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Pakistan is a country with a population of 207 million people and a growth rate of 2.4%. However, keeping absolute numbers aside, a deeper look into the demographic structure of the population insinuates a potential economic challenge of an unprecedented scale.

The current population pyramid depicts an age structure with a growing dependency ratio in the presence of low income per capita. Pakistan is one of the youngest countries in the world, with more than 60% of the population under 30 with many needing jobs. Without the right government approach, this youth bulge is a ticking time bomb that can explode through spiralling incidents of wide scale impoverishment and social unrest. While a large youth cohort can be an asset as a young workforce and as a precursor to increased aggregate demand, lack of adequate employment opportunities along with low capital development can convert this economic boon into a bane.

United Nations World Population Prospects (2019) projects that Pakistan’s population  may reach 340 million by 2050 and 400 million by the end of the century. Several experts such as Population Council’s country director, Zeba Sathar, highlight how excessive demand stemming from unrestrained population growth can outpace the supply of essential resources in a major way. In that sense it shows the manifestation of the Malthusian pessimism in Pakistan.

Reducing fertility

The demographic transition — a change from high to low rates of mortality and fertility – strongly influences the trajectory of economic development. In the experience of developed countries in the West and East Asia, a decline in the fertility rate has been the catalyst for balancing out their demographic structure to maximise the working age segment and attain more evenly spread out economic benefits or in other words capture the demographic dividend. However, a missed opportunity can lead to a demographic disaster if the unemployed working age population become ‘forced dependents’ – a probable scenario for Pakistan.

A decline in mortality rate, ensuing from the advent of standard medical technologies and health investments in the country, is always followed by a decline in fertility rate. Even after mortality rates fall, the lag in reducing fertility rates can often range from 50 to 150 years as experienced in some countries. The reason for the longer transition from low mortality to low fertility rates have to do with endogenous factors including government-supported family planning, as well as the overall economic development of the country – without creation of jobs, the incentive to switch from having more children to supplying one’s labour in the economy is lost. Ultimately, without reducing fertility, the likelihood of the working-age population to grow faster than a country’s dependent population is slim thereby sustaining constricted per capita productive capacity of the economy.

Family planning

Imposing higher costs on parents for raising children serves as a deterrent against having more children than the economy can sustainably accommodate. Through state regulation and investment in creating an equitable job market, parents can be incentivized to invest in their children’s education, health, and life skills preparing them to participate in the economy and beginning the virtuous cycle of demographic transition, i.e. rapid and sustained economic growth with a sustained decline in the dependency ratio due to fertility decline.

The demographic transition unfolds in four stages, beginning with stage one consisting of high death and birth rates, followed by stage two categorized by a drop in the death rate but not followed by a decline in birth rates. Since 1998, Pakistan has been in the third stage of the demographic transition whereby birth rates have fallen as a result of contraceptive awareness, wage increases and urbanization, but not made headway in further reducing fertility rates to reach stage four, where birth rates are equal to death rates i.e. the replacement level fertility rate. The current population growth rate of 2.4% is unsustainable despite a decline from 3.1% prior to 1998 to 2.6% in 1998. If Pakistan does not equate its birth rate and death rate by 2045 – requiring a total fertility rate (TFR) of 2.1 – it’s productive population will be sandwiched between an ageing and an adolescent population, both segments dependent on the smaller productive population segment. This entails parents to conceive on average no more than 2.1 children.

The government has been taking proactive steps to control population growth through multiple ways:

• the creation of national and provincial task forces and adhering to the directives of the Council of Common Interests (CCI)
• efforts towards provision of universal access to contraceptives
• passing legislative bills relating to pre-marital counselling and financial incentives to lactating mothers to optimally space births
• doubling funds for the population welfare department of each province

In Punjab, the Punjab Population Innovation Fund (PPIF), a non-profit, public sector company, is complementing government efforts by supporting interventions for the reduction of fertility rates in the remotest areas of Punjab. Their target is to increase access to contraceptives. They have liaised with the country’s largest social protection program, Benazir Income Support Group (BISP), for improved population planning.

