China’s economic growth over the last two decades is often referred to as a development miracle. When it embraced a free-market economy under the leadership of Deng Xiaoping, the readily available high human capital enabled Beijing to immediately attain double-digit GDP growth. This human capital accumulation was an outcome of persistent state investment in health and education in the post-revolution decades. The absence of investments of similar levels in India explains why New Delhi’s growth trajectory unable to match Chinese growth patterns. Like other South Asian nations, the low level of human capital is a key obstacle in development of Pakistan.
In order to reap the full benefits of economic opportunities including the China Pakistan Economic Corridor (CPEC), Pakistan requires a healthy and educated human resource. But unfortunately, key human development indicators of health and education lag well behind the desired level. In global human development ranking we were at 147th position among 188 nations reported in 2016 Human Development Report (HDR) of the UNDP. The biggest human development challenge in case of Pakistan is the issue of child stunting.
Malnutrition among women during pregnancy and among the child immediately after the birth causes underdevelopment of brain and shortens the height of the child below the actual realisable potential. The lifelong consequences of stunting include a below average mental ability and learning capacity. The stunted children perform low in school and usually earn less in adult life. We boast our youth bulge as an asset but the bitter reality is that a stunted generation can be anything but an asset. With new requirements of hi-tech manufacturing and IT based services sectors, the employment market is rapidly shrinking and future jobs will be mostly available to only highly skilled people.
According to the UNICEF, in 2015 every two out of four stunted children lived in South Asia. In Pakistan, more than 40 percent children under the age of 5 years suffer from stunting. Presently the estimated number of children in Pakistan with stunted growth is about 9.5 million. The World Health Organization (WHO) has set an internationally agreed target of reducing incidence of child stunting by 40 percent by 2025. The Sustainable Development Goals (SDGs) of the UN also endorse this WHO target and emphasise ending hunger, malnutrition and ensuring healthy lives and well-being for every individual by 2030. These goals are to be achieved by national governments with assistance of international organisations wherever required.
Malnutrition and sanitation conditions are main causes of stunting. Even a well-fed child can suffer from malnutrition due to contamination caused by poor sanitation conditions. First thousand days in a child’s life beginning from conception to the age of two years are the period during which stunting can be prevented as well as cured. This is the period in the life of a child which should be basic focus of anti-stunting policies. Malnutrition and poor sanitary conditions are closely associated with poverty. Due to adoption of Multidimensional Poverty Indicators (MPIs) as a measure of poverty in recent years, the extent and intensity of human deprivations has become more clearly visible. For example, according to 2016 HDR only 6.1 percent people in Pakistan are income-poor (below $1.90/day per capita income) — which naturally makes us feel complacent — but according to the MPIs 45.6 percent people of Pakistan suffer from poverty in terms of indicators like education, poor nutrition, health and sanitation conditions including absence of toilet.
Strategic development policy roadmap of Pakistan — Vision 2025 — indicates that development policy makers are cognizant of the problem of child stunting, its causes and consequences for national development. The ‘Pillar 1’ of Vision 2025 strategy titled ‘People First’ clearly mentions that 44 percent of children in Pakistan suffer from malnutrition and only 47.4 percent population has access to improved sanitation facilities. But after the eighteenth constitutional amendment, the major responsibility to translate the strategic vision of federal government into implementable policy interventions rests with the provinces. The provincial health departments have launched nutrition support programs of varying designs, scopes and coverage.
Since the problem of stunting stems from poverty, the policy interventions to combat this problem should be integrated with existing poverty alleviation and social protection framework. Proxy means tested poverty scores and a disbursement mechanism make the Benazir Income Support Programme (BISP) core social protection institution of Pakistan. A monthly grant to women, during pregnancy and first five years of child life to supplement nutritional requirements of mother and child, can be linked with existing cash transfers. The provincial health departments can allocate funds and outsource the disbursement to the BISP to benefit from their expertise.
Improvement in sanitation conditions is the second component of anti-child-stunting policy. This requires bringing change in cultural attitude towards hygiene along with a provision of physical facilities. A 1.5-billion-dollar World Bank program is presently supporting the Indian government initiative called ‘Clean India Mission’ to eradicate open defecation in rural areas. With quite similar rural culture and pattern of poverty, the provision of toilets particularly for the rural poor is important to improve hygiene and sanitation conditions particularly for the infants who can easily get infected from mother and other elders around.
According to the World Bank, India loses the equivalent of 6 percent of its GDP annually because of health problems caused by inadequate sanitation. When compared with China this explains how differentials in human development lead to different pace of economic growth. Human capital development is a prerequisite of economic development. The anthropometric measure of human height is a robust indicator of stunting. Since the Second World War, the average height of the Japanese nation has increased by almost six inches due to better nutrition and hygiene conditions. But in South Asia there is no improvement. The Nobel Laureate Economist Angus Deaton says it will take two hundred years for Indian men to grow as tall as Englishmen are now while it will take nearly 500 hundred years for the Indian women to catch up with the present average height of English women. Things are not much different in case of Pakistan. We should have no doubts that our journey to prosperous future has only one path — the path of human development.
The writer works for the public sector and is a development policy analyst