Countries and Regions

	Table of Contents
p. 15 of 25 BACK | NEXT I. Country Performance Assessment II. Country Operational Strategy III. Sector Strategies A. Agriculture B. Infrastructure C. Social Infrastructure and Environment D. Governance Dimensions of ADB Operations E. Gender Dimensions of ADB Operations F. Province Level Interventions G. Private Sector Development IV. Regional Cooperation V. Donor Activities and Aid Coordination VI. Cofinancing and Catalyzing External Resources VII. ADB’s Operational Program VIII. Economic and Sector Work Program IX. Local Cost Financing

Country Assistance Plans - Pakistan : III. Sector Strategies

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C. Social Infrastructure and Environment

1. Education

65. Student enrolments have not kept pace with population growth and the quality of student learning has remained deficient. Despite severe financial constraints over the past two years, Pakistan has generally, maintained spending for basic education through the SAP including primary education and middle schooling. As a result, enrolments have climbed from 69 percent in 1993 to 73 percent in 1996 and from 54 to 64 percent for girls in the same period. The SAP has provided organizational capacity to increase enrolment growth, improve provincial educational monitoring, augment non-salary budgets for learning materials, and community participation through NGOs. Donor coordination for the SAP through the Multi-Donor Support Unit (MSU) has been particularly effective. Under the SAP umbrella, existing ADB-assisted projects in primary and middle schools and teacher training have been protected from funding cuts. They have had impacts on improving teacher certification and in-service training, scholarships for girls in grades 6-8 and the introduction of community model schools to provide quality classroom learning for primary school girls. These issues of access especially for girls, quality improvements to learning and the system's capacity building under SAP continue to be the ADB's focus in education.

66. With respect to human development, the ADB's main objective is to support Government expansion of quality basic education, especially for girls in rural areas, to raise participation rates in primary schools above 85 percent by 2000. The proposed Primary School Quality Improvement Project, for $50 million and programmed for 2001, will focus on reducing student dropout and raising the standard of education through decentralized supervision and school-community activism to make schools more responsive to students. In particular, the ADB is committed to raising the quality of what is learned in school as measured by improvements in teacher qualifications, in-service training and student test scores. The Teacher Training II Project (2002) for $50 million, will further develop the quality of teaching. Policies in support of basic education have been discussed jointly with donors under the SAP. Policy dialogue continues to emphasize the distribution of non-salary expenditures through school management committees and provision of adequate numbers of trained teachers in schools according to enrolment criteria of one qualified teacher to 35 students. Outside of basic education, the proposed Nonformal Education for Rural Women Project for $30 million programmed for 2000 will help to improve literacy and life skills. A PPTA to design the SAP III loan has been programmed for 2002. A SAP III loan for $200 million has been programmed as a standby loan in 2003. In addition, PPTAs for Balochistan Non Formal Education for Rural Women (2002), Third Girls Primary School (2003) and Early Childhood Development (2003) have been programmed to develop a lending program for future years.

67. Over the next three years, the ADB will continue to place priority on basic and nonformal education with the aim to improve basic social indicators in Pakistan. In basic education, the ADB will provide support to quality improvements to primary education with emphasis on dropout prevention in rural areas through scholarships and community involvement and teacher in-service training.

Health

68. Health services in both public and private sectors in Pakistan are generally of poor quality. A major problem in the health sector is poor governance. While federal and provincial capabilities have improved under SAP, the district level remains ineffective due to lack of authority, absence of accountability and teamwork, and lack of financial resources. There are insufficient female health staff compared to males, and staff absenteeism is high due to adverse recruitment practices, lack of job supervision, inadequate incentives, and social and security problems in rural areas. On the demand side, there is limited community appreciation for the health and nutrition needs of women. The health education and nutrition promotion subsectors have remained marginalized. The ongoing Women's Health Project addresses many of these concerns²⁷.

69. Under the SAP, a core health policy reform agenda has been formulated in each province, which, as the programmatic theme for the next four years, aims to improve the quality of primary health care. The Provinces have also identified a range of organizational priorities to improve the effectiveness and efficiency of the health sector. This includes decentralization, involving communities, development of district health management authorities, public-private partnership, development of supervision and monitoring systems, integration of federal programs and provincial health services, rationalizing public health facilities and staff deployment, introducing performance-based incentives systems, and improving cost recovery. As one of the lead donors in the health sector, the ADB has had a key role in helping the Government to set programmatic and organizational priorities, improve system designs, develop human resources for the sector, and improve service delivery to ensure the impact of policies and programs. Priorities for the ADB's involvement are women's health (including reproductive health, health education, and nutrition promotion), communicable disease control, and health sector reform.