Job creation

The World Bank predicts Pakistan needs at least 1.5 million jobs annually to maintain the current unemployment rate. However, 2020’s projected GDP growth rate of 2.4% (now having fallen even further during the covid outbreak) is insufficient to absorb new entrants into the labour force – a GDP growth rate of at least 7 to 8% is required for that. With an extremely compromised social protection system and limited fiscal space, the strain on Pakistan’s resources is stretching far beyond comfortable levels.

However, a push towards elevating the literacy, skills and education levels of the masses can lead to reducing the burden of dependents on the state by delaying early marriages which in time can help reduce fertility rates and make it easier for the state to accommodate new entrants to the job market. However, the creation of new jobs should in part be driven by young entrepreneurs generating economic activity – this is especially useful in high-value added sectors such as the manufacturing sector which employs the majority of the country’s workforce. Increased spending on education along with more investment in high-value added sectors must be urgently ramped up.

The process can be sped up by bringing technical and vocational training institutes at the forefront of imparting employable skills. The demographic transition relies on a shift from supply-driven to demand-driven skills provided by skills training providers, such as Technical Education & Vocational Training Authority (TEVTA), aiming to increase the likelihood of gainful employment by job aspirants. As such, skills curricula should be formulated with the help of leading industries. Organisations such as Punjab Skills Development Fund (PSDF) help support this objective through trainings aligned to expectations of the job market.

Only by absorbing the youth bulge into the economy through education and employment, can they be productively engaged and become empowered to unlock the demographic dividend.

Population control programs require institutionalisation

The challenges posed by rapid population growth cannot be addressed solely by the government – support from the private sector and civil society-led initiatives are crucial. Provincial Departments of population welfare need support from other departments such as Health, Education and Women Development while also coordinating with Federal Departments relating to data collection and financial inclusion. The aim should be to singularly address with consensus, through their separate platforms, the need to slow down the fertility rate. Such a system of coordination across multiple sectors both inside and outside the government entails institutionalising a multi-sectoral approach, spanning beyond government tenures to ensure meeting pre-defined targets for achieving optimal population outcomes. This is crucial because, in the past, civil and military governments repeatedly injected their separate ideologies for structuring the society to fit their own political interests thereby affecting the priority given to demographic transition and stalling progress.

Coordination between the provinces and the centre is also paramount. After the 18th Amendment, population welfare – among many other subjects such as health and education – was devolved to the provinces. Currently, provinces receive on-going funds toward population welfare initiatives, however, unreliable data sets remain a key impediment in accurately designing policy to this end. Furthermore, after the seventh National Finance Commission (NFC) Award (2010) provinces have little incentive to practice population control as 82% of resource allocation to the provinces out of the divisible pool (of which 57.5% goes to the provinces) is on the basis of population. Reframing provincial incentives to bring urgency in population planning is important.

Social impediments against population control abound as well. Religious and cultural resistance to the concept of population control coupled with staggered political will makes reform challenging. National dialogue on population growth to bring every stakeholder on-board is much needed. The Council of Common Interests (CCI) and the Council of Islamic Ideology (CII) are two constitutional bodies which can spearhead a national consensus on population growth and the demographic dividend. With the right mind-set Pakistan can defuse the population bomb and prove Malthus wrong.

This article has drawn on knowledge from experts at a panel talk organised by CDPR; access the video here. View the  shorter highlights video here.

Interviews:

Dr. Attiya Inayatullah

Dr. Asghar Zaidi

Other information has been drawn from this report.

Authors’ note: The results discussed in this blog are based on a pilot. These findings are preliminary and are being presented for initial consideration and discussion. We will update this blog once information from wider research is available. 

In order to combat the spread of COVID-19, a large number of Islamic countries including Saudi Arabia, Iran, Turkey, and Malaysia have put restrictions on religious congregations and gatherings, including the obligatory Friday prayer. Leading international Sunni and Shia clerics have endorsed these rulings.

And yet, in Pakistan, there has been lack of clarity on the official stance on whether and how congregational prayer is going to be restricted as part of on-going lockdowns.

