The writer is an economist, anchor, jurist, geopolitical analyst and the President of All Pakistan Private Schools’ Federation
president@Pakistanprivateschools.com
The 18th Constitutional Amendment (2010) abolished the Concurrent Legislative List and fully devolved education and health (among other subjects) to the provinces. The stated goal was subsidiarity—“closer to the people, better delivery.” Sixteen years later, absolute numbers of out-of-school children remain extremely high, public spending on both sectors has stagnated or declined as a share of GDP, learning poverty is severe, provincial disparities have widened or persisted, and coordination failures (curriculum, disease control, procurement, data systems) are evident. The 18th Amendment was meant to empower. In education and health, it created fragmentation. Without federal benchmarks, provinces lacked capacity, funds were misused, and outcomes declined. The 18th Constitutional Amendment 2010 devolved Education and Health to provinces. 16 years later, Pakistan has 26.2M out-of-school children, health spending less than 1.1% of GDP, and 4 parallel systems to argue for re-federalisation of policy, standards, and funding while keeping service delivery provincial. The 18th Constitutional Amendment, 2010 devolved 17 ministries, including Education and Health, from Federal to Provincial governments. The intent was “closer to people, better service delivery”. 16 years later, the data show a mixed-to-poor outcome. Modest gains in some mortality and literacy indicators have occurred against a backdrop of population growth, fiscal constraints, and capacity gaps that devolution did not close. This analysis uses pre- vs. post-devolution comparisons and argues for a cooperative federalism model: federal responsibility for national standards, policy frameworks, conditional financing, central procurement of key inputs, and oversight; provincial responsibility for service delivery, human resources, and local adaptation. Full recentralization of day-to-day delivery is neither feasible nor desirable; the collapse of uniform standards and accountability is. Sixteen years after the 18th Amendment promised education and health “closer to the people,” the numbers tell a story of abandonment, not empowerment. We gave provinces autonomy and 57.5% of the national pie, yet literacy crawled up by only 4.3% while out-of-school children exploded by 413% — from 5.1 million to 26.2 million. We spend less of our GDP on education today than we did in 2009, and 3 out of 4 ten-year-olds still cannot read a basic sentence. A child in Punjab gets PKR 48,000 spent on her and has a 90% chance of clean water at school. A child in Balochistan gets PKR 28,000 and has a 60% chance that her school has no water at all. This is not devolution. This is four different countries inside one. In health, the picture is the same. We saved 16 infants per 1000 and 90 mothers per 100,000, but only by spending 1% of GDP and forcing families to pay 58% of costs from their own pockets. A patient in Punjab has 0.85 doctors per 1000 people and a health card. In Balochistan, he has 0.31 doctors and a 65% chance the basic clinic is shut. We dismantled one federal system and replaced it with four broken ones, four tenders, four curricula, four data systems that don’t speak to each other — and a polio virus that happily crossed every provincial border. Autonomy without standards did not bring us quality. It brought us disparity. It brought us a nation where your zip code decides if you can read, and if you live. The 18th Amendment gave us power. The data now begs us for wisdom. The 18th Amendment gave us provincial freedom in education. It did not give us education. In 16 years, national literacy has inched from 57% to 63% — a 6-point gain, with women still stuck at 54%. In the same period, the crisis of exclusion multiplied fivefold: from 5.1 million out-of-school children in 2010 to 25–26 million today. That is 1 in 4 children aged 5–16 locked out of classrooms, the highest absolute number on earth. We did this while spending less. Public education fell from 2.0–2.5% of GDP in 2009 to as low as 0.8% in FY2025. Less than one-fifth of UNESCO’s 4–6% benchmark. We chose salaries over schools. 70% of provincial budgets vanish into payrolls, while Balochistan reports 45% out-of-school rates and schools without water, toilets, or teachers. The result is a fragmented republic. Punjab at 68% literacy. Balochistan at 49%. Four curricula. Four exams. Zero portability. And a generation where most 10-year-olds who are in school still cannot read a simple paragraph. Devolution promised quality through proximity. The data proves it delivered disparity through neglect. We did not decentralise education. We decentralised failure. We devolved power in 2010 and called it reform. What we actually devolved was responsibility.In education, we traded one national system for four broken ones. Four curricula. Four exams. Four definitions of a “qualified teacher.” A child who moves from Karachi to Lahore must unlearn to relearn. Meanwhile, the NFC gave provinces more money than ever, yet education’s share of GDP collapsed from 2% to 0.8%. The funds arrived. The priority didn’t. Development budgets went unspent while 70% of what was spent disappeared into salaries and ghost postings. We handed provinces the federal role without the federal capacity, data, or spine. The CCI never benchmarked. Politics decided where schools were built. The result is mathematically cruel: 5 million out-of-school children became 26 million. In health, we bought modest survival with deep inequality. IMR fell from 78 to 47. MMR fell from 276 to 155. But we did