1. Shahnaz Wazir Ali Special Assistant to the Prime Minister on Social Sectors Pakistan Development Forum Nov 14, 2010 Protecting the Poor

2. Population 174m Male 52% Female 48% Urban 33% Rural 67% Demographic Profile (2010) 54.5% 23% 14% 5.4 % BALOCHISTAN KPK SINDH 1 GB AJK 2% 0.3%

3. TFR=3.6 35 % 26% 2010 174m MaleFemale POPULATION PYRAMID 65+ 50-64 15-49 0-14 WRA MaleFemale 2020 214m 32% 27% 26% TFR=2.8 2 WRA 12%

4. Key Education Challenges Quality/ Access 1.2M PrimaryTertiary Equity UrbanRural (Primary NER %) Private 26% 3% Public 42% 50% 68% 53% 3 16.7M Enrolled 8.8M Out of School 25.5M

5. Key Education Challenges 4.0% of GDP $ 6.7bn 4.7 Funding Gap Rs.213bn ($2.4 bn) Public/Private Investment Rs.372bn ($4.3 bn) (FY 9/10) 4

6. Government Policy Framework Service Provision: Focus in rural areas/urban slums and girls Targeted: Stipends, food incentives/vouchers (e.g. PEF, SEF) Basic facilities, free textbooks/materials and good teachers Standards/improved monitoring and accountability Donor collaboration at provincial level / maximize aid effectiveness Non-state/para-state initiatives (e.g. Citizen’s Foundation, NCHD) 5

7. Food Security and Nutrition Factors that impact household consumption 1. Production/ availability 2. Distribution/ access 3. Affordability/ inflation 6

8. Food Security and Nutrition Caloric intake: 1920 to 1650 cal/d Malnourishment in population: 24% Malnourishment among children: 38% FER 57% of HH income 7

9. Food Security and Nutrition Government Response BISP School Feeding (WFP) Disaster/ flood food support (WFP) Iodized salt, Vit A, E (ed oil) Iron in wheat fortification Utility Stores (subsidized) FSP (Punjab) 8

10. Health Sector Financing Public Sector $1 bn (0.6% GDP) Private spending $2 bn on health Preventive: 45% GoP allocation Curative: 55% public and all private funds Services Public Sector: Preventive >95%, Curative 20% Private sector: Preventive <5%, Curative 80% 9

11. Primary Role of State Maternal and Child Health Ensuring safe deliveries Family Planning Vaccination (polio eradication) Integrated Disease Surveillance Essential Health Services Package Quality, Standards and Regulation Human Resource for Health 10

12. HRH: Types of Healthcare Providers 11

13. Family Planning Services 3.4 million (14%) of MWRA receive FP services any given year Private sector accounts for >50% of FP services 12

14. Protecting the Poor and Vulnerable A. Programs of Social Assistance: BISP (Rs 22bn to 88bn) Baitul Mal – Health net, Child Labor, orphanages, disabilities Zakat (Rs 4.2bn) B. Programs of Social Insurance Social Health Insurance (BISP) EOBI, Workers Welfare Fund Employees Social Security Scheme Workers Profit Participation Fund Workers Children Education cess Provincial initiatives 13

15. Protecting the Poor and Vulnerable 1. Rural Support Programs: Govt funding: Rs 4.5bn Donors Rs 2.3bn Coverage 3.5m HH via community mobilization 2. Private Philanthropy: Est at Rs 150bn (39% health and 30% education) 3. PPAF (Rs 14.3bn) 4.1m beneficiaries 4. NCHD 14

16. Critical Trends Transfer from Federation to Provinces (18 th Amendment and the NFC Award) Shrinking state services and increasing role of markets Mediation by State for Equity Quality Types of services Financing 15