Many mosques in Pakistan continue to hold congregational prayers. In some cases, this has led to clashes between the State and mosques, in which police assigned to enforce the rules on Friday prayers have had violent confrontations with large gatherings of congregants. Since restrictions were introduced, some religious leaders have publicly opposed them, and continued to organise religious events and gatherings. The situation was further complicated on 14 April when prominent religious leaders, who initially acquiesced to support the federal and provincial governments’ restrictions, announced that they no longer support them. They further added that mosques will hold all daily and Friday congregational prayers, as well as special prayers during the holy month of Ramadan which will start on 24 April. By 18 April, the Federal Government effectively agreed to lift the restrictions on congregational prayer. Leading medical doctors in Pakistan and abroad have strongly advised the government to reconsider this decision given that it would increase the risk of exposure substantially. The national conversation on this issue is still on-going and changing rapidly.

The seemingly contradictory stances of the religious leadership and the government on this sensitive issue, and the daily changes in the official guidelines, send mixed signals to the general public. This could possibly result in actions by the public that increase the risk of the virus spreading even more in the coming weeks. There is a need to reach out to the country’s religious leadership, at the national and local levels, as a partner of the government in combating the COVID-19 outbreak.

Engaging with imams of mosques

 Muslims consider prayer to be one of the main religious obligations in Islam. Across the Muslim world, Muslims perform prayers five times every day; these may be prayed at home or in mosques.  Muslims also perform a weekly Friday prayer, which is considered as obligatory for men to perform in congregations. All such congregational prayers involve attendants standing in rows with their shoulders touching. The attendance rates for Friday prayers at mosques tend to be higher compared to daily prayers.

The Centre for Economic Research in Pakistan is conducting a study to test whether outreach with local religious leaders, specifically mosque imams (those who lead prayers at mosques), can enhance state effectiveness in dealing with the COVID-19 crisis. Communities consider imams as trusted sources of guidance on religious and social matters. We are reaching out to imams in the province of Punjab to learn about their response to and compliance with the government’s restrictions on Friday prayer. We are also gauging their knowledge about the spread of the disease and the government’s economic support programmes targeting the poor that have been impacted by the outbreak.

In the on-going study, we hope to contact thousands of imams across Punjab, sharing information about public health and decrees from leading international clerics supporting measures against COVID-19.

Findings from initial engagement

The preliminary findings from our pilot survey of over 100 imams in Punjab, conducted in 2020 from 31 March to 14 April, are as follows. This was the timeframe in which the government’s orders were to suspend congregational prayers.

 

Steps taken to tackle the spread of COVID-19

 There is some degree of conflict between the stances taken by most of the ulema and the provincial and federal governments regarding the status of congregational prayers. We think that this conflict plays out in the results as well.

Despite the lockdown and orders from the government to suspend congregational prayers, approximately 47% of the imams who responded to the survey reporting holding congregational Friday prayers the week before (Figure 1). So far, compliance with the government regulations seems to be better for rural areas as a higher percentage of imams of rural mosques reported suspending Friday prayers (Figure 2). For mosques that did hold Friday prayers, the average turnout was much lower than a typical Friday prayer at that mosque (Figure 3).

Many imams were keeping their mosques open, but reported taking at least some steps to prevent the spread of the virus.  However, most of these were restricted to cleaning the mosque or removing communal prayer mats (Figure 4).  Only about 40% of the imams mentioned that they either encouraged congregants to distance themselves from each other and a similar percentage discouraged handshaking or hugs among congregants.  After these results came in, the government and ulema announced a compromise of keeping mosques open, but with social distancing and hygiene measures as well as restrictions on attendance by the elderly.  Medical groups announced opposition to this plan, in part because these measures may be insufficient and impractical to enforce.  We will continue to gather data to find out how well these measures are being followed.

Sources of information

 The results show that imams mostly trust TV shows and their social networks for information on COVID-19 (Figure 5). Mainstream TV networks discuss the steps taken by the government to prevent the spread of the virus, steps taken by other Muslim countries (like cancelling congregational prayers), and the stance taken by local religious leaders/ulema.

