Pakistan along with other world leaders adopted the Millennium Declaration in the year 2000, and pledged to ‘spare no effort to free our fellow men, women and children from the abject and dehumanising conditions of extreme poverty.’ With only five years remaining, efforts for the achievement of the Millennium Development Goals (MDGs) become increasingly important.
The Millennium Development Goals (MDGs) are the centrepiece of development efforts of the Government of Pakistan.
The 18 global targets and 48 indicators adopted in 2000 have been translated into 16 national targets and 37 indicators keeping in view Pakistan’s specific conditions, priorities, data availability and institutional capacity.
The report covers the period since 2006 in which numerous and far reaching developments have taken place, which have transformed the social, political and economic landscape of Pakistan, all having an impact on the outcomes, achievements and targets of Pakistan’s Millennium Development Goals. Pakistan has faced serious challenges in the last four years, stemming from a sudden meltdown in the global economy in 2008, along with a sharp rise in oil and food prices earlier that year. At the domestic front, security issues, war on terror and IDPs have put further pressure on our economy. Furthermore, the most recent catastrophic floods, have affected approximately more than 20 million people, ravaged different urban and rural areas and caused immense damage to the infrastructure and agriculture of the country. This will adversely impact the overall economy and the achievement of many of the MDG goals and targets.
Despite the adverse circumstances and problems, the Government of Pakistan is fully committed towards the achievement of the MDGs. In addition to the efforts of the Government of Pakistan, provision of access to markets, new technologies and favourable terms of trade by the developed world would help in attaining the MDGs. Although half a decade may sound too short a period towards achieving the MDGs; however, with a strong commitment, persistent efforts by the Government of Pakistan and great resolve shown by the people during current floods to lead their lives out of crisis, the MDG targets may remain achievable.
Goals and Targets
- Target 1. Halve, between 1990 and 2015, the proportion of people whose income is less than one dollar a day
- Target 2. Halve, between 1990 and 2015, the proportion of people who suffer from Hunger
Although there are disagreements over what the extant of poverty in Pakistan is at the moment, there is a general agreement, that the poverty fell in Pakistan over the 2002 to 2006 period largely on account of high growth, greater donor assistance and increased remittances. Moreover, debt write-offs and rescheduling after 9/11, allowed far greater fiscal space than in the past, resulting in high pro poor growth. While poverty fell in this period, there is also clear evidence that inequality increased, both in regional terms and in individual incomes as represented by the Gini coefficient.
Since around 2007 and 2008, the economy has been under considerable pressure due to the following domestic and external developments:
- Global financial crisis, which hit the country when it was already facing a balance of payment crisis stemming from high food and fuel prices in the world markets. The combined effects of the global commodity price check, adversely affected the economy resulting in unsustainable current account and fiscal deficits and unprecedented high level of inflation, which hovered at more than 20 percent in the fiscal year 2008-09;
- The deteriorating law and order situation in the country further aggravating in 2008-09 caused by:
- The domestic costs of fighting militancy and;
- The growing tide of internally displaced persons has put severe strains on the government's finances.
The consequences of these factors have resulted in:
- Growth slowing markedly
- Resource constraint manifesting in low public sector development spending
- Adversely affecting the situation of poverty and employment in the country.
With declining fiscal space, the government was forced to remove a large number of subsidies, and it is probable that a larger number of people have fallen into poverty, which would have negatively impacted human development and, consequently, the country's ability to achieve the Millennium Development Goals.
Targets for the Medium Term Development Framework (MTDF) 2009-10, have not been met in the three indicators for Goal 1, and it does not look likely that the MDG target will be achieved. High growth, low inflation and job creation are required to help in coming close to achieving the MDG 2015 targets.
- Target 3. Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling
This Goal focuses on three core indicators, (a) net primary enrolment ratio; (b) completion/survival rate from grade 1 to 5; and (c) literacy rate. Some of the major results for the above mentioned indicators are as follows:
- Net enrolment at primary level remained below 60 percent until 2008- 09 although there has been marginal improvement in it overtime. The MDG target of achieving 100 percent net enrolment ratio by 2015 requires an increase of 43 percentage point in the next five years compared to the 16 percentage point achieved in the last ten years.
