The price of neglecting social sectors

By Zubeida Mustafa

The state of the social sector in a country is an accurate measure of the value it attaches to human life. For howsoever strong a state might be in terms of military power and rich in economic resources, its institutional greatness will be judged by the quality of life it ovides its citizens.

This is basically determined by the social policy of the government, that is, the priority it gives to providing education, health care, housing and family planning facilities to the people. Pakistan’s performance in this context has not been one of which one can be overly proud. Of course, it depends on how one defines progress. If it is simply a matter of moving forward in terms of absolute numbers from a given baseline — a very low one at that — the country’s achievements over the decades since 1947 might appear to be very impressive.

For instance the number of primary schools in the country has gone up from a little over 8000 in 1947 to 124,000 today. At the time of Independence there were only two universities in Pakistan. Now there are 23. Primary school enrolment has jumped from 770,000 to 13 million. From 13,000 hospital beds in 1947 with which we started, we now have 75,000.

The government is also spending much more on the social sector today. In the First Five-Year Plan period (1955-60), the government’s expenditure was Rs 0.5 billion on housing. It spent Rs 6.4 billion in the last fiscal year on this sector alone. The corresponding figures for education and health in 1955-60 were Rs 0.2 billion and Rs 0.08 billion and for population planning the spending was Rs 0.01 billion in the Second Five-Year Plan period when the family planning programme was launched. Likewise in one year alone in 1992-93, the government spent Rs 6.5 billion, Rs 3.7 billion and Rs 0.8 billion on these heads respectively.

These seemingly giant strides notwithstanding, Pakistan’s social sector has been rated poorly by international agencies. The point to be emphasised is that we started literally from scratch. Centuries of colonial rule had reduced the subcontinent to an appalling state of backwardisation and underdevelopment. Hence whatever progress the country made might appear to be phenomenal. But compared to other states in the same situation as us and given the fact that Pakistan has been an independent country free to determine its own national priorities for over four decades, we have not fared very well at all.

A number of countries which shed the colonial yoke much later and were more underdeveloped than Pakistan have overtaken us in social development. Not surprisingly the UNDP ranks Pakistan a lowly 132nd out of 173 in its Human Development Index for 1993. The failure to place sufficient emphasis on the social sector has produced shocking results. Today there are 18.2 million Pakistanis who have no access to any health facility. Sixtyone million people are without ‘safe’ drinking water whereas 94 million have no sewerage facility There are 28 million children aged 5-9 years who do not attend school. As for literacy, Pakistan has failed to teach the three R’s to all of its people and 43 million adults cannot read and write (25 million being women). To top it all, 36 million people are living in absolute poverty.

Why has this nation failed so dismally when those who led it to independence were men of vision and had set ambitious goals for the people? One major reason why so little progress ha-, been made is that the destiny of the country came to be controlled by a small elitist class of feudals and bureaucrats, both civil and military. Since they were well-endowed themselves and could draw upon the social sectors of the developed nations to fulfil their own basic needs, those in power in Pakistan felt no compulsion to create an infrastructure indigenously for health care and education in the country. Their children studied abroad and received the best of education in world renowned universities. Their family members went to the most modern hospitals of the West whenever they fell ill.

They felt no commitment towards improving the human resources of the country. In fact some of them even resisted the spread of education and enlightenment fearing that this would create general awareness among the people of their human rights and thus undermine the privileged position of the ruling elites and create popular pressures in favour of democracy.

