Gender Differentials in the Cost of Primary Education: A Study of Pakistan

The paper examines the differences in the cost of primary education by gender and by province. It shows that the growth in enrolment outstrips the growth in the relevant population cohort, except in Sindh, and that this is faster in the case of girls than boys; that the school construction programme for girls in Sindh, unlike other provinces, outstrips the growth in female teacher employment. This is also seen in the boys’ school in Pakistan. Cost of providing education are a function of the availability of teachers and schools, opportunity cost of employment, urbanisation and female literacy. The growth in both recurring and capital outlays and in output costs per student are higher for girls and boys except in Balochistan. Using a pooled time series and analysis the paper concludes that there is an optimal level for the availability of schools per 1000 population [6.02 and 5.67 respectively for girls and boys in the Punjab and 3.88 for boys in NWFP and Balochistan] and for the number of teachers per 1000 students [7.69 for girls and 3.36 for boys]. It suggests the policy prescription to reallocate resources to employing more teachers for boys for greater cost effectiveness.

Impediments to Social Development in Pakistan

The development of infrastructure and the provision of basic services in Pakistan lie in the public domain. The quality of the built infrastructure and the service offered reflect successive governments’ capability as a channel for public sector funds, their role in overall financial and macro-economic planning and management, and their administrative efficiency in implementation, operations and management—in essence the extent to which they are able to adhere to the principles of good and humane governance. Good governance is generally conceived of as the judicious exercise of economic, political and administrative authority in the public and private spheres to manage a country’s affairs at all levels to improve the quality of life of the people. It is a continuing process where divergent opinions and desires are satisfied through compromise and tolerance in a spirit of cooperative action for the mutual benefit of the larger whole. It has three dimensions: one, the political regime; two, the systems and procedures for exercising authority; and three, the capacity of governments [World Bank (1994); UNDP (1997); OECD (1995); Commission on Global Governance (1995)]. When Pakistan gained political freedom in August 1947, it inherited an economic and social infrastructure unable to meet the demands of the large influx of refugees from India. Five decades later, policies emphasising public investment, subsidised credit and regulated private sector development have generated strong economic growth, but failed to implement successful social development. Over the last 50 years and more Pakistan’s economy, measured through its GDP, has grown by more than 10 times, an average annual growth rate of 5.1 percent. Rapid population growth, estimated to have averaged just under 3 percent annually, has resulted in real per capita increases of only 2.1 percent per year.

Governance, Decentralisation, and Poverty: The Case of Pakistan

Human development and human rights share a common vision and purpose: to secure the freedom, well being and dignity of humanity. Human development is as essential for human rights as the latter is for the former. Historical evidence suggests that the more civilised societies were those that gave a higher priority to both, for example, the Greek, the Roman and the enlightened years of early Islam. The freedom from want is perhaps the one inalienable right of humanity which stands between dignity and indignity and which must be mitigated against by both state and individual.1 For the first time in history mankind adopted these and other human rights when the Universal Declaration of Human Rights was adopted by the United Nations in 1948. Today all but one of the six core covenants and conventions have been ratified by at least 140 countries and state sponsored anti-poverty programmes were initiated globally, most with the help of civil society [UNDP (2000)]. The lessons from history clearly establish that for improving the social endowment of the poor the state and the individual are key players, money is a necessary requirement, good governance is critical to success and the participation of each component of society as a whole ensures sustainability and continued benefits beyond the initial attempts to mitigate the impact of poverty. In other words decentralisation is a key element to improve the lot of the people, particularly the poor and the disenfranchised.

Impediments to Social Development in Pakistan

The development of infrastructure and the provision of basic services in Pakistan lie in the public domain. The quality of the built infrastructure and the service offered reflect successive governments’ capability as a channel for public sector funds, their role in overall financial and macro-economic planning and management, and their administrative efficiency in implementation, operations and management—in essence the extent to which they are able to adhere to the principles of good and humane governance. Good governance is generally conceived of as the judicious exercise of economic, political and administrative authority in the public and private spheres to manage a country’s affairs at all levels to improve the quality of life of the people. It is a continuing process where divergent opinions and desires are satisfied through compromise and tolerance in a spirit of cooperative action for the mutual benefit of the larger whole. It has three dimensions: one, the political regime; two, the systems and procedures for exercising authority; and three, the capacity of governments [World Bank (1994); UNDP (1997); OECD (1995); Commission on Global Governance (1995)]

Gender Differentials in the Cost of Primary Education: A Study of Pakistan

The paper examines the differences in the cost of primary education by gender and by province. It shows that the growth in enrolment outstrips the growth in the relevant population cohort, except in Sindh, and that this is faster in the case of girls than boys; that the school construction programme for girls in Sindh, unlike other provinces, outstrips the growth in female teacher employment. This is also seen in the boys’ school in Pakistan. Cost of providing education are a function of the availability of teachers and schools, opportunity cost of employment, urbanisation and female literacy. The growth in both recurring and capital outlays and in output costs per student are higher for girls and boys except in Balochistan. Using a pooled time series and analysis the paper concludes that there is an optimal level for the availability of schools per 1000 population [6.02 and 5.67 respectively for girls and boys in the Punjab and 3.88 for boys in NWFP and Balochistan] and for the number of teachers per 1000 students [7.69 for girls and 3.36 for boys]. It suggests the policy prescription to reallocate resources to employing more teachers for boys for greater cost effectiveness

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks