Assessing the Impact of Devolution of Healthcare and Education in Pakistan

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This report presents an assessment of current devolution in Pakistan—an initiative that began in 2001 with the passage of the Local Governance Ordinance. It is the product of meetings with government and donor representatives in the country in December 2005 and January 2006 and a thorough review and analysis of numerous reports on devolution efforts in Pakistan to date.¹ Section 1 of the report summarizes the background of devolution and the structure of local governments. Section 2 focuses on: the progress and challenges of effective and efficient service delivery; local fiscal roles and responsibilities; and accountability and citizen participation under the devolution scheme. Section 3 lists the key finding and conclusions of the assessment. Section 4 presents a set of recommendations.

Since the field assessment is based on a limited sample, specific situations in the districts and tehsils that the team visited cannot be considered representative for the entire country. Each province sets its own slightly different policies, and there are also some differences across districts/tehsils in the same province. However, lessons can still be drawn because all local governments face similar constraints—technical, financial, and managerial—in providing responsive, quality services to their citizens and in involving citizens in decision-making.

This assessment is the basis for designing the three-year "Districts That Work" (DTW) project for USAID/Pakistan. DTW will support devolution with its focus on governance and improved management, and will create synergies between existing USAID programs in the health, education, and water sectors. The Urban Institute's team based its assessment on three core elements that define successful districts. These are:

1. Effective and cost-efficient delivery of services, by focusing on results/performance management principles;
2. Fiscal responsibility, by building own-resource capacity, operating within budget constraints, and managing own finances; and
3. Accountability to citizens, by reflecting their priorities for services and development projects, involving citizens and civic groups in monitoring and oversight, and increasing public participation in decision making.

Notes from this section of the report

1 The team, composed of Ritu Nayyar-Stone (team leader), Robert Ebel, Sonia Ignatova, and Khalid Rashid held meetings with the Government of Pakistan (GOP) and donor organizations in Islamabad in December 2005. The team also met with provincial officials such as Secretary-Local Government, Secretary-Health, and Secretary-Education in three provinces - the North West Frontier Province (NWFP), Sindh, and Punjab. District and/or tehsil visits were made in Mansehra (NWFP), Kohat (NWFP), Thatta (Sindh), and Sialkot (Punjab). Phone consultations were also held with district officials from Sukkur (Sindh) and Ms. Jackie Charlton, previously head of Governance, DFID, overseeing assistance to Faisalabad (Punjab). A subsequent visit in January 2006 by George Peterson focused on donor efforts and funding. During this trip, George Peterson and Khalid Rashid also met with USAID implementing partners in the education and health sectors to explore linkages between ongoing USAID programs in these two sectors and the DTW project.

Note: This report is available in its entirety in the Portable Document Format (PDF).

The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

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