh has dealt indirectly with child abuse issues on a case-by-case basis but concedes its inability to expand the scope of this intervention because of the “cultural context.”

(3)                Ittehad Foundation

Ittehad is a Kasur-based grass-roots CSO with a broad mission of empowerment, literacy and capacity-building of women, children and youth. One limb of its work relates to achieving CRCP through children’s education and community awareness programs. Ittehad provides both formal and non-formal education to children in Kasur free of cost. It started its operations from a small non-formal center in a katchi abadi in 2001 with 30 children when there were no public schools in the area. The aim was to create a smooth transition for out-of-school children, including those involved in child labor. This first center is now a formal school with a current capacity of 150 children. Ittehad continues to operate a number of non-formal schools in localities with high child labor populations in order to integrate education and awareness about child protection into this very vulnerable group of children.

Irshad Safdar – the current Chairperson of Ittehad – states that since January 2018 when the incident of the rape and murder of Zainab arose, Ittehad has been partnering with Sahil (see below) to develop and integrate CRCP awareness materials into the curricula for both their formal and non-formal schools. Ittehad plans to work not only with children and students, but also parents and communities through CRCP trainings and community mobilization.

(4)                Alpha Foundation

Alpha is a Kasur-based grass-roots CSO working in the field of literacy and community development with a focus on children between the ages of 5 and 14 who are employed as labor in tanneries and leather industries.  As part of a recent 5-year program, Alpha has established 12 non-formal education centers across the Kasur district for providing literacy programs to working children who are not enrolled in school. These centers allow children to work while motivating them to experience a school-like experience for a few hours every day. Other components of this program are mobilization of mothers and communities to allow their children to attend the centers after work, as well as awareness programs for factory owners to facilitate working children’s participation in Alpha’s centers. Through this program, Alpha has enabled 180 girl-students to sit for grade 5 board exams and mainstream into formal public schools.

Jawwad Bukhari – the Chairperson of Alpha – states that like other Kasur-based CSOs, Alpha is presently collaborating with Sahil (see below) to integrate CRCP awareness materials into their educational programs in their non-formal centers.

(5)                Good Thinkers Organization (GTO)

GTO is a Kasur-based grass-roots CSO working broadly on human development with a special focus on transgender communities and women, and to a lesser extent, on children. In relation to their work on children, GTO has focused in the recent past on mainstreaming out-of-school children through “drop-in centers” for working and street children to transition them to public schools over time. In 2012, GTO began with 55 children, and was successful in mainstreaming over 200 children in public schools in Kasur through Grade 5 board exams. With respect to child abuse in particular, GTO organized awareness campaigns through local events in both 2015 and 2018, and also provided legal aid and other legal support for some children affected by the child sexual abuse and trafficking scandal that emerged in 2015.

Awais – the Program Officer at GTO – shares that GTO has not been able to sustain much of its work on children because of major financial constraints. He explains that quite apart from the government refusing to allocate funds to child rights issues, international donors dealing with child rights are generally very reluctant to come to Kasur, and funding is fast drying up in this area.

 

SERVICE PROVIDERS & CAPACITY BUILDERS

(6)                KONPAL Child Abuse Prevention Society

KONPAL is a Karachi-based CSO that has a direct focus on child abuse, including child sex abuse and commercial sexual exploitation, child labor in hazardous occupations, and violence against children generally. KONPAL works with four main groups of “stakeholders”: doctors, teachers, mothers and children. Its larger aim is to create awareness among these stakeholders of issues relating to child abuse.

Dr. Aisha Mehnaz – the current Chairperson – explains that because a large majority of professionals associated with KONPAL are doctors, most of their activities tend to be centered on doctors and hospitals. For instance, KONPAL has set up Child Protection Committees (“CPCs”) in a number of major hospitals in Karachi as a way of integrating medical treatment for child abuse into the hospitals’ service provision. Through these committees, KONPAL trains medical staff to recognize and deal with cases of sex abuse, corporal punishment and parental neglect of children coming into these hospitals for medical treatment, and to provide rehabilitative care to the affected children. Some of the CPCs continue to function, but KONPAL is no longer directly involved in funding or monitoring them because of resistance from government hospitals and the general lack of prioritization by the government of the health sector.

More recently, KONPAL’s work has shifted to providing capacity-building trainings to doctors and medical practitioners generally to help them identify and appropriately respond to instances of child abuse.

(7)                Protection and Help of Children Against Abuse and Neglect (PAHCHAAN)

PAHCHAAN is a Lahore-based CSO with a mission to protect and empower children against abuse and neglect and build the capacity of care-givers and duty-bearers (parents, service-providers and government) in relation to child abuse. PAHCHAAN’s approach to CRCP is to focus on the larger “ecological environment” of children; in other words, to integrate children’s rights into healthcare, education, and community mobilization. PAHCHAAN’s earliest project, now running for over 10 years, is the Child Protection Unit at Children’s Hospital, Lahore (“CPU”). The CPU comprises of regular hospital staff that has been trained by PAHCHAAN to make early detections of a broad spectrum of abuse cases, including neglect, violence, psychological abuse, and sex abuse. If this trained staff suspects child abuse, they report it to a Child Protection Officer (“CPO”) – PAHCHAAN’s trained psychologist – in addition to providing medical treatment. The CPO then makes her own assessment and offers counselling services to the abused child and his/her parents and family. PAHCHAAN also covers social support expenditures for patients being counseled by the CPO (such as clothes, food, toys, etc.) as a large majority of them come from outside of Lahore straight into emergency.

Mehak Zafar – the Coordinator at PAHCHAAN – explains that the organization also offers legal help where it is needed through referral to a small group of pro bono lawyers. However, “95 % of the times” people decline legal help, partly because they don’t believe that there is a moral problem with child abuse and partly because of the complications they anticipate in dealing with the legal system.

PAHCHAAN’s more recent work is centered on children’s education. This includes community mobilization programs that seek to sensitize communities toward enrolling out-of-school children in school, and to raise awareness on important social issues like cleanliness, child marriage, etc. The latest education-centered program involves establishing Child Rights Departments (“CPDs”) in college and higher education institutions to integrate child protection into academia. PAHCHAAN has just set up its first CPD at the School of Integrated Social Sciences at University of Lahore.

SERVICE PROVIDERS & ADVOCACY ORGANIZATIONS

(8)                Society for the Protection of the Rights of the Child (SPARC)

SPARC is a country-wide CSO, headquartered in Islamabad with regional offices in Rawalpindi, Hyderabad, Peshawar, and Multan. Its mission is to promote and protect the rights of children through advocacy supported by research, awareness raising, service delivery, and human and institutional development. Its sphere of action relates to child labor, bonded labor, street children, juvenile justice, education, child marriage, and child sex abuse. SPARC’s forte is its advocacy for child rights, for which it releases an annual “State of Pakistan’s Children” report. In addition to this flagship report, SPARC’s current advocacy focus is on juvenile justice and the responsibilities of the relevant authorities under the Juvenile Justice System Ordinance, 2000. Aligned with this advocacy is SPARC’s work on improving conditions in juvenile prisons and securing the release of as many children as possible from jails. On the service provision front, SPARC runs several Centers for Street Children (“CSCs”) – though a few have been shut down recently due to lack of funding – and provides technical and vocational skills to 6,000 girls and young women in Multan and Muzzafargarh.

Farshad Iqbal – the Coordinator at the Islamabad office – states that this latter project relating to provision of technical and vocational skills caters to adolescent and college-level girls between the ages of 16 and 18 from very poor households who have been victims of early and forced child marriages. SPARC, he says, is filling a big vacuum in the government’s child protection policy that does not empower the Ministry of Human Rights to provide dedicated child protection units for girls of this age group.

With respect to child abuse, SPARC reports on child abuse and related issues annually in its flagship report. It also undertook a special fact-finding on Zainab’s case in early 2018, which is available, at the time of writing, on SPARC’s website.

(9)    AGHS Child Rights Unit (CRU)

CRU is a Lahore-based CSO focusing on advocacy, awareness, and legislative reform around issues relating to child protection, including violence against children, child labor, girl child marriages, and juvenile justice. The core activity of CRU is highlighting systemic and procedural faults in the criminal justice system in order to inform and push for legislative reform. Two areas in which CRU has worked extensively to influence policy and legislation are juvenile justice and prison reform for vulnerable groups (mainly women and children). Specially with respect to prison reform, CRU undertakes regular jail visits to document all the serious issues with custodial methodology, and to closely monitor children in jails, most of whom are simply accompanying their incarcerated mothers. In addition, CRU organizes community awareness programs with parents on issues of child labor, child sex abuse, and child marriages.

CRU does not primarily focus on legal aid or assistance. However, it does at times deal with “urgent relief cases” in relation to children in jail and/or involved in criminal police investigation or trial processes as victims, the accused or witnesses. In such cases, CRU helps in taking children out of jail, getting children bail, or monitoring trial processes involving children. It also refers or facilitates the transfer of criminal cases involving children to the newly established Child Protection Courts in Punjab.

Sabahat Riaz – the Coordinator at CRU – explains that the CRU was originally a program of the AGHS Legal Aid Cell but is now physically and financially housed within Dastak, a sister concern of the AGHS Legal Aid Cell that runs a shelter house for women and children. This allows CRU to be fully integrated into the services offered by Dastak, while also enabling it to refer cases of legal aid to the AGHS Legal Aid Cell. However, CRU is not a financially independent entity and depends on Dastak for sustainability.