- The completion/survival rate of students enrolled in primary schools also presents a dismal scenario that implies that almost half of the students enrolled in primary schools do not complete their education. The interim target for 2009-10 was set at 80 percent and could not be achieved.
- Pakistan's literacy rate remains considerably short of the MDG target of 88 percent by 2015, although it has marginally improved to 57 percent by 2008-09. The rate of increase needs to be more than four percentage points for the targets to be achieved. The female literacy rate, especially in rural areas, also needs to be accelerated at a much higher rate since it has a much larger shortfall.
There seems to be considerable shortfall in achieving the MDG targets for Goal 2, even if there is to be a sham upturn in economic activity or government spending for education and other sectors. However, this realisation that the targets will not be met does not deter the government from working to achieve the targets, rather it spur it on to rectify the shortfalls and to make the commitment, that it will move as close to the targets for 2015, as it possibly can.
- Target 4. Eliminate gender disparity in primary and secondary education, preferably by 2005, and to all levels of education no later than 2015
With regard to the four indicators for Goal 3, the status of Pakistan is as follows:
- Pakistan has made steady though slow progress with regard to the Gender Parity Index (GPI) for primary and secondary education. Despite the fact that Pakistan has missed the MDG target of gender parity in primary and secondary education in 2005, with the current pace, the MDG target of gender parity is likely to be unachievable by 2015.
- Youth literacy GPI improved during 2004-09. With the existing pace, the MDG target of 1.00 by 2015 is likely to be unachievable.
- Women's share in wage employment in the non-agricultural sector has increased but Pakistan is making slow progress in achieving the target. Keeping in view the slow progress, proper steps need to be taken to achieve the MDG target of 14 percent.
- With regard to number of women seats in the national parliament, Pakistan has shown substantial improvement over the years. The proportion of seats in the present National Assembly is substantial, and is amongst the highest in the world.
- Target 5. Reduce by two thirds, between 1990 and 2015, the under-five mortality rate
Goal 4 'Reduce Child Mortality' focuses on six key indicators (1) Under- five mortality rate (2) Infant mortality rate (3) Proportion of fully immunised children 12-23 months (4) Proportion of 1 year children immunised against measles (5) Proportion of children under five who have suffered from diarrhea (6) Lady Health Workers (LHWs) coverage of target population. Some of the major results for this goal are as follows:
- The under-five mortality rate has declined moderately from 117 per thousand live births in 1990-91 to 94 deaths for every 1000 live births in 2006-07. However, it is possible that the gains in the economy which took place between 2002-07, with per capita income doubling during 2000-01 to 2007-08, have also had a significant impact on some of the indicators related to MDGs, including Goal 4.
- There has been a decline in the infant mortality rate from 102 to 75 per thousand live births between 1990- 2007; however, it seems to be stagnant during the period 2001-07. The numbers are not very optimistic and need to be investigated further, as to why this indicator, despite lot of efforts and investment, is off track.
- The data relating to the proportion of fully immunised children 12-23 months immunized against six preventable diseases shows improvement to 78 percent in 2008-09 from 53 percent in 2001-02. These results are not very impressive and there is an urgent need to speed up the process. The LHWs programme, which encompasses a total work force of 95,000, has managed to provide primary health care services at the doorstep of the people in rural areas. For many years since its launch, the LHWs programme has been considered to be one of the most successful programmes in Pakistan's health sector.
Out of the six indicators for Goal 4, Pakistan's performance in achieving the desired MDG targets by 2015 is unsatisfactory particularly in case of the first two indicators, i.e. the under-five mortality rate and infant mortality rate. Though Pakistan has managed to lower the under-five mortality rate, there is still a need to reduce it by 42 percentage points by 2015, a highly improbable outcome. If the rising trend achieved during the first four years of the MDGs could be repeated, it is still possible to achieve the MDG target by 2015, with regard to immunization, although it seems increasingly unlikely that this target will be met. The target for 2015 for the proportion of children under- five years suffering from diarrhea was achieved in 2007-08 ahead of time. Similarly, the coverage of households by Lady Health Workers (LHW) increased from 38 percent in 2001-02 to 83 percent in 2008-09 in the first nine years of the MDGs; hence the attainment of 100 percent coverage by 2015 seems to be on track. However, while coverage has increased, the issues of skill and quality need to be highlighted. The LHWs can play a critical role in improving many of the health related indicators of the MDGs.