In light of the conflict and confusion over rules that are being renegotiated every day, it is not clear what role the media and TV shows play in informing the views of imams. We can explore the kind of media that is consumed by imams and the messaging on such media platforms. Using these initial results, we plan to delve deeper into the role of media in informing the views of imams. This will enable us to suggest policy interventions on how talk shows and other forms of media can play a constructive role through their messaging.

Imams are receptive to information

On the whole, the imams seemed to be receptive to information about government rules and statements by religious authorities provided through the survey. While only 50% of the imams said that they planned to cancel Friday prayers at the start of the survey (Figure 6), by the end of the survey around 80% of the imams mentioned that they were considering postponing congregational prayers in light of the information provided during the survey (Figure 7).  However, we would view these numbers with caution as imams might simply state agreement to say what surveyors expected to hear. Going forward, we will collect follow-up information from imams and others in their areas on actual congregational prayers and closures.

We expected community imams to push back against the government suspension of congregational prayers, as some national religious leaders have done.  However, during the period when the suspension was in place, community imams we called were receptive to the information, not defiant. This suggests that there is room for meaningful discussion and change regarding the status of congregational prayers.  However, once the government revised its position in the last few days did respondents start to indicate more disagreement. This suggests that the combination of leadership from government as well as religious legitimacy (from the fatwas issued by international religious authorities) might be important for convincing imams to take steps to protect their congregation through social distancing.

Leveraging imams for spreading information about relief programmes

As imams are considered respected sources of information in the community, they can also act as a means of disseminating trusted information about various assistance programmes that have been launched by federal and provincial governments. In the survey, imams were provided with verified information on the various relief programmes and encouraged to disseminate this information through their mosque’s loudspeaker and to deserving families. Not only are imams aware of families that have faced economic hardship due to lockdown (Figure 8), they are also interested in the information (Figure 9) and willing to announce this information through their mosque’s loudspeaker (Figure 10). This dissemination of information could help ensure that all eligible households learn how to access the programmes, as well as combat the spread of fake information regarding them (Figure 11).

Generating evidence for policymaking on COVID-19 and beyond

We plan to scale up outreach with imams to spread information and quantify the impact of this kind of outreach. In the short-term, we aim for the results of the research to be useful in guiding government agencies in effective community outreach to address the spread of the disease, as well as mitigate the adverse economic impacts. If the results in the coming weeks suggest the engagement had a positive impact, we will actively reach out to the health department and other relevant departments to propose they consider scaling up this kind of outreach through mass media. As mentioned, 70% of imams cited TV programmes as their source of information. As a next step in the study, we will gather data on the specific TV programmes they watch and find credible ways to help inform rapid policy guidance on the most effective channels of outreach.

In the longer term, we hope our research will help us understand how states can best work with traditional authorities such as religious leaders. This will improve the effective response of states in both emergency and non-emergency situations, such as addressing misinformation on issues of law or public health, and improving take-up of government benefits among unreached groups.

 

The government of Pakistan has taken unprecedented steps to counter the effects of the COVID-19 crisis, but it is unclear if these will be enough given the challenges facing the country prior to the pandemic.

Pakistan is amongst the 180+ countries dealing with the coronavirus pandemic. There are now clear warnings of a global economic recession as workers continue to fall sick, factories remain shut, and healthcare systems become overwhelmed. Mitigating the health emergency and extent of economic loss will not be easy for Pakistan. The country of over 200 million is already going through a macroeconomic stabilisation, and ranks below world average on most human development indicators.

The spread of disease within and into Pakistan cannot be separated from the global context. The world’s urban population at 4.2 billion has now exceeded the global rural population, and almost 40% of Pakistanis live in cities. Meanwhile in the country, close to seven million use air transport.

COVID-19 has already surpassed the death toll of the more recent outbreaks of Ebola, MERS and SARS. While fatalities in Pakistan have as of 17 April hit 130, it has more than 7000 confirmed cases, and many more can be unreported. Half of these cases are now locally transmitted. Government estimates suggest by the beginning of June cases in Pakistan could rise to 58,000, while mortalities could lie anywhere between 5 to 10%
of this number. In all eventuality, Pakistan’s healthcare system is likely to be overwhelmed.