it by spending just 1% of GDP and forcing families to pay 60% of all health costs out of pocket. Polio crossed provincial borders because coordination died. Medicines became scarce because four provinces ran four tenders. Balochistan has one doctor for every 3,200 people. Punjab has nearly three times more. A sick child’s odds of survival now depend on a map line drawn in 1947. Devolution did not bring health and education closer to the people. It pushed accountability further away from the state. Devolution did not create four better health systems. It created four weaker ones. Today, a patient’s survival depends on geography. Punjab and KP run insurance cards and hospitals. Sindh runs a payroll with 70% of its budget locked in salaries while BHUs rot. Balochistan runs on 0.31 doctors per 1,000 people and 35% functional clinics. One country, four standards of life and death.We dismantled federal coordination and got chaos in return. EPI, TB, and polio campaigns stalled without a central command. Four provinces ran four tenders for the same medicine and paid 30% more for shortages. DRAP regulates, but no one buys at scale. We have no real-time national health data. We have no one to blame when a district fails. The root cause is not money. The NFC tripled provincial funds. The cause is design. We transferred power overnight with zero capacity building, zero benchmarks, and zero consequences. Salaries ate the budget. Politics decided postings. Ghost facilities stayed on paper. Economies of scale in drugs, textbooks, and surveillance were shattered. Sixteen years later the verdict is clear: Mortality improved despite the system, not because of it. We did not decentralise service delivery. We decentralised failure, and called it autonomy.
Sixteen years after the 18th Amendment handed education and health entirely to the provinces, Pakistan is still the country with the second-highest number of out-of-school children on earth. It still spends less on schooling, as a share of its economy, than almost any country in Asia other than Afghanistan. It still runs four separate curricula, four separate drug-procurement systems, and no single national database for either sector. The devolution of 2010 was sold as subsidiarity — the idea that decisions made closer to the people would be better decisions. What it has produced, on the numbers, is fragmentation without the capacity to manage it. That is the case for bringing national standards, financing discipline, and oversight in education and health back under federal coordination, while leaving day-to-day delivery with the provinces. It is not, and should not pretend to be, a case that devolution caused every failure in these two sectors. Pakistan’s schools and clinics were already in crisis before 2010, and several indicators have kept improving on a decades-long trend regardless of who administers them. But the specific promise made in 2010 — that provincial ownership would raise quality, close regional gaps, and improve accountability — has not been kept, and the record explains why.
The 18th Amendment abolished the Concurrent Legislative List and transferred legislative, administrative, and financial authority over education and health, along with seventeen other subjects, from Islamabad to the four provinces. Provinces gained the constitutional space to set their own curricula, hire and post their own health and education staff, and run their own procurement systems. A new fundamental right was inserted into the constitution at the same time, obliging the state to provide free and compulsory education to every child between the ages of five and sixteen. Financing shifted away from federal development spending and direct federal programs toward the provinces’ own revenue plus their enlarged share of the National Finance Commission award. On paper, this was meant to bring policymaking closer to the people it served and give provincial governments both the authority and the resources to fix long-standing failures the federal government had never solved. In practice, authority and resources arrived; the standards, coordination mechanisms, and accountability structures that make devolved authority work did not. Start with education, where the headline literacy number looks, at first glance, like quiet progress. Pakistan’s literacy rate for people aged ten and above rose from roughly the mid-fifties in percentage terms around 2008 and 2009 to just over sixty per cent in the most recent Economic Survey, with male literacy well ahead of female literacy and a persistent gap between urban and rural areas. Punjab now leads the provinces, followed closely by Sindh and Khyber Pakhtunkhwa, with Balochistan trailing well behind the rest of the country. On its own, that slow upward drift might be read as evidence that devolution has been, at worst, harmless to educational attainment. But it sits alongside a collapse in what the state is actually willing to spend on getting children into classrooms and keeping them there. Combined federal and provincial education expenditure has fallen sharply over the past several years, dropping from close to two per cent of GDP around 2018 to a fraction of that figure in the most recent fiscal year — a decline steep enough that even government officials and independent economists have described it as a national emergency rather than a routine budget adjustment. That level of spending is a small fraction of the four to six per cent of GDP that international bodies recommend, and it leaves Pakistan behind every country in the region except Afghanistan. Whatever autonomy provinces gained in 2010, it has not translated into a stronger political commitment