The Impact Of Population Growth On Development In Sindh
The Impactof PopulationGrowth onDevelopmentin SindhFindings from the Resourcesfor the Awareness ofPopulation Impacts onDevelopment ModelFebruary 2018CIP SecretariatCosted Implementation PlanPopulation Welfare DepartmentGovernment of Sindh
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AcknowledgmentsThis analysis is the result of a partnership between the Health Policy Plus (HP ) project, funded by the U.S. Agency for InternationalDevelopment (USAID), and the Population Welfare Department (PWD), Sindh and associated CIP Secretariat, Costed ImplementationPlan, PWD. HP would like to thank the following partners for their added support for this activity—both in provision of relevant Sindhdata and participation in the data validation process: Department of Health, Sindh Crop Reporting Service Centre, Sindh People’s Primary Health Care Initiative, Sindh Bureau of Statistics, SindhSustainable Development Cell, Planning and DevelopmentBoard, Sindh Pakistan Bureau of Statistics, Islamabad World Health Organization Labour and Human Resources Department, Sindh Greenstar Social Marketing Agriculture Extension, Sindh Urban Policy and Strategic Planning,Planning and Development Board, SindhUSAID Maternal and Child Health Program, Sindh,Implementing Partnersi
About RAPIDThis resource presents findings from the RAPID (Resources for the Awareness of Population Impacts on Development)model, which projects the social and economic consequences of rapid population growth on various healthand non-health sectors. The RAPID model is a computer program that makes projections of social and economicindicators for countries or regions. These indicators include various social and economic indicators such as labourforce participation rate, school enrolment rates, and the number of nurses and doctors per capita, to name a few.The model itself is pre-loaded with country-specific default data, which is then updated with more specific data andinputs, as relevant. Inputted data is then combined with population projections (created in the DemProj module ofSpectrum and based on either census, Demographic and Health Survey, or other available population statistics) toproject the future requirements of the indicators for as much as 50 years into the future.Specific to this application, data sources are noted throughout the booklet and correspond with the relevant topics.Data was validated and updated, as needed, from a validation meeting in Sindh in December 2016 (participantorganizations and departments are noted in the acknowledgments). Following the release of new census data forSindh, HP updated the model and those new outputs are reflected throughout this booklet. Supported by USAID,RAPID has been applied in numerous countries and driven countless policy decisions over the past three decades.This is the first application of RAPID specific to Sindh.
Table of ContentsOverview 1Health 9Education 17Economy 27Agriculture 33Water37Urbanization 41Outlook 47iii
Overview
OverviewPopulation and DevelopmentSlower population growth, more resources availableUnderstanding the impact of population growth on socioeconomic developmentis essential in making strategic policy and program decisions. Continued rapidpopulation growth and urbanization in Sindh will increase pressure on its health,education, economic, and agricultural sectors to meet the population’s demand forbasic needs. Slowing population growth through increased use of family planningwill allow Sindh to invest more in long-term measures to improve the quality of healthservices, guarantee universal education, expand employment opportunities, andattain food security. If strategically implemented, these measures could catalyseprogress toward a healthier, more prosperous country and population.1
Sindh’s PopulationRapidly growingSindh is experiencing rapid population growth—theresult of high fertility rates coupled with decreasedmortality rates. In the past decade, the populationgrew by just over 10 million (almost 30%)—from 38million in 2006 to 47.8 million in 2017.1 Karachi,the capital of Sindh, has the twelfth largest urbanpopulation globally and is projected to have theseventh largest by 2030.212Government of Pakistan, Ministry of Statistics, Statistics Division, Pakistan Bureauof Statistics, 2017.Asian Development Bank, 2015.