(10)            War Against Rape (WAR)

WAR is a Karachi-based CSO with a mission to advocate on behalf and for the rights of women and child victims of sex abuse and violence, and to provide crisis interventions for survivors of rape and domestic violence through free services like legal aid, psycho-therapeutic counseling and basic medical assistance. WAR’s core activities have remained fairly consistent over time and include ongoing awareness raising sessions at schools and other educational institutions about sexual violence, initial as well as long-term counseling and support for survivors of rape and domestic violence, and provision of free legal aid and legal counseling for such victims. WAR also has an aggressive advocacy component for legislative reform.

Beena Hasan – the Coordinator at WAR – states that WAR is the only not-for-profit organization in Karachi that provides such specialized services to survivors of sex abuse and domestic violence. WAR investigates a hundred cases of rape in Karachi each year on average and encourages survivors to press charges against the perpetrators. It prosecutes 20 cases on average within Karachi in a year – but it is unclear what proportion of these cases relates to child sex abuse.

 

CAPACITY BUILDERS & ADVOCACY ORGANIZATIONS

(11)            AAHUNG

Aahung is a Karachi-based CSO with a mission to improve the sexual and reproductive health and rights (“SRHR”) of women, men and adolescents. Aahung is the pioneering – and continues to be the leading – CSO on SRHR in Pakistan. In relation to children, Aahung has been working on the prevention of child sex abuse for almost a decade, mostly through training of teachers and parents to talk about sex abuse with children and young people. The organization has developed a Life Skills Based Education (“LSBE”) program, which is a comprehensive curriculum focusing on body protection and child sex abuse prevention. Through the LSBE, Aahung integrates sexual and reproductive health awareness along with prevention awareness for sex abuse into secondary school curricula. Hence, Aahung works closely with schools and community-based organizations.

Aisha Ijaz – the Program Manager at Aahung – states that the organization was experiencing serious bottlenecks in operationalizing the LSBE in public schools because of non-cooperation from the Sindh government. But after Zainab’s case in early 2018, it was finally able to get a firm commitment from the government, which is now taking tangible steps to incorporate LSBE into the public secondary school curriculum.

 

SERVICE PROVIDERS, CAPACITY BUILDERS & ADVOCACY ORGANIZATIONS

(12)            Sahil

Sahil is a country-wide CSO, headquartered in Islamabad with regional offices in Lahore, Sukkur, Abbottabad and Jaffarabad. Its mission relates directly to child protection through the development of “a protective environment for children free from all forms of violence,” with a particular focus on child sex abuse. Each Sahil office provides two core services through trained resident staff: legal advice and referral, and psychological counselling.

Sahil’s work can be divided into four components. The first is a teacher training program on child protection, consisting of resource material for educational practitioners to create awareness around child abuse, in particular child sex abuse. Sameera – the Resident Psychologist at the Lahore Office – states that Sahil’s material is culturally sensitive and contains “soft messages” that can effectively get otherwise taboo concepts across without being offensive. Sahil also sensitizes and trains teachers to identify child abuse cases in the classroom and to communicate with abused children. Sahil’s teacher training programs are currently running in both private and public schools across the country.

The second component is Child Protection Networks (“CPNs”) which are essentially community programs offering general health awareness for both children and adolescents as well as awareness about child abuse. Sahil is presently involved in setting up CPNs at the village level with representation in Union Councils so that they may be linked through a larger referral support system to relevant public and private organizations at the district level. The third component of Sahil’s work is counselling services for affected children and families on a walk-in basis. The fourth is legal advice and aid provided through a resident legal advisor and a referral network of lawyers funded by Sahil. Most legal aid cases come to Sahil through teachers, community members in the CPNs, and Sahil’s own helpline.

 

ADVOCACY ORGANIZATIONS

(13)            Human Rights Commission of Pakistan (HRCP)

This mapping exercise would be incomplete without a mention of HRCP as the leading human rights advocacy organization in Pakistan. Fact-finding missions are HRCP’s flagship advocacy output. In 2015, HRCP undertook a middle-tier fact-finding mission on the child sex abuse and trafficking scandal in Kasur in partnership with a few other CSOs (including AGHS and South Asia Partnership Pakistan (SAP-PK)). The mission was led by Hina Jillani. A copy of the main observations from the fact-finding mission is available on file with IDEAS.

