Haq's Musings

Riaz Haq writes this data-driven blog to provide information, express his opinions and make comments on many topics. Subjects include personal activities, education, South Asia, South Asian community, regional and international affairs and US politics to financial markets. For investors interested in South Asia, Riaz has another blog called South Asia Investor at http://www.southasiainvestor.com and a YouTube video channel https://www.youtube.com/channel/UCkrIDyFbC9N9evXYb9cA_gQ

Showing posts with label Infant Mortality. Show all posts

Sunday, June 23, 2019

Inspirational Story of University-Going Daughters of Karachi's Rickshaw Driver

Three daughters of a Karachi rickshaw driver named Amjad Ali are attending top universities in Pakistan. All three graduated from The Citizens Foundation's K-12 schools located across Pakistan, including poor districts of Pakistan's megacity of nearly 20 million residents. Amina Amjad, the eldest is studying at Dow University of Health Sciences (DUHS) to become a medical doctor, the second daughter is enrolled in Shaheed Zulfikar Ali Bhutto Institute of Science and Technology (SZBIST) to become an engineer and the third Muskan Amjad is going to the Institute of Business Administration (IBA), Karachi's top business school on a full scholarship.

Girls' Education:

Muskan Amjad

This would be unusual for a poor man's children attending top universities regardless of gender. What makes it particularly noteworthy is that these are daughters of a poor man in a country where girls' education is often ignored. “People often mocked and criticized me, saying that girls are bound to get married and move out and to stop wasting my hard-earned money on my daughters,” Amjad Ali told hosts of Samaa TV, a private television channel in Pakistan. The Citizens Foundation (TCF) making it possible by making K-12 education accessible and affordable for Pakistan's disadvantaged children. There are many success stories of TCF alumni posted on TCF's Facebook page.

Back in 2013, another TCF alumna Anum Fatima, a resident of Ibrahim Goth slum located near Karachi's Steel Town, made history; she went to Harvard Business School as part of a student exchange program. Anum's father is employed as a driver and her mother works as a maid. The slum school she attended is run by The Citizen's Foundation (TCF), a private foundation.

Karachi Rickshaw Driver Amjad Ali and Family

The Citizens Foundation:

The Citizens Foundation (TCF) is a non-profit organization, and operates one of the largest privately owned networks of low-cost formal schools in Pakistan. The Foundation runs 1,567 school units, educating 252,000 students through 12,000 teachers and principals, with over 17,400 employees. It has very low overhead by Pakistani NGO's standards. Approximately 94% of the Foundation's expenditure is allocated to the Education program.

Pakistan Truck Art Message From A Girl: "Let me Study; Let me Advance"

TCF plays a very important role in the lives of its students during school and after they graduate. It runs an Alumni Development Program (ADP) where successful alumni inspire and mentor students and fellow TCF alumni. Muskan Amjad volunteers for ADP.

If you read Pakistan media headlines and donation-seeking NGOs and activists' reports these days, you'd conclude that the social sector situation is entirely hopeless. However, if you look at children's education and health trend lines based on data from credible international sources, you would feel a sense of optimism. This exercise gives new meaning to what former US President Bill Clinton has said: Follow the trend lines, not the headlines. Unlike the alarming headlines, the trend lines in Pakistan show rising school enrollment rates and declining infant mortality rates.

Key Social Indicators:

The quickest way to assess Pakistan's social sector progress is to look at two key indicators: School enrollment rates and infant mortality. These basic social indicators capture the state of schooling, nutrition and health care. Pakistan is continuing to make slow but steady progress on both of these indicators. Anything that can be done to accelerate the pace will help Pakistan move up to higher levels as proposed by Dr. Hans Rosling and adopted by the United Nations.

Rising Primary Enrollment:

Gross enrollment in Pakistani primary schools exceeded 97% in 2016, up from 92% ten years ago. Gross enrollment rate (GER) is different from net enrollment rate (NER). The former refers to primary enrollment of all students of all ages while the latter counts enrolled students as percentage of students in the official primary age bracket. The primary NER in Pakistan is significantly lower but the higher GER indicates many of these kids eventually enroll in primary schools albeit at older ages.

Source: World Bank Education Statistics

Declining Infant Mortality Rate:

The infant mortality rate (IMR), defined as the number of deaths in children under 1 year of age per 1000 live births in the same year, is universally regarded as a highly sensitive (proxy) measure of population health. A declining rate is an indication of improving health. IMR in Pakistan has declined from 86 in 1990-91 to 74 in 2012-13 and 62 in the latest survey in 2017-18.

Pakistan Child Mortality Rates. Source: PDHS 2017-18

During the 5 years immediately preceding the survey, the infant mortality rate (IMR) was 62 deaths per 1,000 live births. The child mortality rate was 13 deaths per 1,000 children surviving to age 12 months, while the overall under-5 mortality rate was 74 deaths per 1,000 live births. Eighty-four percent of all deaths among children under age 5 in Pakistan take place before a child’s first birthday, with 57% occurring during the first month of life (42 deaths per 1,000 live births).

