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XXVIII. The Prevailing Social Problems of Pakistan

📂 START HERE — How This Page Is Organised

No child pages here — read the sections below in order, then the solved past papers at the end.

📝 Actual CSS questions from this chapter

  • CSS 2017 Q6 — HEC measures for higher education and research
  • CSS 2026 Q8 — Health and education after the 18th Amendment

📺 Directly Relevant YouTube Lecture Sources

📌 Topic Contents

  1. 📖 Overview
  2. 📖 1. Poverty
  3. 📖 2. Education
  4. 📖 3. Health
  5. 📖 4. Sanitation
  6. 📖 Cross-Cutting Strategy Themes (common exam ask)
  7. 📖 Health and Education After the 18th Amendment (CSS 2026, Q8)
  8. 📖 What devolution did
  9. 📖 Education — performance
  10. 📖 Health — performance
  11. 📖 Why results are mixed
  12. 📖 Way forward
  13. 📖 Answer structure (20 marks)
  14. 📖 Exam Angle
  15. 📖 Further Reading
  16. 📖 ✍️ Model Answer (20 marks)
  17. 📖 Outline

20-mark technique: frame a thesis; explain causes and consequences; substantiate claims; assess alternative explanations.

Overview

  • Narrower in scope than the umbrella Ch10. Pakistan: Problems and Challenges page — this syllabus point asks specifically about poverty, education, health, and sanitation, plus the strategies to address them. See Ch10 for the wider political, economic and security dimensions.

1. Poverty

Picture

  • Multidimensional poverty is far higher in Balochistan and rural Sindh than the national average.
  • It covers more than income: health, education and living standards.

Drivers

  • Population growth outpaces economic growth.
  • Inflation eats into real wages.
  • A large informal labour market.
  • Historically weak safety nets.

Strategies

  • BISP / Kafaalat cash transfers
  • Ehsaas: education stipends, health cards
  • Microfinance and skills training
  • Better targeting through the National Socio-Economic Registry

2. Education

Picture

  • Literacy around 60%, with sharp gender and rural–urban gaps.
  • Over 20 million out-of-school children — mostly in Balochistan, Sindh and among girls.

Structural problems

  • Spending far below the 4%-of-GDP benchmark.
  • Parallel public, private and madrassah systems with unequal outcomes.
  • Weak learning even among enrolled children.

Strategies

  • Single National Curriculum (2021; still contested)
  • Cash transfers tied to girls' enrolment
  • Public–private partnerships
  • Provincial programmes since the 18th Amendment

3. Health

Picture

  • Public health spending about 1% of GDP → high out-of-pocket costs.
  • Access is unequal, especially in rural areas.

Indicators of concern

  • High maternal and infant mortality compared with the region.
  • Widespread child stunting and malnutrition.
  • Polio still endemic (one of only two countries).

Strategies

  • Sehat Sahulat health-insurance card
  • More Basic Health Units; the Lady Health Worker programme
  • Provincial delivery with federal coordination on immunisation and disease control

4. Sanitation

Picture

  • Open defecation and poor sanitation persist in rural Sindh, Balochistan and southern Punjab.
  • Directly linked to stunting, waterborne disease and child deaths.
  • Drinking water is contaminated (arsenic; sewage mixing with supply lines in cities).

Strategies

  • Clean drinking water programmes
  • Community-led rural sanitation and hygiene promotion
  • Urban wastewater treatment (most sewage is still discharged untreated)

Cross-Cutting Strategy Themes (common exam ask)

  • Break the poverty–poor health–low education cycle through integrated conditional cash transfers rather than sector-siloed programmes.
  • Strengthen provincial capacity post-devolution (health and education are now provincial subjects) while retaining federal coordination on standards and disease control.
  • Prioritize female education and health as the highest-leverage intervention — it correlates with lower fertility, lower child mortality, and higher household income.
  • Improve data and targeting (census-linked registries) so subsidies and services reach the poorest, not just the politically connected.

Health and Education After the 18th Amendment (CSS 2026, Q8)

What devolution did

  • 18th Amendment (April 2010): abolished the Concurrent Legislative List; health and education became provincial subjects; 17 federal ministries devolved by June 2011.
  • Article 25-A: made free and compulsory education for children aged 5–16 a fundamental right.
  • 7th NFC Award (2009): provinces' share of the divisible pool rose to 57.5%, giving them the money to deliver.