to fund the sector; if anything, the opposite has happened, with education spending treated as one of the most easily cut line items whenever fiscal pressure rises. The out-of-school figure is the most contested statistic in this entire debate, and it deserves an honest accounting rather than a single dramatic number repeated without context. International agencies have long cited a figure in the range of twenty-five to twenty-six million out-of-school children, a number that has made Pakistan a fixture in global rankings of educational exclusion. More recent government survey data suggests a somewhat less bleak picture, with the out-of-school rate reportedly falling by a meaningful margin over the past two years, driven by improvement in the provinces that started from the worst position, particularly Balochistan. Even taking that more encouraging reading at face value, Pakistan is still home to somewhere between twenty and twenty-five million children who are not in school — still one of the largest such populations anywhere in the world, and a number that has barely moved in absolute terms even as the percentage rate has improved, because population growth keeps adding new children to the base faster than the system can absorb them. It is in the quality of learning, more than in enrollment statistics, that the costs of fragmentation become hardest to explain away. Independent assessments carried out year after year have found that a large majority of children in the fifth grade cannot perform arithmetic expected of a child two years younger, and that even in Punjab, the best-resourced and highest-performing province, a majority of ten-year-olds cannot read a simple sentence in their own language. The gap between provinces on basic numeracy and literacy tasks is wide enough that a child in Balochistan and a child in Punjab, formally educated under the same constitution, are in practice being prepared for entirely different futures. A student who moves from Lahore to Karachi partway through the school year does not simply change cities; because there is no single national curriculum, no shared assessment framework, and no common teacher-training standard, that student effectively changes education systems, often losing a year or more of continuity in the process. This is precisely the kind of problem that a national floor of standards was designed to prevent, and precisely the kind of problem that four independently run provincial systems, each moving at its own pace and with its own priorities, have proven unable to solve on their own. Health mirrors education: modest gains built on a foundation of chronic neglect. Infant and maternal mortality have fallen, skilled births have risen, and vaccination campaigns have saved lives. These are real wins. But they follow a South Asia-wide trend that began decades before 2010, and they owe more to donor-funded vertical programs than to provincial systems. The underlying structure never improved because the money never did. Public health spending was under 1% of GDP before devolution. Sixteen years later, it is still under 1.1%. The real cost of devolution is not in the mortality averages. It is in the fragmentation. Four provinces now run four separate drug tenders, raising costs and creating shortages. Polio, a disease that demands one national surveillance system, was set back years because coordination collapsed. Pakistan remains 1 of 2 countries where it is still endemic. We have no single, real-time national health data system. We cannot even compare provinces honestly. Capacity gaps are brutal: Balochistan has less than half the national average of doctors, and the share of functional BHUs swings wildly, even as Punjab and KP build insurance programs others cannot replicate. Put education and health together, and the pattern is clear. Outcomes improved slowly, as they were already doing. Fiscal priority declined. The machinery meant to hold the federation together — CCI benchmarks, shared standards, conditional funding, national procurement — was never built. The NFC sent more money to provinces with zero conditions attached. In some provinces, over 60% of the health budget vanishes into salaries before a single patient is treated. This is not an argument for rolling back the 18th Amendment. That debate is closed politically and constitutionally. The smaller provinces are right: centralisation failed them for decades. The argument is for completing devolution through Cooperative Federalism. Set one national floor: a core curriculum, common learning assessments, teacher licensing, hospital accreditation, and a national essential medicines list. Tie federal grants to hard KPIs on enrollment, learning, IMR, MMR, and immunisation. Use the CCI for what it was created for. Centralise procurement for vaccines, drugs, and textbooks to capture scale. Build one national data system so we can see which province is failing and why. Sixteen years on, devolution gave provinces responsibility without standards, money without discipline, and autonomy without accountability. A child’s right to read and to survive should not be determined by a provincial border. Pakistan does not need less devolution. It needs the standards and accountability that should have come with it from day one.
Autonomy without a safety net turned education and health into a postcode lottery. Fifteen years after the 18th Amendment, Pakistan still abandons its children to the provinces. Pakistan must stop abandoning its children to the provinces — and re-federalize standards, policy, and accountability. Pakistan must now reclaim national standards — before another generation is abandoned to the provinces.