Human Development Ranking:

It appears that improvements in education and health care indicators in Pakistan are slower than other countries in South Asia region. Pakistan's human development ranking plunged to 150 in 2018, down from 149 in 2017. It is worse than Bangladesh at 136, India at 130 and Nepal at 149. The decade of democracy under Pakistan People's Party and Pakistan Muslim League (Nawaz) has produced the slowest annual human development growth rate in the last 30 years. The fastest growth in Pakistan human development was seen in 2000-2010, a decade dominated by President Musharraf's rule, according to the latest Human Development Report 2018.

UNDP’s Human Development Index (HDI) represents human progress in one indicator that combines information on people’s health, education and income.

Pakistan's Human Development Growth Rate By Decades. Source: HDR 2018

Pakistan saw average annual HDI (Human Development Index) growth rate of 1.08% in 1990-2000, 1.57% in 2000-2010 and 0.95% in 2010-2017, according to Human Development Indices and Indicators 2018 Statistical Update. The fastest growth in Pakistan human development was seen in 2000-2010, a decade dominated by President Musharraf's rule, according to the latest Human Development Report 2018.

Pakistan@100: Shaping the Future:

Pakistani leaders should heed the recommendations of a recent report by the World Bank titled "Pakistan@100: Shaping the Future" regarding investments in the people. Here's a key excerpt of the World Bank report:

"Pakistan’s greatest asset is its people – a young population of 208 million. This large population can transform into a demographic dividend that drives economic growth. To achieve that, Pakistan must act fast and strategically to: i) manage population growth and improve maternal health, ii) improve early childhood development, focusing on nutrition and health, and iii) boost spending on education and skills for all, according to the report".

Summary:

The story of Muskan Amjad shows that the state of Pakistan's social sector is not as dire as the headlines suggest. There's reason for optimism. Key indicators show that education and health care in Pakistan are improving but such improvements are slower than in other countries in South Asia region. Pakistan's human development ranking plunged to 150 in 2018, down from 149 in 2017. It is worse than Bangladesh at 136, India at 130 and Nepal at 149. The decade of democracy under Pakistan People's Party and Pakistan Muslim League (Nawaz) has produced the slowest annual human development growth rate in the last 30 years. The fastest growth in Pakistan human development was seen in 2000-2010, a decade dominated by President Musharraf's rule, according to the latest Human Development Report 2018. One of the biggest challenges facing the PTI government led by Prime Minister Imran Khan is to significantly accelerate human development rates in Pakistan.

Here's a video clip of Amjad Ali and his family's appearance on Samaa TV's Naya Din show:

https://youtu.be/7qXI93xdOn8

Tuesday, June 4, 2019

How Grim is the State of Pakistan's Social Sector?

If you read Pakistan media headlines and donation-seeking NGOs and activists' reports these days, you'd conclude that the social sector situation is entirely hopeless. However, if you look at children's education and health trend lines based on data from credible international sources, you would feel a sense of optimism. This exercise gives new meaning to what former US President Bill Clinton has said: Follow the trend lines, not the headlines. Unlike the alarming headlines, the trend lines in Pakistan show rising school enrollment rates and declining infant mortality rates.

Key Social Indicators:

Pakistan Children 5-16 In-Out of School. Source: Pak Alliance For Math & Science

Rising Primary Enrollment:

Source: World Bank Education Statistics

Declining Infant Mortality Rate:

Pakistan Child Mortality Rates. Source: PDHS 2017-18

Pakistan Human Development Trajectory 1990-2018.Source: Pakistan HDR 2019

Human Development Ranking:

It appears that improvements in education and health care indicators in Pakistan are slower than other countries in South Asia region. Pakistan's human development ranking plunged to 150 in 2018, down from 149 in 2017.

Expected Years of Schooling in Pakistan by Province

There was a noticeable acceleration of human development in #Pakistan during Musharraf years. Pakistan HDI rose faster in 2000-2008 than in periods before and after. Pakistanis' income, education and life expectancy also rose faster than Bangladeshis' and Indians' in 2000-2008.

Now Pakistan is worse than Bangladesh at 136, India at 130 and Nepal at 149. The decade of democracy under Pakistan People's Party and Pakistan Muslim League (Nawaz) has produced the slowest annual human development growth rate in the last 30 years. The fastest growth in Pakistan human development was seen in 2000-2010, a decade dominated by President Musharraf's rule, according to the latest Human Development Report 2018.

UNDP’s Human Development Index (HDI) represents human progress in one indicator that combines information on people’s health, education and income.

Pakistan's Human Development Growth Rate By Decades. Source: HDR 2018

Pakistan Human Development Growth 1990-2018. Source: Pakistan HDR 2019

Pakistan@100: Shaping the Future:

Pakistani leaders should heed the recommendations of a recent report by the World Bank titled "Pakistan@100: Shaping the Future" regarding investments in the people. Here's a key excerpt of the World Bank report:

"Pakistan’s greatest asset is its people – a young population of 208 million. This large population can transform into a demographic dividend that drives economic growth. To achieve that, Pakistan must act fast and strategically to: i) manage population growth and improve maternal health, ii) improve early childhood development, focusing on nutrition and health, and iii) boost spending on education and skills for all, according to the report".