OverviewFertility RateSteadily highSindh’s total fertility rate—a measure of the average number ofchildren a woman will have over her lifetime—has decreasedslightly over time. It fell from 5.1 children per woman in 1990 to4 in 2014. Fertility in Sindh remains considerably higher in ruralareas (5.2) compared to urban areas (3.2).33National Institute of Population Studies Pakistan and ICF International, 2013.3
Age StructureThe overall population is skewed towardyoung people, a group that increased fromapproximately 16 million in 19984 to 23 millionin 2016.5 Young people under the age of 19make up 50% of the population.6 Therefore,even if fertility declines, Sindh’s population willcontinue to grow rapidly because of the highnumber of young women who will soon entertheir reproductive years.female75604530maleAge in yearsAn expanding young cohort150%5115%%0110%%55%%00%%55%Percentage of total population456Government of Pakistan, Statistics Division, Population Census Organization, 1998.Population Welfare Department, Government of Sindh, 2015.National Institute of Population Studies Pakistan and ICF International, 2013.%0110%%5115%%02
OverviewPopulation in 2050Two scenariosSindh’s population in 2050 will largely be influenced by future fertilitytrends.Constant CPR: If the contraceptive prevalence rate (CPR) remainsconstant—at 29.5%7—the population will grow from 47.8 million in20178 to 98.5 million by 20509—nearly doubling in just 29 years.High CPR: If CPR increases to 45% by 2020,10 and then reaches 70%by 2050, the population will increase to 70.5 million by 2050.11National Institute of Population Studies and ICF International, 2013.Government of Pakistan, Ministry of Statistics, Statistics Division, Pakistan Bureau of Statistics, 2017.Avenir Health (RAPID Model), 2017.10Population Welfare Department, Government of Sindh, 2015.11Avenir Health (RAPID Model), 2017.Sindh’s populationis expected to be28% lowerif CPR increases to 70%by 20507895
OverviewImpact on FutureDevelopmentConsequences for key sectorsContinued rapid population growth will have consequences for six keydevelopment sectors in Sindh: HealthEducationEconomy AgricultureWaterUrbanization7
HEALTH9
Status of Health SectorMore caregivers and infrastructure neededConsiderable efforts are needed to adequately address the health needs of Sindh’s growing population—tacklinghuman resource shortages and making services more accessible is critical. In Sindh, over half of women facechallenges in accessing healthcare. Among women in rural Sindh, distance is a challenge for 68% of womenand transportation is a challenge for 76% of women, highlighting the urgent need to make health services moreaccessible. Further, despite high regard for the lady health worker programme, which is intended to provide basichealth services, including family planning, just over half of women are aware of lady health workers in their area.1212National Institute of Population Studies Pakistan and ICF International, 2013.
Health11
Health ProfessionalsIncreasing demand for trained doctors andnursesIn 2016, there were about 15,252 doctors and 3,844nurses in Sindh.13 By 2050, a projected 9,860 nursesand 49,299 doctors will be needed under the constantCPR scenario (29.5%), compared with 7,053 nurses and35,263 doctors under the high CPR scenario (70%).141314Data, originally from Bureau of Statistics, Planning & Development Department, Sindh, 2013,was revised during the HP RAPID Validation Workshop in December 2016 in Karachi.Avenir Health (RAPID Model), 2017.16,843fewer doctors and nursesneeded by 2050 ifCPR is increasedto 70%
HealthHealth Units(hospitals and health centres)Increasing demand for sufficient facilitiesThere were approximately 1,059 health units in Sindh in2016—88% of which were primary health units (healthposts or health centres). The number of hospitals in 2016was estimated at 122 for the entire province.15 By 2050,a projected 3,616 health units will be needed under theconstant CPR scenario (29.5%), compared with 2,586health units under the high CPR scenario (70%).161516Data, originally from Bureau of Statistics, Planning & Development Department, Sindh, 2013,was revised during the HP RAPID Validation Workshop in December 2016 in Karachi.Avenir Health (RAPID Model), 2017.1,030fewer hospitals andhealth centres neededby 2050 if CPRis increasedto 70%13
Annual Health ExpenditurePKR 1.3 trillion can be saved by 2050Improvements to health system capacity, infrastructure, and outcomes require financial resources, andmore resources will be required under a higher fertility scenario. To meet future capacity and infrastructurerequirements, the Department of Health, Sindh will need to increase annual recurrent health expendituresto PKR 381 billion by 2050 under the constant CPR scenario versus 272 billion with a high CPR.1717World Bank, 2014.Avenir Health (RAPID Model), 2017.