At the moment, it is hard to calculate and forecast the true impact of coronavirus beyond the estimated human toll. The outbreak is on-going, and researchers are continuing to learn about this new form of virus. While the SARS outbreak cost the world $50 billion, initial estimates for coronavirus are already suggesting a loss of $360 billion. In Pakistan, relatively localised epidemics (such as Dengue, measles and Hepatitis C) have posed challenges. A full-fledged global pandemic can have dire implications.

A fractured health system

Outbreaks of such scale expose gaps and fractures in the underlying healthcare system. This can be related to the timely detection of disease, availability of basic healthcare, tracing contacts, quarantine and isolation procedures, and preparedness beyond the health sector. All of these issues are especially prominent in resource-constrained settings.

Pakistan spends 2% of its GDP on healthcare, against a global average of 10%. It also fares much worse than its neighbours, Iran and India, in terms of health-related indicators. Latest data from the World Bank, presented in figure 1 below, show that in 2016 Pakistan spent around $40 per citizen on healthcare. By contrast, the comparative figure in India was $62, and Iran $415. With the growing crisis in Iran despite this higher spending on healthcare per capita, it is clear why policymakers in Pakistan are deeply concerned.

Figure 1

Source: World Bank

Some feel that Pakistan focuses on public health preparedness only sporadically, mainly as a reaction to episodes when vulnerabilities spike. The country therefore lacks a health system that can scale up both detection and treatment to adequately and timely address large-scale outbreaks.

Moreover, disease prevention is not just about a sound health system, but also concerns confronting factors that create conditions for poor health outcomes. For example, certain segments of the population (such as the poor or those with underlying health issues) remain disproportionately at risk of the disease. Low income is associated with higher rates of chronic health conditions such as diabetes and heart disease, and lower uptake of precautionary health measures.

Unequal access to healthcare combined with a lack of social protection

Unequal access to healthcare is a problem for everyone, since this disease does not differentiate between the rich and poor. Yet the poor are far less resilient than the rich in having tools such as access to private health care, better education, option to work from home, and access to insurance to lessen the shock of such outbreaks. In fact, this particular coronavirus can be up to 10 times more deadly for the poor.

The need for social protection is also almost always accentuated during an emergency. In Pakistan, social protection expenditure is just under 2% of GDP, far lower than the global average of 11.6%. Most of the informal sector is not covered by such schemes despite its contribution to the GDP (almost one-third) and employment (72% of all jobs outside agriculture). The Pakistani equivalent of a public distribution system, the Utility Stores Corporation, is grossly underfunded and unlikely to plug gaps if food supply chains are disrupted.

Dealing with resistance

The Government of Pakistan is particularly hampered in its ability to deal with COVID-19 by the social, political and cultural context of the country. Resistance created by community dynamics, local/religious beliefs, political instability, economic fragilities, and a lack of trust in government and institutions, has made Pakistan struggle with far less infectious diseases like polio. The fight against Ebola in Africa was subjected to similar challenges. Pakistan is now facing the same obstacles with coronavirus.

To counter this, mosques have been shut down in most Muslim nations including Saudi Arabia. However, Pakistani policymakers have not adopted such stringent measures for fear of a backlash from the religious wing. They have so far only restrained congregational prayers on Fridays. It is nonetheless important to explore ways of working with religious organisations and leaders to influence outcomes and behaviour.

Cooperation between different levels of government

On top of the challenge from religious institutions, within the government there are cooperation obstacles that must be overcome. There is a lack of coordination between the federal and provincial governments. Well-coordinated governance structures are critical for a quick and efficient response to such a crisis. As most critical services including health and social protection are now the responsibility of the provinces, each province is making decisions independently. However, border control and aviation remain with the federal government and provinces lack jurisdiction to tighten surveillance at airports.

Moreover, for countries as populated as Pakistan, local governments can play a pivotal role in reducing disease transmission and resistance to health providers by leveraging local networks. An absence of local governments has meant a delay in reaching communities to offer both healthcare and relief.