Meeting the targets of the MDGs for Goal 4 will be challenging, as is the case with other social sector interventions, given the state of the economy and fiscal constraints, which have resulted in the reduction of allocations to the social sectors. However, given the fact that the Seventh National Finance Commission Award and the 18th Amendment to the Constitution are now in place, it is expected that provinces will have far greater funds to spend on the social sectors; and perhaps some of the MDGs, including Goal 4, may be more feasible to achieve.
- Target 6. Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio
Some of the key findings for the indicators of maternal health are as follows:
- The maternal mortality ratio declined from 350 in 2001-02 to 276 in 2006- 07. The MTDF target has been achieved, however, in order to achieve MDG target, a dedicated effort is required.
- The share of deliveries attended by skilled personnel, which was already quite low (48 percent in 2004-05) has gone down substantially to 41 percent in 2008-09. The situation demands immediate attention and consistent efforts to increase this rate.
- During 2001-02 to 2008-09, usage of contraceptive increased moderately. A decrease in the total fertility rate has been estimated from 4.1 percent in 2006-07 to 3.75 percent in 2008-09, and it seems that the MDG target for both the indicators is unlikely to be achieved.
In terms of the first indicator (the maternal mortality ratio), Pakistan, while attaining some success, has a considerable distance to go to meet the MDG targets by 2015. For the maternal mortality ratio, the MDG target for 2015 still requires almost a halving of the ratio. The 2015 target for skilled birth attendants is still more than twice of the proportion achieved in 2008-09. A third indicator relating antenatal care also shows low progress. In terms of family planning indicators, the contraceptive prevalence rate is considerably short of the 2015 MDG target.
What seems clear, sadly though, is that many of the specific targets for Goal 5 will not be met in the immediate future, and it will be challenging to meet the targets by 2015 unless herculean efforts are made to do so. With the economy still growing at a slower pace than the trend growth rate and with strong fiscal constraints on development spending, it is always going to be difficult to find the additional resources to raise the level of spending for Goal 5, or for any of the other social sector development targets.
- Target 7. Have halted by 2015 and begun to reverse the spread of HIV/AIDS
- Target 8. Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases
Goal 6 covers five indicators, key findings for the indicators of the said goal are as follows:
- Recent trend shows that HIV/AIDS spread is increasing, however Pakistan is still classified as a low prevalence country. The government is giving special attention to the situation and with commitment shown to this disease it seems possible that Pakistan will achieve the target by 2015.
- The percentage of TB cases detected and cured under DOTS has increased from 79 percent in 2001-02 to 85 percent in 2008-09 and the MDG target has been met before time. However, attention towards the incidence of TB per 100,000 population needs to be paid as the figure is stagnant at 181 since 2001-02.
- Malaria related issues need attention as the proportion of population in malaria risk areas using effective malaria prevention treatment and measure has increased slightly by ten points (from 20 to 30) during 2001 to 2009.
- Target 9. Integrate the principles of sustainable development into country policies and programmes and reverse the loss of environmental resources
- Target 10. Halve by 2015 the proportion of people without sustainable access to safe drinking water
- Target 11. By 2020 to have achieved a significant improvement in the lives of at least 100 million slum dwellers
The latest estimates show that the land area under forest cover has marginally increased from 4.9 percent in 2004-05 to 5.02 percent in 2008-09. The poor developing countries are constantly challenged in restoring a balance between environment and development. The trend rates since 2004-05 have stagnated and in order to meet the MDG target by 2015, a dedicated effort along with huge investments and community involvement is required.
Pakistan has become one of the largest users of Compressed Natural Gas (CNG) in the world and the MDG target for this indicator has already been achieved.
Halving, by 2015, the proportion of people without sustainable access to a safe and improved water source, is the tenth MDG target. Access to improved drinking water sources, especially for the poorest of the poor, remains a challenge. In addition to water scarcity and surface water pollution, Pakistan is also marred with low coverage in safe drinking water supply, which is a major source for water borne diseases. The PSLM survey for 2008-09 reported that:
- Water supply coverage increased from 53 percent in 1990 to 65 percent in 2008-09. However, it still has a long way to go in reaching the MDG target of 93 percent by 2015; and with current trends this may prove to be an insurmountable challenge.