Cumulative Health Savings by 205018HealthExpenditure (PKR billions)ConstantCPR381272cumulative savings by2050 if CPR increasesto 70%High CPR2016182028World Bank, 2014.Avenir Health (RAPID Model), 2017.2040PKR 1.3trillion205015
EDUCATION“Education is one of the most important pillars of governmentthrough which government enhances technical andprofessional skills of its people so that they can play their duerole in the development of the country.”– Government of Sindh, School Education & Literacy Department17
StudentsIncreasing numbers of school-age childrenMany children in Pakistan are in need of schooling.19 In terms of need, if Sindh experiences the constant CPR scenario(29.5%), around 12.3 million children will be of primary school age by 2050. If Sindh achieves the high CPR scenario(70%), the number of children of primary school age will be more than halved, to 5.8 million. Moreover, the numberof children of secondary school age is projected to reach 2.3 million by 2050, yet, under the high CPR scenario, thiscould decrease to 1.4 million children.201920Education and Literacy Department, Sindh, 2014.Avenir Health (RAPID Model), 2017.
Education1919
TeachersIncreasing demand for qualified teachersSindh’s teacher-to-student ratio was 1 teacher for every30 students in 2011.21 Assuming an ideal ratio of 1 to 25by 2050, Sindh will need an extra 607,849 teachers(primary and secondary) by 2050 under the constantCPR scenario, compared to an extra 300,617 teachersunder the high CPR scenario.222122Education and Literacy Department, Government of Sindh, 2014.Avenir Health (RAPID Model), 2017.
EducationSchoolsVast infrastructure improvements, more schools neededIn 2011, there were 43,089 primary schools in Sindh, many in need of infrastructure improvements to increasefunctionality. Further, Sindh has experienced an imbalance in the number of schools, between primary, middle, andhigh schools, based on overall need. This imbalance is further seen in resource distribution across schools, with mostresources (53%) going to middle schools and the smallest amount (15%) going to primary schools.23In addition to meeting the already existing, and urgent, infrastructure needs, as Sindh’s population grows and morechildren enter school age, these needs will only increase as the issues and challenges become more severe.23Alif Ailaan, 2016.21
Students, Teachers, and Schools7.4millionmore schoolchildren toeducate24307thousandmore teachersneededEducation and Literacy Department, Government of Sindh, 2014. Avenir Health (RAPID Model), 2017.EducationBy 2050, more students will require more teachers and schools under the constant CPRscenario2469thousandmore schoolsneeded23
School ExpenditureTo meet future capacity and infrastructure requirements, Sindh’sEducation and Literacy Department will need to increase primaryschool expenditures to PKR 170 billion by 2050 under the constantCPR scenario (29.5%), compared to PKR 80 billion under the highCPR scenario (70%). Similarly, the required secondary schoolexpenditures will be PKR 32 billion and PKR 18 billion, respectively.When comparing the two scenarios, there is a cumulative totalsavings of PKR 1.2 trillion under high CPR from 2016 to 2050.25 Theseresources are needed to guarantee sufficient numbers of qualified,trained teachers and can be used to build new schools and improveand update current infrastructure.25FHI 360, Education Policy and Data Center, 2016.Avenir Health (RAPID Model), 2017.EducationPKR 1.2 trillion can be saved by 2050PKR 1.2trillioncan be saved by 2050if CPR is increasedto 70%25
ECONOMY“Sindh, Pakistan’s second largest province plays a pivotalrole in the national economic and development agenda.”– Sindh Board of Investment27
Economic SectorPopulation’s impact on the economyPakistan’s economy has recently grown at approximately4.7% per year26; Sindh enjoys a similar growth rate andcontributes to national growth.27 The GDP per capita forSindh is PKR 159,678, above average for the country.28A rapidly growing population will affect Sindh’s abilityto expand the labour force and improve economicperformance.262728World Bank, 2014.Sindh Board of Investment, 2017.World Bank, 2014.PKR142,130higher GDP per capitaby increasing CPRto 70%** Avenir Health (RAPID Model), 2017.