Education — performance

  • Positives: all provinces passed Right to Education laws (Sindh 2013, Punjab and Balochistan 2014, KP 2017); innovations such as Punjab's school outsourcing and education foundations, KP's Independent Monitoring Unit, provincial higher education commissions.
  • Literacy rose slowly: ~58% (2010) to 63% (2025) — about half a point a year.
  • Access gaps: out-of-school rate still ~28% (2025); over 25 million children out of school; Balochistan literacy only 49%.
  • Spending fell: public education spending dropped to ~0.8% of GDP in FY25, far from the 4% benchmark, despite higher provincial resources.
  • Quality crisis: around three-quarters of 10-year-olds cannot read a simple text (World Bank learning poverty); weak teacher training; only ~59% of primary schools have electricity.
  • Coordination gaps: disputes over curriculum (Single National Curriculum resisted by Sindh), HEC vs provincial HECs; weak national data.

Health — performance

  • Positives: provincial health care commissions to regulate quality; KP's universal Sehat Card (2020) and Punjab's health insurance; Lady Health Worker programme continued.
  • Coordination failure exposed: the federal Health Ministry was abolished in 2011 and recreated in 2013 as the Ministry of National Health Services, Regulations and Coordination; DRAP created in 2012 to regulate medicines.
  • Indicators remain poor: high maternal and infant mortality relative to the region; ~40% child stunting; polio still endemic.
  • Spending low: public health spending around 1% of GDP; high out-of-pocket costs.
  • COVID-19 (2020–21) showed that federal coordination (NCOC) is essential even in a devolved system.

Why results are mixed

  • Devolution stopped at the provinces: Article 140-A local governments are weak or suspended, so services are not devolved to districts.
  • Weak provincial capacity, political appointments and absenteeism.
  • No binding national minimum standards or spending floors.
  • Population growth (~2.55%) outpaces new schools and clinics.
  • The 27th Amendment (2025) reopened federal-provincial responsibility for education and population planning — critics see it as partial recentralisation.

Way forward

  • Empower local governments with protected funds via Provincial Finance Commissions.
  • Minimum spending floors: e.g., 4% of GDP for education and 3% for health, jointly by federation and provinces.
  • National standards through the Council of Common Interests — curriculum benchmarks, learning assessments, disease surveillance — without undoing devolution.
  • Data and accountability: independent learning assessments and health surveys published annually.
  • Focus on the lagging regions: Balochistan, merged districts, rural Sindh; girls' education and female health workers.
  • Public-private partnerships and technology (tele-health, digital classrooms), with regulation.

Answer structure (20 marks)

  1. Introduction — 18th Amendment as a landmark of cooperative federalism; state the thesis (more autonomy, uneven results).
  2. What devolution changed — legal and fiscal framework.
  3. Education — successes, failures, data.
  4. Health — successes, failures, data.
  5. Causes of mixed performance.
  6. The recentralisation debate (27th Amendment).
  7. Way forward.
  8. Conclusion — the problem is not devolution itself but incomplete devolution.

Exam Angle

  • Common question: "Discuss the prevailing social problems of Pakistan and suggest strategies."
    • Build the answer on the four areas: poverty, education, health, sanitation.
    • Show how they feed each other.
    • End with a realistic way forward.
  • For broader questions, combine with XXVI (Economic Conditions) and Ch10.

Further Reading

  • Ch10. Pakistan: Problems and Challenges — broader political, economic, governance, and security dimensions.
  • II. Land and People of Pakistan — demographic and educational baseline data.

✍️ Model Answer (20 marks)

Question (CSS 2026): Critically assess the performance of the health and education sectors after being handed over to the provinces under the 18th Amendment and suggest a way forward.