A major economic downturn

The economic ramifications of the crisis are also significant in Pakistan. A downturn in Pakistan’s GDP growth was anticipated even before the epidemic reached the country. The State Bank had already revised downwards the GDP growth rate to 3% from an earlier estimate of 3.5% for the 2020 fiscal year. The Asian Development Bank also lowered its projected growth rate to 2.6% from an estimated 2.9% while the World Bank has revised it downward to 1.1% and in the worst case scenario a negative 2.2%. Official assessments estimate an initial loss of PKR 2.5 trillion (around $15 billion)

It has further forecasted an economic loss of up to $5 billion, while official authorities expect anywhere between 12.3 to 18.5 million layoffs.

How is Pakistan responding?

The government of Pakistan has unveiled a PKR 1.13 trillion ($6.76 billion) rescue and stimulus package with a good balance between providing direct assistance to the vulnerable and protecting industry and businesses. The allocation is sizable but its true impact can only be assessed by how it is implemented. Some of this will be funded by support from the World Bank and Asian Development Bank coming in over the next few months.

Like many other countries, the government is experimenting with various forms of a lockdown. Sindh was the first province to implement a curfew-like lockdown. Karachi faces the most stringent measures compared to anywhere else in the country. Meanwhile, Punjab has implemented a milder form of the lockdown and Khyber Pakhtunkhwa (KP) a partial lockdown. The Prime Minister, Imran Khan, has been adamant against a complete nation-wide lockdown, stating Pakistan’s inability to handle its far-reaching economic ramifications.

Direct investments into healthcare infrastructure and services have also been undertaken. Currently, only half the 2,200 ventilators in Pakistan are functional to treat coronavirus patients. An amount of PKR 50 billion ($298.94 million) has been set aside to purchase medical equipment. Pakistan’s testing capacity has also been enhanced from 30,000 to 280,000 and according to official sources will be further enhanced to 900,000 within April.

The federal government has set up a Command and Control Centre for Coronavirus (COVID-19) to have a centralized mechanism for sharing information, updates, figures and directions on disease prevention and is gearing up to provide protective gear to frontline workers.

Using technology to create awareness

Pakistan is coming up with innovative smart solutions and exploring the use of technology to create awareness, mitigate the risks, and contain the shock created by such pandemics. To promote public knowledge, the government has, in collaboration with the telecommunication industry, replaced ringtones with an awareness message to the caller about the dangers of Covid-19 and measures that can be taken to remain safe. The government regularly sends an SMS to encourage people to wash hands and practice social distancing. Authorities are also contacting suspects of confirmed cases through mobile tracking and pushing them to get their tests done.

Ensuring food security

Of course, ensuring food security and access to a safety net are just as critical as having a sound health system. The government plans to temporarily abolish all taxes on food items and has announced a significant reduction in oil prices. Payment of utility bills has been deferred for three months for households with bills falling below a certain threshold. A sum of PKR 50 billion ($298.94 million) has been earmarked for government-run utility stores to ensure the constant availability of food and other necessities. PKR 280 billion ($1.68 billion) has been allocated to ensure wheat farmers do not face cash flows and to smooth wheat procurement. The government has also kept funds for logistical support to the National Disaster Management Authority (NDMA), the federal authority mandated to deal with a wide spectrum of disasters, to ensure food supplies.

Furthermore, cash transfers are being leveraged in the country. In fact, Pakistan already has in place one of the world’s most well targeted cash transfer programmes – the Benazir Income Support Programme (BISP). As an immediate top-up to the existing five million families under BISP, the government has enhanced their monthly stipend from PKR 2000 ($13) to PKR 3000 ($20). More recently the government has announced a basic income scheme to provide an emergency cash transfer of Rs 12,000 (compared to a minimum legal monthly wage of Rs 17,500) using data analytics to decide who is eligible to receive cash transfers. It is further expanding the inclusion criteria to provide relief to those on the margins of hunger such as daily wage workers, street vendors, rickshaw drivers, particularly during the lockdown period.

The provincial governments are also gearing up. The government of Sindh is providing relief in cash and kind through a mechanism of self-targeting where the needy call a designated telephone line. The process to determine eligibility is being refined alongside the rollout.