Growing working-age population, requiringmore jobsSindh’s working age population is currently about 26million.29 If the CPR remains constant, 882,140 additionaljobs will be needed to employ the working-age populationin 2050. This figure can be greatly reduced if the country’sCPR increases to 45% by 2020 and then 70% by 2050.302930National Institute of Population Studies Pakistan and ICF International, 2013.Avenir Health (RAPID Model), 2017.523thousandEconomyEmploymentfewer jobs needed by2050 if CPR isincreasedto 70%2929
Constant CPR results in more dependentsIf CPR remains constant, there will be more than 34 millionchild dependents in Sindh by 2050.31 If the CPR rate isincreased, this number is projected to fall to 15 million,permitting greater investments in health and education perchild.323132National Institute of Population Studies Pakistan and ICF International, 2013.Avenir Health (RAPID Model), 2017.EconomyChild Dependents19 millionfewer child dependentsby 2050 if CPR isincreased to70%31
AGRICULTURE“The economic development of Sindh largely depends on theprocess and the growth of the agriculture sector.”– Agriculture, Supply, and Prices Department, Government of Sindh33
Agricultural SectorPopulation’s impact on arable landIn Sindh, approximately 40% of the land is arable and 5.08million hectares are currently used for agriculture.33 Rapidpopulation growth often leads to dense settlements that putpressure on the land and other natural areas as families seekto meet their needs for sustenance. Intensive agriculturalproduction often leads to soil degradation, erosion, andincreased salinity, which results in lower productivity. While thisdecline can occur in just a few years, it takes decades to restoreland productivity.33Pakistan Bureau of Statistics, 2011a.40%more arable land percapita by 2050 ifCPR is increasedto 70%** Avenir Health (RAPID Model), 2017.
Population’s impact on food securityIn 2016, wheat production was 3.3 million metric tons per yearfor a population of approximately 46 million.34 Populationgrowth creates greater demand for food, thereby increasing costsand diminishing access to food for domestic consumption; thisdisproportionately affects the country’s poorest residents.34Data, originally from Pakistan Bureau of Statistics, 2011b, was revised during the HP RAPIDValidation Workshop in December 2016 in Karachi.3.7AgricultureWheat Production andDemandmillion tonsmore wheat consumedby 2050 if CPRremains constantat 29.5%** Avenir Health (RAPID Model), 2017.3535
Indus River, Jamshoro
WATER“Water is the critical resource for humanity. No life can existwithout water.”– Karachi Water and Sewerage Board37
WaterEnsuring water availability meets total consumptionWater scarcity in Sindh, especially in the face of rapid population growth, is a serious threat. Current estimates suggestthat there is about 110–121 billion m3 (cubic metres) of available water in Sindh, enough to meet yearly consumption.35If the population continues to grow at its current rate (assuming the constant CPR estimate of 29.5%), total waterconsumption will hit a critical point by 2040, reaching an estimated 110 billion m3. By 2050, total water consumptionwill reach 136 billion m3 (exceeding the projected 110–121 billion m3 of available water) and Sindh will not haveenough water. However, under the high CPR scenario, water consumption will only reach 97.8 billion m3, which willnot outpace total water availability.36Water consumption is only one factor affecting the province’s water supply. Additional water conservation andenvironmental protection efforts are needed to ensure the viability of the water supply for future generations.3536Agriculture Extension, Government of Sindh, 2016.Avenir Health (RAPID Model), 2017.
