Pakistan: Government Response to the Committee's Tenth Report of Session 2012-13 - International Development Committee Contents

Appendix: Government response

The UK Government welcomes the opportunity to respond to the International Development Committee's report on the UK programme of development assistance to Pakistan and the Committee's conclusion that the case for maintaining bilateral aid is strong. Success in Pakistan is critical to achieve the MDG and post 2015 agenda. A prosperous and stable Pakistan is in everyone's interests, including the UK's.

The UK Government is committed to seeking change and reform in Pakistan. Ultimately only the Government of Pakistan (GoP) has the responsibility and reach to solve Pakistan's problems and make significant, sustainable progress on tackling poverty. Revenues must increase; further investment is needed in essential basic services like health, education and social protection; and governance, accountability and transparency must also improve.

On election day on 11 May 2013, Pakistan made a crucial step on the transfer of power from one democratically elected Government to another. Together with other donors, DFID supported the Election Commission of Pakistan and civil society to ensure credible elections. Early indications are that, whilst challenges remain, this was the best organised election in Pakistan's history with the highest ever voter turnout at over 55%, including record numbers of female and young voters. The strength of the new government's mandate represents a huge opportunity for long term change for the better in Pakistan. We will work with the new federal and provincial governments to support the reforms needed for Pakistan's long term prosperity and to help Pakistan meet the needs of its growing population.

We expect the new federal and provincial governments to set out their policy priorities and commitments in the coming months. The UK Government will actively engage with the new government and press for economic and tax reforms, progress on anti-corruption efforts and investment in basic services such as education, health and social protection.

However, the scale of the challenge in Pakistan means change will not happen over-night. In the meantime it is vital that the poorest do not suffer. Our aid programme is designed to reach those most in need. We welcome the Committee's recognition of the good work DFID is delivering in Pakistan. Our country programme is also designed to catalyse and support key reforms at all levels of Government. We are additionally using our resources and influence with the international finance institutions and the UN to drive change.

DFID's Operational Plan (2011-2015) prioritises four areas seen as critical to stability and prosperity in Pakistan. These are to help: build peace and stability; make democracy work; increase macroeconomic stability, growth and jobs; and the delivery of key public services. Between 2011-15, DFID Pakistan aims to:

  • Basic Services: Benefit 4 million children in primary school, 400,000 children in lower secondary education and help 800,000 children complete the final grade of primary school. Avert 3,600 maternal deaths.
  • Economy: Help 1.23 million more people (701,000 female) access microfinance, train 40,000 (16,000 female) additional people in new skills and support over 1.78 million people (894,000 female) with cash transfers.
  • Governance: Increase voter turnout from 35 million to 37 million in the elections.
  • Humanitarian: Reach 2.5 million flood affected individuals with humanitarian assistance.

Response to conclusions and recommendations


Recommendation 1: However critical our witnesses were of the failings of successive Pakistan governments to deliver development, all agreed that the UK should maintain a development assistance programme. We agree that DFID should have a bilateral programme in Pakistan which has an important strategic position in the world, strong ties with the UK and its stability and prosperity is currently in question.

Agree. During their visit to Pakistan, the IDC heard that DFID is a trusted and valued partner able to operate at scale and make a positive impact on millions of people's lives. Pakistan is the sixth most populous country in the world with an estimated population of 180 million[1]. As many as one in three Pakistanis live on 30p a day or less[2]. One in eleven children die before their fifth birthday[3]. Levels of under nutrition are above emergency thresholds at 19%[4]. Pakistan also faces an education emergency. Half of all adults, and two thirds of women, are illiterate and 12 million children are out of school[5].

Entrenched poverty is denying opportunities to millions of people and undermining Pakistan's long term stability and prosperity. Furthermore, population growth is high. By 2020 the population could exceed 205 million, with nearly 40% aged 10-29 years[6]. With economic growth averaging only 3.5% over the past 5 years and the population increasing by 2% year on year, Pakistan is struggling to maintain living standards or to create jobs for millions of young people[7], leading to increased poverty and instability.

A stable Pakistan can also help support security and development across the region. As NATO troops withdraw from Afghanistan in 2014, Pakistan will have a key role to play in regional stability. Helping Pakistan take advantage of opportunities for trade with India and the wider region will make a significant contribution to regional and global prosperity.