Some Early Observations

  • Broadly, the 13 CSOs we mapped fell into 5 substantive categories: (i) general crisis assistance and advocacy, (ii) child rights and child protection (CRCP), (iii) sexual and reproductive health and rights (SRHR), (iv) sex abuse and violence, and (v) specifically or predominantly child sex abuse. Most CSOs fit into (ii), 2 fell into (i), only 1 each fell into (iii) and (iv), and 2 fell into (v). The CSOs in this last category of child sex abuse are KONPAL and Sahil. All the other 11 respond to child abuse and/or sex abuse in some manner or degree, whether directly or indirectly. Mostly, however, activities and advocacy around child sex abuse are part either of a larger menu of issues in relation to CRCP or of a broader target population that includes children as one of more vulnerable groups. Nonetheless, there is much overlapping of issues relating to children in these CSOs, especially in those working on CRCP.
  • As expected, we found much variation in the size, organizational structure, capacity, and social capital of CSOs working on CRCP. This very small sample size offers some very preliminary and tentative observations. Firstly, local grass-roots organizations tend largely to be service providers. This seems to go hand in hand with greater flexibility in the nature of their work, so they can shift periodically from one target population or issue to another in order to obtain sufficient and diversified funding, or a “survival budget,” to remain afloat. The nature of their work is, thus, either broadly defined or project-based. Secondly, service providers, whether at the grass-roots or higher level, tend generally to struggle financially and are more susceptible to quick changes in their core focus or activities. Thirdly, service providers who have graduated to becoming service providers & capacity builders tend to report greater financial stability, though at times at the expense of the service provision. This also seems to be the case for service providers & advocacy organizations which tend to have a relatively larger portfolio of advocacy activities. Finally, CSOs that rest on a very narrowly defined or highly specialized issue or activity tend also to have more organizational stability, report less resource constraints, and show greater consistency and focus in relation to their core work (examples include WAR (legal aid for victims of sex abuse), Aahung (SRHR), and Sahil (child abuse).
  • While we did not include governmental departments and entities focused on CRCP in our preliminary study, we were able to elicit responses from many of the CSOs we mapped about the quality of their interaction with the government sector. We noted four kinds of CSO-government links that potentially impact the organization of civil society, the nature of CSOs’ work, and both the enabling and constraining factors that shape CSOs’ core activities. The first kind of link was defined by the need for CSOs involved in advocacy to lobby the government for legislative reform. Such activity necessitated a CSO-government link. The second kind of link was between CSOs involved in capacity-building of government-sector employees working in the CRCP field. Once again, this sort of activity positioned such CSOs within an overlapping space with the government. The third kind of link was between CSOs involved in capacity-building of specific stakeholders straddling the public and private sectors, such as teachers and doctors. This meant that while such CSOs did not routinely interact with the government, they nonetheless required the government’s formal cooperation to achieve scale. The fourth kind of link was an indirect one, in which CSOs involved in service provision designed CRCP programs and activities in response to the vacuum left behind by the government. Such CSOs tended to operate in a largely independent sphere.
  • One very unexpected discovery while trying to gauge the institutional links and voluntary connections between the CSOs we mapped was that many of them were members of an increasingly organized group of CSOs known as the Child Rights Movement or “CRM.” The CRM is a country-wide network with secretariats at the national and provincial levels. The CRM secretariats are rotated annually through an electoral process that is based on a formal voting mechanism involving all CRM member organizations that fulfill minimum participation requirements in CRM dialogues and meetings. Organizations that hold the secretariat in any given year are expected to facilitate dialogue and consensus on the CRM’s collective agenda, implement an actionable plan relating to the agenda, lobby and liaison with concerned government departments for child rights, and lead and execute CRM’s advocacy targets. SPARC holds the national secretariat for CRM in 2018. There are roughly 46 CRM members at the national level, and 33 in CRM-Punjab. This remarkable voluntary association of CSOs that has emerged in the last decade offers a fertile field for studying this particular civil society space in Pakistan, its underlying social networks and relations, its internal structure and politics, and its modes of mobilization on issues relating to child rights.

 

Maryam S. Khan is a Research Fellow at IDEAS.

Dania Mukhtar  is a practicing lawyer based in Lahore and holds a Masters degree from Columbia Law School.

[i] https://www.bbc.com/news/world-asia-43096344

[ii] We excluded from our search CSOs that were primarily or wholly working in the general education and health sectors.

[iii] The boundaries between service provision, capacity building and advocacy can oftentimes be indistinct. We acknowledge that this typology is one of a number of possible ways of categorizing CSOs. Note that the CSOs in our list may or may not fully identify with this typological categorization, but based on our qualitative understanding of the CSOs’ work, we believe that this is a reasonable reflection of their current core activities.

 

Image source: A girl holds a sign while chanting to condemn the rape and killing of 7-year-old Zainab Ansari during a protest in Karachi, Pakistan, Jan. 13, 2018. (Reuters)