The 18th Amendment gave provinces power without capacity, and Pakistan got fragmentation instead of reform. Re-federalise policy, standards, conditional financing, monitoring, and strategic procurement while retaining provincial implementation of services. This is not a full rollback of the 18th Amendment but a targeted correction via constitutional adjustment (placing “national standards and frameworks in education and health” on the Federal Legislative List Part II or using Article 149(4) direction powers more robustly) and institutional design. The CCI under Article 154 was never used. No one was asked why Sindh spends 70% of its health budget on salaries, or why Balochistan runs 12,000 ghost schools. We gave them more money through NFC and got worse outcomes: education fell to 0.8% of GDP, and health never crossed 1.1%. This is fiscal irresponsibility masquerading as federalism. Fifteen years after the 18th Amendment transferred education and health to the provinces, the evidence is no longer ambiguous: devolution without enforceable national standards, common measurement systems, or real accountability has produced not vibrant local innovation but a fragmented landscape of uneven mediocrity. The 18th Amendment correctly expanded provincial autonomy, but education and health outcomes reveal that autonomy without capacity, standards, conditionality, and accountability produced fragmentation, under-prioritisation, and inequity. The 18th Amendment did not fail because of bad intent, but failed because we confused autonomy with capacity. We handed provinces the entire federal machinery overnight — with no staff, no data, no benchmarks, and no consequences. Literacy crawls forward in some provinces while stagnating or slipping in others; net enrolment at the primary level has actually declined in key regions; learning poverty remains catastrophic, with the majority of children still unable to read a simple text by age ten; and health indicators — from immunisation gaps to stubbornly high stunting — continue to map more closely onto provincial borders than onto any coherent national ambition. Literacy has risen slowly; absolute out-of-school numbers remain massive; public spending shares are critically low; mortality has improved but from a high base and with large provincial gaps. Pakistan cannot afford four divergent systems in foundational human capital sectors. A cooperative model—federal standards, policy, funding conditionality, and oversight paired with provincial delivery—offers the best path to uniformity, quality, results, and accountability. This is not anti-federalism; it is the institutional design required for one nation to deliver comparable life chances to all citizens. Updated data through 2024–26 reinforce the urgency of course correction. Overnight, we transferred education and health with no staff, no benchmarks, no CCI oversight, and no fiscal conditionality — so Sindh spent 70% of its health budget on salaries, Balochistan let 12,000 schools die, and national spending on education and health fell despite bigger NFC shares. The result is four different systems: four curricula, four drug tenders, four disease plans, and no national data, leaving a child in Quetta with far less chance than a child in Lahore. The fix is not to reverse devolution but to complete it through Cooperative Federalism: the Federal government must set one national curriculum, one health policy, conditional funding tied to KPIs, and central procurement, while provinces handle implementation and delivery. By moving “National Standards in Education & Health” back to the Federal List, we ensure one nation, one standard, and one future — because Pakistan cannot afford to fail its children four times. Expected gains: Uniformity and equity (a child in Balochistan entitled to comparable standards as one in Punjab); quality via shared expertise and scale; accountability via transparent KPIs and federal oversight; efficiency (20–30% potential savings on procurement cited in similar analyses); better national disease control and labour mobility of credentials. Constitutional route: Amendment to restore concurrent or federal powers over national standards, or stronger use of existing intergovernmental mechanisms with statutory force. Parallel strengthening of provincial capacity (technical cadres, independent monitoring units) remains essential. Sixteen years after the 18th Amendment, the verdict is no longer theoretical. The collapse was structural, not transitional. We replaced one national system with four fractured ones. Four curricula that do not speak to each other. Four drug tenders that pay more for less. Four disease control plans that a virus ignores. No national data; No shared benchmarks; No economies of scale. In the process, we gave provinces power without capacity, and money without conditions. The result is two Pakistans inside one. A child in Lahore is taught a different textbook, treated in a better hospital, and given a higher chance of survival than a child in Quetta — not because of merit, but because of geography. This was never the promise of devolution. The path forward is not to undo provincial autonomy. It is to complete it. Pakistan needs Cooperative Federalism: Federal government to set one national curriculum, one health policy, conditional funding tied to outcomes, and central procurement for scale. Provincial governments to deliver, hire, and run services locally. Because a nation cannot afford to educate its children four different ways and heal its people four different ways. The 18th Amendment gave us provinces. Only re-federalising standards will give us Pakistan. Greater fiscal transfers and provincial spending have not translated into commensurate outcomes, revealing that proximity alone does not guarantee capacity, priority, or integrity. The constitutional experiment has delivered autonomy; it has not delivered the fundamental rights it was meant to secure. Re-federalising minimum standards, curriculum frameworks, assessment systems, data architecture, and accountability mechanisms is not a nostalgic return to centralisation — it is the minimum condition for ensuring that a child’s chance of learning to read or surviving infancy does not depend on the accident of which province they were born in. Pakistan can no longer afford the polite fiction that provincial freedom, unmoored from national obligation, is progress. The next generation will measure the success of this republic not by the eloquence of its devolution rhetoric, but by whether every child, in every district, is guaranteed a baseline of knowledge and health that only a coherent national framework can enforce. Autonomy without a safety net turned education and health into a postcode lottery. Fifteen years after the 18th Amendment, Pakistan still abandons its children to the provinces. The case for reclaiming national standards, policy, and accountability is no longer optional — it is overdue. Education and health are reduced to a postcode lottery. Pakistan must stop abandoning its children to the provinces — and re-federalise standards, policy, and accountability. Pakistan must now reclaim national standards — before another generation is abandoned to the provinces.