On election day on 11 May, Pakistan made a crucial step in the transfer of power from one democratically elected Government to another for the first time in its history. This nascent democracy creates potential for positive change and real progress. But the development challenge is enormous and support is needed to help Pakistan get on track to stability and growth.

Pakistan remains one of the UK's most important foreign, defence and development priorities. The UK has one of the largest Pakistani diasporas in the world (1 million people, 1.7% of the UK population), creating strong family and business links. A prosperous and stable Pakistan is in everyone's interests.

Recommendation 2: It is for the Pakistan federal and provincial governments to shape reform programmes and institutions to improve public services and alleviate poverty. DFID has a role to play working alongside the federal and provincial governments.

Agree. In the long term, only the GoP has the responsibility and reach to solve Pakistan's problems and make significant, sustainable progress on tackling poverty. The UK Government works at both the federal and provincial level to catalyse and support GoP commitment to implement reforms that will create a stronger economy, deliver better services and strengthen governance.

For example, on education the Constitutional guarantee to free and compulsory education for all 5-16 year olds is a bold new step. The UK Government's sector support programmes in Punjab (with the World Bank and CIDA) and Khyber Pakhtunkhwa (with AusAid) are supporting this through: reforming teachers' pay and performance to improve the quality of education; improving budgeting and public financial management, so more funds are directed to areas most in need; decentralising management functions to the school level so that schools have more control over their budgets and issues like teacher numbers; and empowering school councils to make head teachers more accountable to parents. Combined with political leverage gained by the Roadmap approach - led by Sir Michael Barber, DFID's Special Representative for Education in Pakistan - UK aid has helped increase student attendance by almost one million and led to an investment of around $2 billion (2012/13) from the Government of Punjab (GoPb). The Roadmap has also resulted in GoPb recruiting teachers on merit, rather than political and family patronage, having a direct impact on teacher quality.

At the federal level, the UK Government, together with international partners including the IMF, has been engaging with the Caretaker Government and political parties to emphasise the need for tough decisions to be taken on tax reform when the next Government assumes power. DFID's new Sub-National Governance programme will also have a strong focus on tax reform, supporting the establishment of provincial revenue authorities and improved revenue generation in Punjab and Khyber Pakhtunkhwa.

The UK Government engages with both the federal and provincial Governments on women's empowerment, using the annual 'International Day for the Elimination of Violence Against Women' as an advocacy platform. DFID programmes work with local communities across Pakistan to provide support to and protect women from honour killing, acid burning, domestic violence and other abuses. Other examples of DFID support include providing stipends to girls in some of the poorest districts in Punjab and Khyber Pakhtunkhwa to complete secondary education; supporting more women to vote in the national and provincial elections; and supporting the Acid Survivors Fund.

Recommendation 3: DFID's development assistance should be conditional on the Pakistan authorities committing to and implementing economic reforms and policy changes that will foster inclusive economic and social development.

Agree. UK aid programmes with GoP only proceed when GoP provides the majority of funds, commits to increase spending and delivers results and reforms. It is also vital that UK aid is protected from corruption. These benchmarks are at the heart of all our joint programmes with both federal and provincial governments. This is a standard approach for DFID and many other donors. In Pakistan, examples of recent progress achieved through this approach include:

  • Education: Through our Punjab Education Programme coupled with the Education Roadmap we successfully pushed GoPb to adopt objective and transparent criteria for recruiting district education officials and new teachers, delivering a shift from patronage to merit-based appointment of 81,000 teachers.
  • Governance: With our support, the Government of Khyber Pakhtunkhwa (GoKP) has established a budgeting model which gives decision making power to local communities. The cost of classroom construction fell by over 40% during the pilot, while quality increased. GoKP is now scaling up the model across the province.
  • Health: With our support GoPb has increased skilled birth attendance from 33% in 2006 to nearly 60%.

  • Social protection: Our support for Pakistan's national cash transfers programme has helped secure significant increase in GoP financial commitments. It is driving improved transparency and reducing corruption -through e-banking and better use of technology. Careful data collection has generated a national poverty database; a pre-requisite for a wide range of other pro-poor initiatives. 