Outline

  1. Introduction
  2. What devolution changed
  3. Education: performance
  4. Health: performance
  5. Why results are mixed
  6. The recentralisation debate
  7. Way forward
  8. Conclusion

1. Introduction

The 18th Amendment (April 2010) was the most far-reaching reform of Pakistan's federal structure since 1973. By abolishing the Concurrent Legislative List, it transferred health and education to the provinces, and the 7th NFC Award (2009) gave them the resources to deliver. Fifteen years later, the results are mixed: devolution produced innovation and more money for the provinces, but outcomes in literacy, learning and health remain among the weakest in the region. The central argument of this answer is that the problem is not devolution itself but incomplete devolution.

2. What Devolution Changed

  • The Concurrent List was abolished and 17 federal ministries were devolved by June 2011.
  • Article 25-A made free and compulsory education for children aged 5–16 a fundamental right.
  • The provinces' share of the divisible pool rose to 57.5% under the 7th NFC Award.
  • The federation kept a coordinating role through the Council of Common Interests, the HEC and later the Ministry of National Health Services, Regulations and Coordination (2013).

3. Education: Performance

Achievements

  • All provinces passed Right to Education laws (Sindh 2013, Punjab and Balochistan 2014, KP 2017).
  • Provincial innovations: Punjab's education foundation and school outsourcing, KP's Independent Monitoring Unit, provincial higher education commissions.
  • Literacy rose from about 58% to 63% (Economic Survey 2025-26); the out-of-school rate fell from 38% (2023) to 28% (2025).

Failures

  • Progress is slow: about half a percentage point of literacy a year.
  • Over 25 million children are still out of school; Balochistan's literacy is only 49% and rural Sindh's 39%.
  • Public education spending fell to about 0.8% of GDP in FY25, far below the 4% benchmark.
  • A learning crisis: around three-quarters of 10-year-olds cannot read a simple text.
  • Only about 59% of primary schools have electricity.
  • Curriculum disputes (the Single National Curriculum was resisted by Sindh) and uncertainty about the HEC's role.

4. Health: Performance

Achievements

  • Provincial health care commissions regulate quality.
  • Health insurance: KP's universal Sehat Card (2020) and Punjab's programme.
  • The Lady Health Worker programme continued; DRAP (2012) was created to regulate medicines.

Failures

  • The federal health ministry was abolished in 2011 and recreated in 2013, showing a coordination vacuum.
  • Indicators remain poor: high maternal and infant mortality, about 40% child stunting, and polio still endemic.
  • Public health spending remains around 1% of GDP, so out-of-pocket costs are high.
  • COVID-19 showed that federal coordination (the NCOC) is essential even in a devolved system.

5. Why Results Are Mixed

  1. Devolution stopped at the provinces: local governments under Article 140-A are weak or suspended.
  2. Capacity gaps: weak planning, political appointments, teacher and doctor absenteeism.
  3. Money without accountability: no spending floors or outcome targets.
  4. Population growth (~2.55%) outpaces new schools and clinics.
  5. Weak data makes performance hard to measure.
  6. Inequality between provinces in capacity and resources.

6. The Recentralisation Debate

  • Critics: provinces have failed; the federation should take back education and population planning.
  • The 27th Amendment (2025) reopened these questions.
  • Supporters of devolution: centralisation also failed before 2010.
  • Their answer: complete devolution to districts and set national standards — don't reverse it.

7. Way Forward

  • Complete devolution: empowered local governments with protected funds through Provincial Finance Commissions.
  • Spending floors: e.g., 4% of GDP for education and 3% for health, shared by the federation and provinces.
  • National standards through the CCI: curriculum benchmarks, national learning assessments, disease surveillance and immunisation.
  • Accountability: independent annual learning and health surveys published by district.
  • Equity: extra resources for Balochistan, the merged districts and rural Sindh; focus on girls and female health workers.
  • Technology and partnerships: tele-health, digital classrooms and regulated public-private partnerships.
  • Population planning as a shared federal-provincial priority.

8. Conclusion

The 18th Amendment gave the provinces both the right and the resources to transform health and education. Some have innovated, but overall outcomes remain poor because devolution was never completed and accountability never built. Reversing devolution would repeat past failures. The way forward is to finish it: take power to the districts, set national standards, protect spending and measure results. Only then will Article 25-A's promise and the constitutional right to a dignified life become a reality for every child.

📝 CSS Past Papers 2014–2026 — This Chapter (Solved)

📊

Asked so far: 2 subjective questions (2017 on the HEC, 2026 on health and education after the 18th Amendment) · 3 MCQs (2020). Population, poverty and youth questions are under II. Land and People.