Pakistani Children 5-16 Currently Enrolled. Source: Pak Alliance For Math & Science

Summary:

The state of Pakistan's social sector is not as dire as the headlines suggest. There's reason for optimism. Key indicators show that education and health care in Pakistan are improving but such improvements are slower than in other countries in South Asia region. Pakistan's human development ranking plunged to 150 in 2018, down from 149 in 2017. It is worse than Bangladesh at 136, India at 130 and Nepal at 149. The decade of democracy under Pakistan People's Party and Pakistan Muslim League (Nawaz) has produced the slowest annual human development growth rate in the last 30 years. The fastest growth in Pakistan human development was seen in 2000-2010, a decade dominated by President Musharraf's rule, according to the latest Human Development Report 2018. One of the biggest challenges facing the PTI government led by Prime Minister Imran Khan is to significantly accelerate human development rates in Pakistan.

Tuesday, February 20, 2018

How Can Pakistan Reduce High Rates of Infant Mortality?

Of every 1,000 babies born in Pakistan, 45.6 die before the end of their first month – 1 in 22, the highest infant mortality rate in the world, according to a United Nations Children's Fund report titled "Every Child Alive: The urgent need to end newborn deaths". Pakistan’s newborn mortality rate has declined by less than one quarter, from 60 in 2000 to 46 in 2016, according to UNICEF.

Highest Contributors to Newborn Deaths Source: UNICEF

Worst Countries:

Of the 2.6 million newborn dying each year worldwide, India tops with 24% share followed by Pakistan with 10%. Ten countries, Bangladesh, Ethiopia, Guinea-Bissau, India, Indonesia, Malawi, Mali, Nigeria, Pakistan and Tanzania account for more than half of the world’s newborn deaths, according to the report. Four of these 10 countries are in South Asia while the rest are in sub-Saharan Africa.

The percentage of mothers in Pakistan who gave birth in a health facility increased from 21 per cent to 48 per cent between 2001 and 2013, and the proportion of women giving birth with a skilled attendant more than doubled, from 23 per cent to 55 per cent over the same period. But despite these remarkable increases, largely the result of rapid urbanization and the proliferation of private sector providers not subject to satisfactory oversight, Pakistan’s very high newborn mortality rate fell by less than one quarter, from 60 in 2000 to 46 in 2016, according to UNICEF.

The report says that more than 80 per cent of newborn deaths can be prevented "with access to well-trained midwives, along with proven solutions like clean water, disinfectants, breastfeeding within the first hour, skin-to-skin contact and good nutrition."

Community-Based Health Care:

How can Pakistan increase the number of childbirths in the presence of skilled attendants? The best option appears to be a skilled midwives program along the lines of the Lady Health Workers (LHW) program that is considered effective in delivering health education and care to women in remote villages.

“It (LHW) is one of the best community-based health systems in the world,” said Dr. Donald Thea, a Boston University researcher, talking about Pakistan's Lady Health Workers Program. Thea is one of the authors of a recent Lancet study on child pneumonia treatment in Pakistan. He talked with the New York Times about the study.

Published in British medical journal "The Lancet", the study followed 1,857 children who were treated at home with oral amoxicillin for five days and 1,354 children in a control group who were given standard care: one dose of oral cotrimoxazole and instructions to go to the nearest hospital or clinic. The home-treated group had only a 9 percent treatment-failure rate, while the control group children failed to improve 18 percent of the time.

Community Midwives:

In response to the low levels of skilled birth attendance in rural Pakistan, the government has introduced a new cadre of community midwives (CMWs).

In 2008, Pakistan extended community-based health system with the introduction of an 18-month training program for community midwives. Then, in 2014, United Nations Population Fund – together with the Department of Health and Sindh Province’s Maternal, Newborn and Child Health program – launched a pilot effort to supplement the midwifery courses with hands-on training. Midwifery coaches visited the midwives’ clinics, offering guidance and mentorship, according to UNFPA. So far, over 300 midwives have benefitted from the coaching and mentorship program.

The Sindh UNFPA model needs to be scaled up across the country with the help of the federal and provincial governments in Pakistan.

Summary:

Pakistan is the riskiest country for newborns. Of every 1,000 babies born in Pakistan, 45.6 die before the end of their first month – 1 in 22, the highest infant mortality rate in the world, according to a United Nations Children's Fund report titled "Every Child Alive: The urgent need to end newborn deaths". Pakistan’s newborn mortality rate has declined by less than one quarter, from 60 in 2000 to 46 in 2016, according to UNICEF. The country's progress in reducing infant mortality rates has been very slow. There is an urgent need to improve the situation by by scaling up community-based midwife programs nation-wide.

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