Our investment plans also take into account progress on key reforms areas specified in the 2006 Development Partnership Agreement and discussed with the Government at the UK/Pakistan Annual Aid Talks:

  • Social sector spending: Pakistan must increase its own investments in poverty reduction if DFID resources are to be additional. Working with GoP, DFID will only invest where the Government is committed to increasing its own spending.
  • Tax revenue: Pakistan must broaden its tax base. Without this, it will not be able to meet the needs of a population projected to reach 205 million by 2020. This is central to Pakistan's discussions with the IMF. DFID is leading donors to ensure that the IMF programme takes a firm line on tax; and encouraging the World Bank to lead work on tax reform.
  • Anti-corruption (including public financial management): DFID is working through our programmes and new anti-corruption strategy to safeguard tax payer's funds and help GoP strengthen its own systems to reduce corruption.
  • Human rights and democracy: Working with Foreign Office colleagues, DFID has regular discussions with GoP counterparts and others to seek improvements on human rights and governance, particularly to improve the rights of women and girls and minorities.

The UK has begun discussions with the new governments, at both official and Ministerial level, on reform priorities and encouraging urgent action. We will continue these discussions, including through visits by Ministers and senior officials. We will undertake formal bilateral aid talks with the new federal and provincial governments in our two focus provinces, Punjab and KP, at the earliest opportunity. These will be within 6 months and will discuss reform, review results, assess risks and agree action, including on economic reform, tax and corruption.


Recommendation 17: If the political system in Pakistan continues to be characterised by corruption, insufficient tax collection, poor human rights and a failure to protect minorities, the effectiveness of donor supported programmes will always be undermined. We recommend that:

  • the UK use its influence with the IMF to ensure that any additional loans are contingent upon prior commitments and action by the Government of Pakistan to meet clear conditions and targets;
  • the UK Government communicate clearly to the Pakistan authorities the conditions under which UK development assistance will either increase or be reduced;
  • DFID only increase official development assistance expenditure to the planned £446 million per annum if there is clear evidence that the newly elected Pakistan administration will increase tax revenues in general and income tax, in particular, and if it subsequently succeeds in increasing the amount of tax taken; and
  • if the Pakistan Government is unwilling to take action to increase its revenues and improve services for its people, it cannot expect the British people to do so in the long run. We cannot expect the citizens of the UK to pay taxes to improve education and health in Pakistan if the Pakistan elite is not paying income tax.

Agree. The UK Government has made it clear to GoP and opposition politicians, both in public and in private, that it is not acceptable in the UK for British tax payers to fund public expenditure in Pakistan if GoP is not taking steps to increase its own tax take.

A new IMF programme will offer the best long term prospects to support tax reform efforts. The UK Government will remain fully engaged and redouble efforts with the IMF to ensure any future programme leads to credible economic reforms, stands firm on the need for federal tax reform and includes robust prior actions - including on tax revenue.

Over the last three years DFID has built close relationships with the core donors in Pakistan to share information and thinking on economic policy. We will step up our work with international partners to lay the groundwork for reform, ensuring GoP has sound policy options and support in place to develop an ambitious and realistic reform programme. Co-ordinated action across international partners, rather than individual donors setting their own economic reform conditions, offers the best potential for securing results.

As noted above, the UK Government will undertake formal bilateral aid talks with the new GoP at federal and provincial level at the earliest opportunity and within 6 months, to discuss reform, review results, assess risks and agree action. These talks will help us think about the prospects for reform, investment choices and overall shape of our portfolio. Our resources will continue to be linked to reform measures through individual programmes.

Due to a combination of massive floods in 2010 that consumed significant resources both in DFID and GoP; decentralisation of basic service delivery in mid-2011; delays in Pakistan due to the elections this year; and on-going challenges in the security/operating environment, our spending profile from 2011-2015 has been revised downwards to £1.184bn. Despite this, Pakistan could still potentially become our largest bilateral aid programme in 2014/15.

If the new federal government can meet the challenge of setting out a credible programme for macroeconomic reform, DFID will work with the IMF and World Bank to explore opportunities to support their efforts. Any such support will be linked to progress under an IMF programme.


Recommendation 6: We recommend that DFID work with other donors to encourage Pakistan to make progress on tax policy and revenue collection and seek to ensure this is a high priority for all donors. We further recommend that the UK Government use its influence in the IMF to ensure this institution presses for reforms to Pakistan's tax system. The UK Government also should be ready to support the new Pakistan government in implementing a nationwide, strategic communication plan to explain the need and benefits of the desired tax policy changes so as to help the authorities to build political momentum for reform within Pakistan.

