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
THE CASE FOR REFORM
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.
THE PAKISTAN GOVERNMENT AND ITS PROGRESS ON REFORM
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.
TAX REFORM
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.
THE 'GOLDEN THREAD'
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.
DFID'S EDUCATION PROJECTS
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.
DFID'S HEALTH PROJECTS
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.
UK PAKISTANI DIASPORA
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.
FLEXIBILITY TO RESPOND TO POLITICAL EVENTS
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.
WOMEN AND GIRLS
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 http://data.worldbank.org/country/palistan 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
http://esa.un.org/wpp/Other-Information/faq.htm Back
7
Government of Pakistan. Pakistan Economic Survey, 2011-12 Ministry
of Finance. Back
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