- The sanitation coverage in the country has increased from 30 percent in 1990 to 63 percent in 2008-09 according to the PSLM survey 2008-09. However, it is still a long way to go in reaching the MDG target of 90 percent by 2015.
- With regard to Goal 7 of MDGs targets for 2015, there are numerous environmental challenges, which face the country and need urgent redress.
- Target 15. Deal comprehensively with the debt problems of developing countries through national and international measures in order to make debt sustainable in the long term
- Target 16. In cooperation with developing countries, develop and implement strategies for decent and productive work for youth
- Target 17. In cooperation with the private sector, make available the benefits of new technologies, especially information and communications
The consequences of a globalised world have been felt and recognised by all participants who make up the global economy. Whether it is environmental disasters or natural occurrences — such as the recent Icelandic volcanic eruption, the 2008 global financial crisis and the nascent European one of May 2010, or the war on terror in and around Pakistan and Afghanistan, the consequences of numerous local and supposedly isolated events, have global outcomes, some of which can be catastrophic. Since there is little doubt that the world is interconnected, just as the negative fallout can have disastrous consequences on different countries and their economies, so too can global efforts and initiatives improve the lot of one country or the region.
Pakistan's location, both in terms of geography and in terms of development, has become, and can remain a focal point requiring help and assistance to achieve all seven of its MDGs by means of the Eighth Goal, which includes greater market access, development assistance, and greater connectivity. Pakistan has been an aid dependent country for many decades and aid has been crucial for achieving many of its developmental goals and MDGs. However, the manner of aid distribution, with its conditionality, variability and uncertainty, has also caused problems, which may have undermined some of the benefits from that assistance. With trade now replacing aid as a means to development, Pakistan's desire for greater market access is largely supply- constrained, where Pakistan's narrow export base has limited exportable services and commodities. Therefore, bilateral and multilateral overseas development assistance can play a key role in providing support in developing the faculties of Pakistani producers to take advantages of the global economy, rather than be victims of it.
The improvement in the economy and stability in the country between 2002 and 2007 would have resulted in improvement in some of the MDG targets. However, with the numerous disruptions identified above, in 2008 and 2009, certainly, as well as in 2010, there is likely to have been a slowing down of progress and probably even a reversal of the successes achieved earlier. Yet, if 2011 suggests that the economy and political situation improves, and if they are sustainable, then one could probably see a return, albeit slow return, for most targets to be on track in years to come. The adoption of the Seventh National Finance Commission Award in 2011 will free up some resources from the federal government to the provinces and allow the less developed provinces to access further funds. Since provinces are responsible for many of the Goals of the MDGs, this transformation in resource allocation may be fortuitous for achieving some of the MDG Goals, as long as these Goals receive their priority.
One of the key observations that emerge from this Report, and one which is repeated with regard to three or four Goals, is regarding the interconnectedness of numerous indicators. For example, the infant mortality rate and the maternal mortality ratio, as well as indicators about the population having access to Lady Health Workers and those having access to adequate drinking water, are all closely interlinked. If there is not enough access to safe improved water, there will be high diarrhea and this will result in higher infant and child mortality. Similarly, the maternal mortality ratio can be lowered with the provision of adequate antenatal care, trained birth attendants, increased usage of contraceptives and input by Lady Health Workers. Hence, while each Goal is separate with its own sets of indicators, this Report also emphasises the need to map interventions that are interlinked and inter¬dependent.
However, unless there is urgency and a renewed and concerted effort to mobilise resources, both domestically and internationally, and to refocus the priorities in favour of these Goals, there is a high risk of considerable shortfalls in the MDGs set for 2015. Half-a-decade may sound too short a period to fill this yawning gap between performance and expectations that exists presently, but future trends do not necessarily have to be predicated on past performance and dramatic reversals in past trends often occur when nations are faced with overwhelming challenges. A popularly elected democratic government will need to take extraordinary measures to achieve many of the targets set up for each of the Eight MDGs, but that does not mean that it cannot do so. As long as there is a clear commitment to achieving these Goals, these targets can be met.
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