Agree. The IMF and World Bank are leading work on tax reform including measures to increase the tax base. The UK Government is fully engaged and will use our Board role to ensure that any future IMF programme stands firm on the need for federal tax reform.

DFID will continue to work with the World Bank in their efforts on provincial tax reform in order to generate revenue to improve health and education services, which are now provincial responsibilities. DFID's new Sub-National Governance Programme will also have a strong focus on tax, supporting the establishment of provincial revenue authorities and revenue generation in Punjab and Khyber Pakhtunkhwa. In Punjab, we will work with the World Bank to implement our programme and co-ordinate policy dialogue with the new GoPb.

We will continue to encourage reform efforts by federal and provincial governments through a combination of:

  • High level policy dialogue with government partners and in concert with international partners.
  • Direct conditionality in our programme partnerships to drive reforms and improve delivery in specific sectors by linking programme payments to indicators and policy dialogue. DFID will only invest in poverty reduction where the Government is committed to increasing its own levels of resources.
  • A detailed policy dialogue within those sectors around the government's policy and budget decisions, building on our programme conditionality.
  • Support to civil society and the private sector to help build demand and accountability for reform across Pakistani society.
  • Exploring options for what further support the UK can provide to the new government to help them increase tax revenue, including the possibility of HMRC expertise through the new, DFID-funded, Developing Countries Tax Unit.

DFID is committed to supporting a credible IMF programme with technical assistance and a nationwide strategic communications plan on tax reform where a credible case of effective impact can be made. The World Bank also has a key, overarching, role to play.

DFID's current governance and security projects

Recommendation 4: We commend DFID anti-corruption aspirations but recommend that in its response to us DFID should:

  • confirm that:
    • the Pakistan Government remains committed to an anti-corruption strategy and programme led by the National Accountability Bureau;
    • once appointed, the Bureau's principal officers cannot be dismissed by the President, Government, Parliament or the armed forces of Pakistan; and
    • the Bureau has the budget and power to investigate, charge and prosecute people without seeking approval from the President, Government, Parliament or armed forces of Pakistan.
    • set out measurable targets to see if its investment in anti-corruption is having the desired, positive effect.
    • indicate at what point monitoring and evaluation will take place to determine whether DFID and the Government of Pakistan's investment in anti-corruption is being achieved.
    • hold discussions with the Commonwealth Secretary General about what further steps the Commonwealth can take to help all Commonwealth Governments to reduce corruption.

Agree. Following the May elections, the new GoP will set out its policy priorities and commitments. This should include how GoP will tackle corruption and the continued role of the National Accountability Bureau (NAB). Pakistan is currently being reviewed on its compliance to the UN's Convention Against Corruption (UNCAC), providing an assessment of the country's progress against international standards. DFID will actively seek opportunities to engage with the new GoP's anti-corruption efforts, including discussing the review's main recommendations.

The National Accountability Ordinance 1999, passed by General Musharraf, established the National Accountability Bureau (NAB) and states: "Chairman NAB to be appointed by the President in consultation with the Leader of the House and the Leader of the Opposition in the National Assembly for a non-extendable period of four years on such terms and conditions as may be determined by the President and shall not be removed except on the grounds of removal of Judge of Supreme Court of Pakistan." The NAB has the budget and power to investigate, charge and prosecute people without seeking approval from the President, Government, Parliament or armed forces of Pakistan.

DIFD's Anti-Corruption Strategy sets out our commitment to protect UK funds in Pakistan through robust programme and financial management, risk assessments, audit, increased beneficiary monitoring and the use of new technologies to bypass intermediaries. The strategy also sets out our commitment to support efforts to reduce corruption by building political commitment for accountability, supporting better access to information and transparency, improving public financial management, strengthening civil society's ability to hold the government to account and working through UNCAC. All our programmes, including anti-corruption elements like audit and establishing payrolls, are also monitored on an annual basis according to standard DFID programme management procedures. Our Anti-Corruption Strategy is underpinned by a detailed work plan monitored on a 6 monthly basis.

As set out in the Commonwealth Secretariat's strategic plan, there is a role for the Secretariat in tackling corruption. DFID will seek to ensure that their work in this area adds value and supports members to take action. We will also explore the potential for regional bodies to support Pakistan in this area.