Protecting businesses

Setting the right foundation to kick-start the economy is imperative for the government. The economic stimulus package contains a whole range of fiscal measures (tax breaks, financial support via utilities, fuel and transport subsidies, concessions and tax refunds) to protect exporters and businesspersons. The government has also announced a separate package worth PKR 100 billion ($600.42 million) just for SMEs, which form close to 90% of all enterprises in Pakistan and generate 40% of non-agriculture employment.

The State Bank of Pakistan (SBP) has announced a Temporary Economic Refinance Facility to fuel new investment. This will offer subsidised loans to the manufacturing sector and a Refinance Facility to allow banks to get loans at zero mark-up, which they can offer to hospitals at 3% for five years. The SBP has also reduced the interest rate to 11%, still much higher than other countries that have cut down, but 150 basis points lower than before.

More recently the central bank has introduced a new refinance scheme to avoid layoff of workers in exchange for a loan at very low markup rates (5%).

Concluding remarks: The challenges remain severe

Such pandemics expose the inadequacies of the responses of successive governments to poverty, healthcare, and inclusive social protection and governance.

Some questions and thoughts for policy practitioners and researchers to ponder over. How can experts build a trajectory of how the disease is progressing in Pakistan, based on scientific and robust models using contextualised data? How can existing health management structures be leveraged across all levels of governance to enhance the overall national capacity to respond to the crisis? What policies can be adopted to protect the especially vulnerable segment of the population engaged as informal workers and not being targeted by existing social protection/relief strategies? Lastly, how can the plethora of information and data coming in, be used strategically to help the government plan and formulate strategies?

While one cannot predict what will spur the next major epidemic and when, early action can help prepare governments to handle it better. However, any strategy that counters such a pandemic must address underlying vulnerabilities. The challenges facing Pakistan in the current crisis are stark, and it remains to be seen whether the huge interventions that the government has undertaken will be enough to mitigate the loss of life and economic hardship.

Hina Shaikh is a Country Economist at the International Growth Centre (IGC).

This is an updated version of the article which first appeared on the International Growth Centre’s website here.

 

Special education, catering to the special needs of the disabled, is in in a debilitated state in Pakistan. A rise in the number of disabled is not supported with appropriate tools to identify and integrate them into mainstream society. However, with a Special Education Policy in the works, the Government of Punjab aims to move towards a more inclusive education system. This policy intends to categorize disabilities into four main groups, namely mild, moderate, severe and profound, and enhance public policy towards persons with disabilities (PWDs). Nonetheless, the adoption of this new pedagogical approach collides with the existing stigma attached with ‘disability’, and when this is further coupled with inadequacy in identifying and targeting those who suffer from it, it becomes difficult to construct a viable support system to facilitate those with disabilities in Pakistan.

According to the 2017 Population and Housing Census, 0.48 percent of Pakistan’s population is disabled; this shows a stark decrease from the 2.38 percent figure in the 1998 census. Other sources, such as the World Bank Report on Disability places the disability ratio in Pakistan at 3.56 percent, whereas the Annual Status of Education Report (ASER) indicates that 22.1 percent of the government schools have children with disabilities. This discrepancy regarding the number of disabled in Pakistan is connected to an underlying problem of identification. With no universal definition of disability in place and limited constitutional cover in Pakistan, these figures are deemed as controversial and unrepresentative of the true extent of this issue.

The Consortium for Development Policy Research organized a Policy Exchange talk, focused on ‘Leaving No One Behind,’ bringing together a panel of experts to discuss the future of special education in Pakistan. It explored the state of special education in Pakistan, as well as discussed the recent initiatives the Government has undertaken in improving access to education for people with disabilities.

The panel highlighted that a traditional binary approach was used for identifying PWDs in the census, where respondents were asked a yes or no question about whether they have a disability. The binary nature of this question does not account for those who suffer from undiagnosed disabilities or those who do not wish to identify as disabled due to family pressure and stigma. This inability to gather robust and meaningful data on disability severs the efforts made to integrate PWDs into the mainstream education system, and emphasizes the continued need to design and implement stronger mechanisms for the identification of those with disabilities.