Another factor which accounts for the failure of Pakistan to make any headway in social development is the loyalty of the policy-makers to the strategy devised by the erstwhile colonial rulers. They have failed to innovate and adjust according to the needs of society. Thus Macaulay’s approach of educating just a sufficient number to a minimum level in order to produce administrators to run the country still determines the size and pattern of the education sector. Similarly, the health delivery system was initially designed to treat mainly the ruling oligarchy and it has not expanded much more. That would explain why health and education in Pakistan are not so easily accessible to the masses. The social sector is not geared to meet the popular needs. For many years the bulk of the education budget went towards financing higher education although a very limited number of people went to the university. Till the eighties, Pakistan’s lopsided education pyramid ensured that primary schooling did not form the base of the country’s education svstem it should have. Mercifully, this weakness has been rectified. But other flaws remain. Thus the curricula are not always tailored to the needs of the people and the economy. The country ends up producing people who cannot be absorbed by the employment market. This is damaging for the economy as well as the morale of the people. On the one hand, there is a dearth of skilled labour and vacancies cannot be filled because the appropriately trained manpower is not available. This affects productivity. On the other hand there is a growing army of unemployed graduates who cannot be provided jobs. This spawns discontent and resentment leading to crime and violence. The same misplaced priorities govern planning in the health sector as well. A large proportion of the health budget is spent on curative medicine, although this is more costly and less effective in improving the state of health of the people. In other words, hospitals consume quite a large part of the government’s funds for health whereas preventive medicine, the supply of clean water and sanitation and the eradication of diseases like malaria do not receive that much attention. The concentration of the health facilities in the urban areas (90 per cent of the modern health delivery system is located there) where only 28 per cent of the population lives while the health delivery system in the countryside remains scanty also points to a pattern that is not conducive to the promotion of a sound health policy. One very important reason why the limited achievements of the social sector since 1947 have failed to create an impact is the country’s failure to curb its runaway population growth rate. In the fifties, the very high mortality rate neutralised somewhat the high crude birth rate. But once mass killers such as smallpox, tuberculosis and malaria stopped taking as heavy a toll as before and mortality rate was halved, the population growth rate soared. As a result

Pakistan’s population doubled in twenty years (from 1951 to 1972) when the previous doubling had taken 50 years (from 1901 to 1951). Although the growth rate has come down from 3.2 per cent per annum to 2.8 per cent as claimed by the government, this is still much higher than the Third World average. Moreover, given the massive size of the population (121.5 million in 1991) this has serious implications in absolute terms. There are over three million new mouths to feed every year. Pakistan’s population policy has been a failure all these years on account of a number of factors. While the socio-cultural environment has not been conducive to a small family norm for many years, the government’s intervention has also been minimal. Even when economic compulsions and greater enlightenment increased the demand for family planning services, the failure to set up an adequate infrastructure led to a massive shortfall. Today Pakistan’s unmet need for contraceptives is estimated to be nearly 25 per cent — nearly 12 per cent of married couples in the reproductive age group use birth control measures when 37 per cent women in that group do not want any more children.

The massive increase in the size of the population has also contributed to the enormity of the demands in the social sector and has been partly responsible for the government’s inability to keep pace with the education, health and housing needs of the people. It has resulted in a situation similar to the one Alice in- Wonderland faced when she had to keep running fast to remain in the same place. Over-population accounts for the crowding in every area and the deterioration in the quality of services offered. A very important factor in the appalling state of the social sector is the scarcity of resources available for investing in the opening of educational institutions and health facilities and improving the physical environment on which the physical and mental well-being of the people depends.

Is Pakistan such a poor country that it can hardly spare funds for the social development of its population? One cannot help noting that countries much poorer than us have managed to channel more resources into the social sector because their priorities are different. Take the examples of Maldives, Bangladesh and India in South Asia. All of them have a lower per capita GDP than Pakistan. Yet the mean years of schooling in all of these countries is more than in Pakistan. In our country the children attend school for 1.9 years on an average. The corresponding figures for Maldives, Bangladesh and India are , 00 and 2.4 respectively.

The fact is that we have traditionally faced a financial constraint in the social sector because our defence spending has been exorbitantly high. The UNDP’s report is quite an eye-opener in this context. Pakistan’s defence expenditure was 6.6 per cent of its GDP in 1990 (it was 5.5 per cent in 1960). The average for the Third World was 3.4 per cent in 1990 having decreased in 30 years. The disproportionately high defence spending in Pakistan is more disturbing because it compares so poorly with the social expenditures. Thus the military expenditure as the percentage of combined education and health expenditure in Pakistan was 239 per cent in 1990. It was 214 per cent in 1977. This imbalance between defence and social spendings is one of the most pronounced in the Third World, only Iraq, Oman and Nicaragua’s being worse. This trend is reflected in the ratio between soldiers, teachers and doctors. In Pakistan, there are 43 soldiers for every 10,000 people. For one teacher there are 1.5 soldiers and 10 for every doctor.

How do we compare with India, the country from which the government claims comes the biggest threat? India spends 3.3 per cent of its GDP on defence and its military spending is 80 per cent of its health and education budgets combined. As a result India has proportionately more teachers and doctors, there being 16 soldiers for 10,000 people and 0.3 armed forces men for every teacher and 4 for every doctor.

Given the fact that national defence is based not just on the arsenals a country can assemble and the soldiers it trains but also on the quality of its human resources and the morale of its population, one wonders whether Pakistan is neglecting its social sector at its own peril.

Source: Dawn 14 August 1993