Recommendation 5: We are concerned that DFID's anti-corruption targets do not include bringing public officials accused of corruption to court and securing convictions and sentences against those found guilty.

Disagree. DFID is working, through our programmes and new Anti-Corruption Strategy, to safeguard tax payer's funds and help the Government strengthen its own systems to reduce corruption. NAB is the principal institution for prosecuting corruption cases in Pakistan. International experience indicates it is important for a range of national institutions to work together to address corruption rather than concentrating responsibility in an anti-corruption commission only.

The UK Government also supports the enforcement of corruption cases in Pakistan by supporting reform and increased access to Pakistan's criminal justice system. We are working with GoP at the federal and provincial levels to improve capacity to successfully investigate, prosecute, convict and detain high profile criminals in accordance with international human rights standards. We are also exploring with UK authorities how we might tackle illicit flows from corruption to the UK, including scoping work to recover money being laundered through the UK and strengthening action to address bribery.

DFID will actively review opportunities to deepen our engagement on anti-corruption issues with the new GoP, taking into account international experience and where UK aid will have the most impact.


Recommendation 7: Pakistan is a country where the Golden Thread is lacking - there is corruption, a frequent absence of the rule of law and low tax collection. We were surprised that addressing these important failings does not seem to be the main focus of DFID's governance work. We recommend DFID review and re-design the DFID Governance programme to support key Pakistani reformers to design and deliver a credible reform programme, involving increases in revenue collection, applying the rule of law and reducing corruption.

Partially agree. The 'Golden Thread' runs through DFID's portfolio of assistance in Pakistan. We agree that more could be done and, together with the new GoP, will review our governance portfolio to identify opportunities to increase our focus particularly on tax and corruption. However, DFID's governance programmes already focus on sustainably improving the lives of the poorest by helping to address the drivers of conflict; promoting the rule of law; supporting credible elections; empowering citizens to have a voice on how services are delivered; and strengthening political institutions to be more accountable and responsive to citizens.

For example, DFID is supporting the government to build peace in Pakistan's border areas in a number of ways. DFID is the largest contributor to the World Bank managed Multi Donor Trust Fund (MDTF) for Khyber Pakhtunkhwa, FATA and Balochistan which aims to rebuild trust between the people and state by supporting a GoP led programme of reconstruction and development interventions. As part of the MDTF we are supporting a new legal tribunal in FATA - the first time people in FATA have been granted access to any institution providing justice. DFID's new Peace Building Support programme will help build citizen-police interaction in KP to build trust and deliver better policing. DFID is also working with other parts of the UK Government on a major new programme to support GoP to reform the counter terrorism legal process, from crime scene management and evidence collection through to prosecutor training and changes to legislation. We have also worked with other donors including the EU to ensure that support for the rule of law is prioritised through other donor programmes.

DFID has worked closely with the Elections Commission and civil society to support the delivery of credible elections and a more inclusive political process. 43,000 domestic election observers were trained with our assistance and 172,000 national identity cards (a pre-requisite for voting) issued, 60% of which are for women.

DFID is also supporting GoPb and GoKP to be more accountable and responsive to citizens through the new Sub-National Governance Programme. In Khyber Pakhtunkhwa we have helped to improve financial management by supporting the Government to link budgets and spend to performance as well as increase citizens' say in how budgets are drawn up, reducing corruption and improving service delivery. For example, school enrolment in the pilot district of Buner has increased from 38% to 84% as a result. We are currently scaling up support to 15 districts with matching funding of 1 billion rupees a year from GoKP. In Punjab, DFID is supporting GoPb to contact 30,000 people a day through mobile phones to track the quality of services delivered. At least ten officials have already been suspended for corruption as a result. The programme will also have a strong focus on tax reform in both Provinces, supporting the establishment of provincial revenue authorities and revenue generation.

DFID recognises that this work is both innovative and challenging. We have built flexibility into the management arrangements for our programmes to allow us to scale up interventions that work and stop those that do not.


Recommendation 8: The connections between education and extremism are unclear. The UK Government believes that education will counter extremism, but others are sceptical. Nevertheless, recruitment into a jihadist movement would seem likely to be easier where there is hardship, poverty and unemployment.