70. The ADB's policy interventions in the sector focuses on: (i) improved public sector efficiency through strengthening of the management and the development of public-private partnerships in the delivery of services; and (ii) increasing equity through improving the access of women to health services and the quality of women's health care. The current program includes PPTAs for Nutrition Improvement in 2001 and for NWFP Health Sector Reform in 2002. In the program period, loans have been included for Reproductive Health $30 million, 2001, to improve access to reproductive health services and reduce fertility of married couples through community workers and the private sector, and improve clinical health services; and Nutrition Improvement $30 million in 2002. In 2003, a NWFP Health Sector Reform loan for $50 million has been programmed. In addition, the PPTA and loan for SAP III (para. 67) include a health component.

3. Urban Development

71. Although at present Pakistan's water supply and sanitation indicators rank slightly above the average for South Asia, sector investments continue to fall behind the growth in demand for environmental services caused by urban expansion, the urban environmental and social development indicators continue to decline. Infrastructure investments in the sector are not keeping pace with the rapid growth of urbanization in recent years and service quality is poor. Only the largest of Pakistan's cities have sewage conveyance networks, and low-income areas typically receive inadequate sanitation services. Many urban water supply and sewerage systems that have been installed or upgraded more than 20 years ago are operating at or above their capacity. These systems are in poor condition and many have already come to the end of their life. Piped water supply is irregular, often provided for less than six hours per day and system losses are high, estimated at 50 percent. Underground sewerage facilities are provided only in major cities, and squatter settlements and low-income areas are often left unserved. In urban areas, only about 40 percent of solid waste can be transported to the final disposal site, due to inadequate resources and management capacities. Substantial deficiencies remain in the provision of shelter for the urban poor. In addition, the large Afghan migrant and refugee populations in NWFP's and Balochistan's urban centers are further taxing the strained capacity of urban services in these areas.

72. In addition to insufficient investments in both urban and rural infrastructure, major constraints on sector efficiency are: (i) poor public sector management at all levels of Government; (ii) a lack of accountability in governance; (iii) ineffective markets for land and shelter; (iv) underfunding of investments, poor cost recovery, and poor O&M. Local resource generation for the provision of public utilities as well as beneficiary and community participation in the operation and maintenance of the utilities has also been limited. Increased private sector participation for the provision of urban services is encouraged by the Government, but hindered by a poor regulatory framework.

73. The main focus of ADB assistance to the sector, in conformity with the 1995 COS and the 1999 COF, will be on environmental aspects and poverty reduction. Policy dialogue will broadly cover: (i) institutional restructuring with emphasis on elimination of overlapping functional responsibilities, professionalization of urban management, staffing policies, and devolution of services delivery; (ii) private sector involvement in the delivery of selected urban services; (iii) budgeting and finance and increased cost recovery and municipal revenue; and (iv) increased community involvement. Capacity building efforts will be pursued for institutional strengthening of provincial and municipal urban management and operations, including planning and implementation capabilities, financial management, and environmental management. Assistance for privatization of utilities and urban waste management will also be considered, as appropriate.

74. Future sector investments will be province-based through selective use of the SDP modality. Planned assistance to urban development over the program period is significant with proposed interventions in several provinces. Punjab Urban Development Sector loan ($80 million) is included in the 2002 loan pipeline to strengthen responsible institutions, develop urban infrastructure, waste management and slum improvement in selected cities in Punjab. A loan for Quetta Water Supply and Sanitation ($60 million) is also included for 2002. An ADTA on Quetta Water Supply Institutional Strengthening (2002) and PPTA on Balochistan Urban Development (2003) are also included. A PPTA on Low Income Housing for 2001 and a $80 million loan in 2003 are included to facilitate provision of housing for the poor.

4. Environment

75. The main objective of the ADB's environment strategy in Pakistan is to promote the full integration of environmental concerns into the country's development process. The ADB has provided TA support for the implementation of the National Conservation Strategy with emphasis on strengthening the capacity of EPA staff²⁸. With regard to the present capacity of the Government, the implementation of the strategy requires a multi-pronged approach to enhance incentives for environmentally responsible behavior, increased investment in environmental protection by both the public and private sectors, and capacity building assistance to agencies responsible for environmental planning, management, and enforcement. Priority areas include: (i) preventing and controlling urban and industrial pollution; (ii) improving management of water resources; and (iii) promoting more effective partnership among the Government, the private sector, and the public at large to address environmental concerns.

76. Over the program period, environmental protection and management will be the secondary objective of most proposed ADB interventions in water resources and urban development sectors. Environmental concerns will also be mainstreamed under the proposed area-based rural development projects. A major stand-alone initiative is also envisaged for assistance to improve industrial efficiency and environmental management. The proposed PPTA for Industrial Efficiency and Environmental Management (2002) will complement the ADB's assistance to reduce the incidence of environmental damage through market-based controls in heavily polluted industries and provide a model for restructuring agencies in the environment sector. Urgent environmental concerns to reduce pollution levels in the very heavily polluted Ravi river, are also being addressed under the Punjab Water Resources loan described in para. 48.

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