2014–2023 MCQs come from published answer keys (the FPSC copies only contain Part-II), so their options are rewritten but the keyed answer is kept and checked.

Part-I — Past MCQs

1. (CSS 2020) Which Article of the Constitution makes education free and compulsory for children aged 5–16?

  • (A) Article 37
  • (B) Article 38
  • (C) Article 25
  • (D) Article 25-A
  • ✅ (D) Article 25-A — inserted by the 18th Amendment (2010). Before that, Article 37(b) only set the aim of removing illiteracy.

2. (CSS 2020) In the WHO's ranking of health systems of 190 countries (2000), Pakistan ranked:

  • (A) 92
  • (B) 112
  • (C) 122
  • (D) 142
  • ✅ (C) 122 — World Health Report 2000 (France 1st, USA 37th).

3. (CSS 2020) What percentage of Pakistan's population lived below the national poverty line (at the time of the paper)?

  • (A) 18%
  • (B) 21%
  • (C) 24%
  • (D) 29%
  • ✅ (C) 24% — 24.3% in 2015–16 (cost-of-basic-needs method).
    • ⚠️ Newer figures: World Bank about 25.3% (2024); government about 28.9% (2024–25).

Part-II — Past Subjective Questions

1. CSS 2017 Q6 — Enumerate the measures adopted by HEC for promotion of higher education and qualitative research in Pakistan. (20)

Outline

  1. Introduction
  2. Measures to widen access
  3. Measures to improve quality
  4. Faculty development
  5. Promotion of research
  6. Achievements
  7. Challenges
  8. Recommendations
  9. Conclusion

Answer

1. Introduction

  • The Higher Education Commission was set up in 2002, replacing the University Grants Commission, with Dr Atta-ur-Rahman as its first chairman. It remained a federal body after the 18th Amendment, although some provinces have since created their own higher education commissions.

2. Measures to widen access

  • The number of universities has grown from about 59 in 2002 to around 260 by 2025, with sub-campuses in remote districts.
  • Need-based scholarships, the Prime Minister's Laptop Scheme and the Fee Reimbursement Scheme have helped students from poorer families.
  • Special quotas and scholarships support students from Balochistan and the former tribal areas.

3. Measures to improve quality

  • A Quality Assurance Agency was established, and each university was required to set up a Quality Enhancement Cell.
  • The Tenure Track System was introduced in 2004 to reward productive faculty.
  • A plagiarism policy was enforced, using software such as Turnitin.
  • Accreditation councils were created for professional degrees, and curricula were revised around learning outcomes.
  • The Undergraduate Education Policy of 2020 made the four-year BS the standard first degree.

4. Faculty development

  • More than 10,000 scholarships have been awarded for PhD study at home and abroad, including through partnership with the Fulbright programme.
  • The Interim Placement of Fresh PhDs programme helped returning scholars find university posts.

5. Promotion of research

  • The National Research Programme for Universities funds research projects.
  • Offices of Research, Innovation and Commercialisation, along with technology incubation centres, link universities with industry.
  • Research journals are recognised and ranked through the HEC Journal Recognition System.
  • The Pakistan Education and Research Network and the national digital library give access to more than 75,000 international journals.
  • Pakistan's annual research output has risen from about 800 papers in 2002 to more than 30,000.

6. Achievements

  • Pakistani universities such as NUST, Quaid-i-Azam University and LUMS now appear in international rankings.

7. Challenges

  • Funding has been cut since 2018.
  • Rapid expansion has sometimes come at the expense of quality.
  • Links between universities and industry remain weak.
  • Many graduates leave the country.
  • Plagiarism persists.
  • Delays in appointing vice-chancellors and weak governance hold universities back.

8. Recommendations

  • Higher education needs stable funding of around one per cent of GDP.
  • Universities should work closely with industry and focus more on applied research.
  • Universities should be given greater autonomy, along with stronger governance.

9. Conclusion

  • The HEC has transformed access to higher education and the volume of research in Pakistan. Its next task is to raise the quality and relevance of that education and research.