Partially agree. The drivers of extremism are complex and multi-dimensional. Research by the Brookings Institute and others suggests that lack of education is one of a range of factors that can increase vulnerability to radicalisation. This is not to say all militants come from low or no education backgrounds, but weak education systems can make young people vulnerable to extremist messages. In Pakistan, inequity over access to education can also fuel grievances amongst those who are not able to go to or complete school and therefore unable to access economic opportunities; for example, the poor, rural based population, minorities and non-Urdu speakers. Education is one strand of a much broader strategy to reduce extremism and conflict over the medium term.

Recommendation 9: All are agreed that it is vital that the quality and coverage of education is dramatically improved in Pakistan. The Punjab Road Map looks to be a good project, but DFID will need to be able to adapt it should there be a change in Chief Minister with a successor less enthusiastic about the programme. A similar US programme in Sindh failed once the US withdrew funding. To help ensure this does not happen in Punjab and that the programme is sustainable, DFID should continue to help the Government of Punjab build widespread public support for an improved education policy and programme. The aim is to build informed demand from parents and an accountable response from education managers and the teaching profession that continues from one political administration to the next.

Agree. The interest and support of the former Chief Minister of Punjab has been important to the success of the Education Reform Roadmap. This initiative aims to engage political leaders and secure commitment to reform. Election scenario planning has helped ensure risks around post-election sustainability are mitigated as far as possible.

Following the dissolution of the Punjab Assembly, the Chief Secretary chaired the March 2013 stocktake, which was attended by Chairman Planning and Development as well as Secretaries for Education and Finance. Decisions were taken in the absence of a Chief Minister and the Chief Secretary stated that the Roadmap would continue into the next administration signalling a clear commitment to the process on the part of Punjab's most senior officials.

Building parental demand for education reform and a cross-party coalition of political will for change is the main purpose of DFID's Transforming Education in Pakistan programme, developed to underpin the UK's portfolio of investments in the sector at provincial level. In recent months this programme has delivered nationwide advocacy ahead of the elections by highlighting education manifesto commitments and encouraging voters to ask politicians what they are doing to tackle the education emergency. A network of district-level advocates is currently being built who will work directly with parents and communities to build demand for reform.

Recommendation 10: We are concerned by the quality of education provided by the schools we visited in Punjab, but are pleased that DFID's Punjab education programme has planned improvements to teacher quality and action against corruption of the examination system. DFID should report regularly on progress in improving the quality of education.

Agree. The quality of teaching and therefore learning levels in public schools is generally poor, and the assessment system weak. DFID is working through our Punjab sector reform programme and the Education Reform Roadmap to make progress on teaching quality and learning levels.

Current education priorities in Punjab include intensive work with the cadre of teacher educators in Punjab to improve their coaching skills and commitment to providing regular support to teachers in the classroom. DFID is working with the Punjab Examination Commission to strengthen its management capabilities by setting quality assessments and interpreting data on learning outcomes. We will also track how exams are conducted by the Department for Education and work with the new GoPb to deal with issues of misconduct.


Recommendation 11: DFID needs to look carefully at its health programme following the ICAI criticism. We have not seen enough of a change in the design of the Maternal and New-born Health programme to be reassured that the problems identified by ICAI at the national level will not just be replicated at the provincial level - mainly the interaction and relationship between the Community Midwives and Lady Health Workers. We support the basis of both programmes so are not asking for the funding to be stopped for either but that the remuneration packages and way of working are made complementary not competitive.

Partially Agree. Subsequent to ICAI recommendations, DFID has completed a significant redesign of its support to the health sector in Pakistan to ensure full opportunity is taken of the devolution process and transfer of health services from the federal to the provincial level. The new Provincial Health and Nutrition Programme (PHNP) was approved in December 2012 by the Secretary of State and, responding to the issues raised by ICAI, differs from the earlier Maternal New-born and Child Health Programme in a number of ways:

  • it works directly at the provincial and district level rather than supporting federal funded health programmes;
  • payments will be made directly to provincial governments on achievement of results with supporting evidence;
  • contracts between all districts and provincial Governments link the provision of additional resources with performance;
  • there is a focus on improving the clinical skills of health staff and to strengthen pre-service training, rather than funding less effective short courses;
  • it addresses critical areas like nutrition and reproductive health; and
  • it supports performance management of both Lady Health Workers (LHW) and Community Midwives (CMW) cadres.