Challenges for Addressing Special Education Needs

The aim of embracing inclusive education for people with disabilities has grown from minimal awareness and prioritization to a recognized component of the education policy in Pakistan, especially with the introduction of Article 25A in the Constitution of Pakistan, which guarantees a right to education for all. However, when one zooms in at the school level, there is still a sense of widespread confusion regarding what it means to be inclusive. Currently, children with disabilities are not only ten times less likely to attend schools compared to their peers without disabilities, but for even those who attend mainstream schools, the dropout rates are much higher for those with disabilities. This depicts a self-perpetuating trap, where lack of education amplifies the disadvantage associated with a disability, becoming another impediment towards the rehabilitation of PWDs.

Inclusive education entails that all children must be accepted as members of the social community, where the education setting for those with disabilities should be the same as their non-disabled peers. This mainstreaming approach at the school-level is focused on those who suffer from low to medium levels of disability. Experts recommend that children with mild levels of disability should not be segregated, but supported with special teachers and policy reforms in the mainstream education system. On the other hand, special education schools are required to accommodate those with severe or profound disabilities in order to address their special needs adequately aimed towards making them productive participants of society.

Although inclusiveness is a recognized goal on paper, it is not practiced at the school level, where either inadequate teacher training or social stigma prevents the identification of those with special needs. It is easier to identify a child with a physical disability, but becomes much more complicated in the case of a child who is mentally challenged and yet appears to be similar to his or her peers in other aspects.

Moreover, the rampant ignorance and discrimination against those with disabilities becomes more apparent in their life after school. With bleak employment prospects and lack of government support, these PWDs lack the means to sustain themselves. Their agony was evident in the recent protests at Mall Road, Lahore, where the visually impaired came out on the road to demand the Government to fill in the 8,000 vacant positions for the disabled in Punjab’s public sector alone.

The Role of Punjab Special Education Department

In the case of Punjab, special education falls under the mandate of the Special Education Department, which became independent from the School Education Department in 2003. Since then, the Special Education Department has successfully established 302 special education institutes at primary, secondary, and university levels, with the capacity to cater to around 35,000 disabled students. It has more than 600 buses to offer a pick and drop service to both teachers and students, and 42 hostels, offering accommodations to 2,000 disabled students. The Punjab Government now also offers a monthly stipend of 800 PKR to those with a disability, along with a health card to compensate for their medical expenses. Hence, this begs the question that if not capacity, where does the government lag in terms of policy making to improve access to education for PWDs?

Moreover, the new special education policy in Punjab promises to create better collaboration with different departments, especially the health and education departments, to improve the future prospects of PWDs. It also aims to increase the number of special education institutes in the province, while improving the role played by the research and development unit in enhancing decision-making and identification of disabilities.

The Way Forward

It is essential to understand that inclusion of any kind comes with acceptance, and hence, establishing an inclusive education system in Pakistan requires commitment towards cultivating relationships across students, parents, teachers, and the broader community based on increased awareness about mental illness. Examples exist worldwide where those with special needs have been integrated into mainstream society with proper support and inclusive policymaking. The education system in Finland, for instance, acknowledges the fact that at some stage in his or her life, every child requires help and support to move forward. Hence, the Finnish Government prioritizes early identification of those with special needs, such as learning difficulties, emotional or behavioral problems, and physical disabilities, by offering specialized support at the school level.

To ensure that inclusive and equitable education is offered to all children in Pakistan, the country needs to provide support at every level. This entails clearly devising identification parameters for different forms of disabilities and preferably combining social diagnosis for disabilities with a medical one. For instance, ASER has moved away from a binary questionnaire towards a more multi-dimensional approach, underpinned by the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) model. The ICF model recognises disability as a three-fold issue based on an individual’s biological, psychological and social condition, generating unique insights regarding the incidence of disability in Pakistan.

Moreover, proper identification of disability must be followed by greater awareness at school-level for students, parents, teachers, and the school administration. Teachers must be trained to identify children with special needs during the early years of education, while the Higher Education Commission (HEC) must also facilitate these children with relaxations in subject selection and examinations. Lastly, it is also essential to create more inclusive spaces at the societal level, whether it is through designing more inclusive buildings or setting quotas for employment.