Full 20-mark answer: CSS 2017 — Pakistan Affairs Paper (Solved)

2. CSS 2026 Q8 — Critically assess the performance of health and education sectors after being handed over to the provinces under the 18th Amendment and suggest way forward. (20)

Outline

  1. Introduction
  2. What the 18th Amendment changed
  3. Performance of the education sector
  4. Performance of the health sector
  5. Comparison between provinces
  6. Main problems
  7. Way forward
  8. Conclusion

Answer

1. Introduction

  • The 18th Amendment of 2010 abolished the Concurrent List and made education and health provincial subjects. It also added Article 25-A, which makes free and compulsory education a right for all children aged five to sixteen. The idea was that provinces, being closer to the people, would deliver these services better. Fifteen years later the record is mixed.

2. What the 18th Amendment changed

  • The federal Ministries of Education and Health were devolved in 2011.
  • The federation kept responsibility for higher education through the HEC, for drug regulation through DRAP and for national standards. A Ministry of National Health Services, Regulations and Coordination was recreated in 2013.
  • The provinces' share of the divisible pool rose to 57.5 per cent to help them pay for these services.

3. Performance of the education sector

Reforms

  • Punjab introduced data-based monitoring of schools and handed some weak schools to private partners through the Punjab Education Foundation.
  • KP recruited teachers on merit through tests and set up an Independent Monitoring Unit.
  • Sindh passed a Right to Education Act in 2013 and worked with the Sindh Education Foundation.
  • All provinces passed laws to give effect to Article 25-A.

Outcomes

  • About 26 million children are still out of school.
  • The literacy rate is around 60 to 63 per cent, with wide gaps between men and women and between cities and villages.
  • World Bank estimates suggest that around three-quarters of ten-year-olds cannot read a simple text.
  • Spending on education remains far below the target of four per cent of GDP, and the Single National Curriculum of 2020 caused disputes, particularly with Sindh.

4. Performance of the health sector

Reforms

  • KP introduced the Sehat Card health insurance scheme in 2020, and Punjab followed in 2021 and 2022.
  • Provinces set up health care commissions to regulate quality.
  • The Lady Health Workers programme was continued at provincial level.
  • The National Command and Operation Centre coordinated a successful federal-provincial response to Covid-19.

Outcomes

  • Public spending on health is only about one per cent of GDP.
  • Maternal and infant death rates remain high, and about 40 per cent of children under five are stunted.
  • Pakistan is still one of only two countries where polio is endemic, and cases rose again in 2024.
  • Rural health facilities often lack doctors and nurses.

5. Comparison between provinces

  • Punjab and KP have introduced more visible reforms, while Sindh and Balochistan have lagged behind because of weaker governance and capacity.

6. Main problems

  • Spending is too low for the needs of a growing population.
  • Many provincial departments lack planning and management capacity.
  • Ghost schools, absent staff and political appointments waste resources.
  • Provinces have not passed power and funds down to local governments, even though schools and clinics are local services.
  • Coordination between provinces on standards, curricula and disease control is weak.
  • The 27th Amendment of 2025 has reopened the debate over whether some of these subjects should return to the centre.

7. Way forward

Education

  • Spending should be raised steadily towards four per cent of GDP.
  • The focus should shift to basic reading and arithmetic, supported by teacher training and regular assessment.
  • Out-of-school children, especially girls, should be reached through stipends such as BISP's Waseela-e-Taleem.
  • Teachers should be recruited on merit and held accountable.
  • National minimum standards should be agreed through the Council of Common Interests.

Health

  • Primary health care should be strengthened and spending increased.
  • Health insurance should be put on a sustainable financial footing.
  • Polio eradication should be pursued with community support and proper security.
  • Incentives should encourage doctors and nurses to serve in rural areas.

Governance

  • Local governments should be given control of schools and clinics.
  • Data systems and independent monitoring should track results.
  • Federal-provincial coordination should be institutionalised on the model of the NCOC.

8. Conclusion

  • Handing health and education to the provinces was a sound decision, and some provinces have made real progress. The poor results in many areas are due to low spending, weak governance and poor coordination, not to devolution itself. The answer lies in completing devolution properly, not in reversing it.

Full 20-mark answer: CSS 2026 — Pakistan Affairs Paper (Solved)