Provincial Governments are also funding, managing and supervising LHW. These play an important part in the health system by reaching girls, women and children, often in remote rural areas, with primary health services such as family planning, immunisation and nutrition. In addition, Provinces are now responsible for managing the new cadre of Community Midwives who provide essential pre and post natal care and ensure safe delivery for pregnant women (the key factor in reducing the unacceptably high rates of maternal mortality in Pakistan). Given complementary mandates, there should be no competition between their roles, and whilst LHWs are paid through the Provincial Governments, CMWs are permitted to charge modest fees to supplement their incomes.

Recommendation 12: We welcome DFID's recognition of the need to improve the nutrition of mothers and new born children in Pakistan. However we are unconvinced that 'scaling up' the Lady Health Worker interventions is the solution until we see evidence of the redesign of the health programmes as suggested by ICAI. We ask DFID in its response to explain what has been done to date to rectify the issues. In addition we would like to receive information on the progress towards a food fortification intervention programme.

Partially Agree. Since the ICAI visit and report, the Secretary of State approved a new provincial health programme, the Provincial Health and Nutrition Programme (PHNP), for Punjab and Khyber Pakhtunkhwa. PHNP will not increase the number of LHWs, who number over 100,000 nationwide, or fund salaries. Through PHNP, DFID will deliver better health services through LHW networks by helping LHWs deliver interventions based on evidence that they have a positive impact on nutritional status. This could include identifying micronutrient deficiency among girls and pregnant women; providing preventive nutritional services including iron and folic acid supplements; implementing a globally-proven Infant and Young Child Feeding strategy to promote behaviour change; and screening and referring severe acute malnourished children. PHNP also seeks to address institutional weaknesses at the hospital and basic health unit levels by helping medical staff identify and treat severe acutely malnourished patients.

A new programme focusing on food fortification in Pakistan is being designed. Areas under consideration include: the provision of micro-nutrients; technical support to the legislative and regulatory framework; the role of the private sector in developing a market-based approach to food fortification; and options within the agricultural sector for example on bio-fortification and crop diversification. We expect the programme to be approved by autumn 2013. DFID is also considering options for investing in a World Bank-led multi-donor trust fund on nutrition.

DFID is the co-chair of the donor network for the global Scaling up Nutrition (SUN) movement. We have successfully advocated for Pakistan to join this movement which is founded on the principle that all people have a right to food and good nutrition. It unites people - from government, civil society, the United Nations, donors, businesses and researchers - in a collective effort to improve nutrition. On 15 April 2013, GoP signaled their commitment to SUN. Pakistan sees adequate nutrition as a key ingredient for overall development and the Government has agreed with donors and developments partners to develop federal and provincial nutrition plans of action.


Recommendation 13: We recommend that DFID explore innovative ways of working with the UK Pakistani diaspora:

  • to improve the effectiveness of the development assistance programme, in particular by involving the diaspora in monitoring projects; and
  • to align, where appropriate, diaspora funding and remittance flows to Pakistan with DFID supported programmes.

Partially agree. The diaspora have an important voice both in the UK and in Pakistan. There are a number of areas where the community already plays a strong role and could do more:

  • advocating for positive change in Pakistan through business, family and friendship networks;
  • contributing to the flow of remittances and charitable donations from the UK to Pakistan; and
  • advocating for Pakistan in the UK, particularly on development, trade and investment.

DFID already engages with the UK Pakistani diaspora in a number of ways. We regularly participate in outreach events in London, Birmingham and Manchester. The Secretary of State made a keynote speech at the Pakistan Minority Majority Programme Event in March 2013 and in May hosted a media event with representatives from the diaspora media. Senior officials have attended and addressed outreach events in Birmingham and Manchester organised by the British Pakistan Foundation. DFID has improved communications through contributing articles and editorials about our programme in Pakistan to diaspora media networks. DFID officials also meet with diaspora organisations individually and collectively to discuss programme work in Pakistan and operating challenges.

DFID is considering how to engage further, to help British Pakistanis become more aware of DFID activity in Pakistan and encourage their support for development in Pakistan through donations or volunteering. DFID is also considering how to broaden existing initiatives, such as UK Aid Match, to make funding more accessible to diaspora organisations involved in development work in Pakistan.

We disagree that diaspora funding flows and remittances should be aligned with DFID supported programmes. These are choices for individuals to make for themselves and it is unlikely that DFID efforts to steer public donations this way would be successful or represent a good use of time. However, DFID is engaged with diaspora groups to explain our assessment of the interventions needed and how they can help support development efforts in Pakistan.


Recommendation 14: We recommend that DFID ensures that its programmes have sufficient flexibility to respond to future political events especially following the elections due to be held in May this year.

Agree. It is important that DFID's programmes have the flexibility to respond to political events and other uncertainties in Pakistan while ensuring our investment delivers the best results. This includes building a portfolio that has a mix of programmes at the National and Provincial levels; and a balance across Government, multilateral, civil society and private sector delivery channels. Where appropriate, post-election scenario planning has helped manage risk in individual programmes such as the Punjab Education Reform Roadmap.

As noted above, the UK Government will undertake bilateral aid talks with Government within six months of the election to discuss reform, review progress on results, assess risks and agree actions going forwards. In addition, risks and results will continue to be kept under review as programmes are designed and implemented through monthly progress meetings with senior management at HQ; and quarterly meetings of the DFID Pakistan Programme Board.

Recommendation 15: We are concerned that DFID funding for the Benazir Income Support Programme and the Punjab Education programmes may lead some in Pakistan to believe that DFID is working unwittingly for selected Pakistan political parties, albeit these major programmes support different parties. In its response to this report, DFID should state how it will dispel such perceptions before Pakistan's forthcoming elections.

Partially Agree. DFID has worked to ensure all our programmes remain technically sound and politically neutral through the election process. We have worked to ensure that our support is not misunderstood by political parties and have actively engaged with them at a policy level to explain our education and national cash transfer programmes. This has been reflected by politicians in Pakistan, for example the Benazir Income Support Programme was unanimously passed by all political parties through an act of parliament. In the run up to the elections, political parties noted the importance of social protection, education and health delivery as part of their campaigns. The new government has signalled its intention to continue and possibly expand the national cash transfer programme. It plans to change its name to the 'Pakistan Income Support Programme', underscoring a commitment to ensure the programme delivers for poor Pakistanis across the country.


Recommendation 16:  It is essential that DFID makes the position of women and girls central to its work and that gender analysis and action is at the core of its Pakistan programme.  We recommend that DFID establish a gender advisory group made up of Pakistani women. We believe it should include women like Mariam Bibi. The group would advise on the impact of development work on women and explore where DFID could do more. We will continue to monitor the progress of women's role and inclusion in development in Pakistan.

Agree. DFID agrees on the importance of women and girls in our programme portfolio. Social Development Advisers already provide robust analysis on all programmes and endeavour to ensure that all programme indicators are disaggregated by sex wherever possible. In April, a gender expert from DFID HQ reviewed our programmes to ensure their compatibility with DFID's Strategic Vision for Women and Girls, identify gaps where more effort is required, capture synergies, lessons and learning across the office and update the DFID Pakistan Operational Plan.

DFID already works closely with Maryam Bibi and other women activists.  We will discuss with them the recommendation to establish a Gender Advisory Group and explore what options are possible. We will also seek to include Pakistan in the wider Girls and Women Advisory Group being established by DFID. In the run up to the March 2013 UN Commission on the Status of Women meeting on Violence Against Women, DFID lobbied in Pakistan and New York to help secure Pakistani delegation approval of all the draft conclusions (including those which Pakistan had previously blocked). This is a positive step forward and we will work with other donors, Pakistani gender violence networks and Pakistani officials to take forward these conclusions.

1 Back

2   This refers to the food poverty line (connected with daily calorific intake) which is equivalent to 30p a day. Calculations are

based on poverty figures given in the Pakistan Economic Survey 2008-09 of 36.1%. However estimates range from 17 - 36.1%. Back

3   UN Interagency Estimates for Child Mortality, 2011. Back

4   UNICEF (2009). Tracking Progress on Child and Maternal Nutrition.  Back

5   DFID Pakistan E-brochure UK aid: Changing lives and delivering results in Pakistan (Summer 2012). Back

6 Back

7   Government of Pakistan. Pakistan Economic Survey, 2011-12 Ministry of Finance. Back

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Prepared 17 June 2013