Water Consumption37High and constant CPR scenariosConstantCPR97.8 billion m3High CPR2016372020202520302035Agriculture Extension, Government of Sindh, 2016.Avenir Health (RAPID Model), 2017.2040204512.2billion m3Water136 billion m3of water can be saved by2050 if CPR increasesto 70%205039
URBANIZATION“Karachi, the capital of Sindh, has the twelfth largest urbanpopulation globally. By 2030, it will have the seventh largest inthe world.”– Asian Development BankCantt, Karachi41
Urban Growth OutcomesFertility’s impact on urban populationSindh’s urban population is growing. In 2014, over one in three (39%) livedin urban areas.38 If urban population growth remains the same, it is projectedthat urban areas will house 59 million people in the constant CPR scenario(29.5%)—of whom 15 million will be urban youth (15–24 years old). Underthe high CPR scenario (70%), the population living in urban centres decreasesconsiderably to a projected 42 million (28% decrease), with urban youth at9.7 million (35% decrease).393839Ministry of Finance, Government of Pakistan, 2015.National Institute of Population Studies Pakistan and ICF International, 2013.Avenir Health (RAPID Model), 2017.
Urbanization4343
Urban Population and HouseholdsBy 2050, a constant CPR will result in more urban youth, adults, and households405.4millionmore urbanyouth4017millionmore peopleliving in urbanareas2.8millionmore urbanhouseholdsneededMinistry of Finance, Government of Pakistan, 2015. National Institute of Population Studies Pakistan and ICF International, 2013. Avenir Health (RAPID Model), 2017.
HouseholdsIncreasing number of households, increased strain on resourcesUrbanizationThe number of new households is also expected to increase.41 By 2050, the constant scenario will create anadditional 2.8 million urban households relative to the high CPR scenario.42 With an increase in the number ofhouseholds, comes increased strain on access to resources such as electricity, water, and transportation.4142Sindh Bureau of Statistics and UNICEF, 2015.Avenir Health (RAPID Model), 2017.45
Outlook
43Avenir Health (RAPID Model), 2017.OutlookIf Sindh’s CPR remains constant, its population will double by 2050, increasingpressure to adequately meet the needs of an estimated 98.5 million people.43However, if CPR is increased, population pressures will be reduced across allsectors, leading to a more prosperous province.47
Looking to the FutureInvesting in family planning leads to positive outcomes across all sectorsOutlookContinued rapid population growth in Sindh will increase pressure on the province’s health, education, economic,and agricultural sectors and make it increasingly difficult to meet the population’s basic needs. For Sindh to fulfill itsdevelopment potential, the province must expand access to equitable, high-quality, and voluntary family planninginformation, services, and a wide range of methods. Expanding access to family planning programs will requireadequate financial backing and alignment of existing social sector investments with population and developmentgoals. Enhanced political will to tackle the challenges associated with population growth is essential. All sectors have aresponsibility to advocate for increased investment in family planning programs.Investment in family planning is not only good for socioeconomic development at the provincial level, it also improvesthe lives and well-being of individuals and communities. If Sindh can do more to curb rapid population growth andincrease its investment in family planning, the province can improve the lives of its citizens and fully realize the benefitsof adequate access to education, food, economic opportunity, and vital day-to-day needs, such as electricity andclean water.49
ReferencesAgriculture Extension, Government of Sindh. Departmental data shared duringvalidation workshop, December 8, 2016 in Karachi.Agriculture, Supply, and Prices Department, Government of Sindh. n.d.“Message from Secretary.” Available at: http://www.sindhagri.gov.pk/sectary-mesg.html (accessed May 1, 2017).Alif Ailaan. 2016. The State of Education in Sindh. Islamabad: Alif Ailaan.Asian Development Bank (ADB). 2015. Key Indicators for Asia and the Pacific2015. Manila: ADB.Avenir Health. 2017. Spectrum Model, version 5.51 beta 23 (RAPID Model).Glastonbury, CT: Avenir Health.Bureau of Statistics, Planning & Development Department, Sindh. 2013. HealthProfile of Sindh (District Wise) As on 01-01-2013. Available at: 013.pdf (accessed November 1, 2016).Education and Literacy Department, Government of Sindh. 2014. SindhEducation Sector Plan 2014-18. Karachi: Education and Literacy Department,Government of Sindh.FHI 360, Education, Policy and Data Center. 2014.“Data, Pakistan.” Available at:https://www.epdc.org/country/pakistan (accessed November 1, 2016).Global Agricultural Information Network. 2015. Pakistan: Grain and FeedAnnual. Washington, DC: Global Agricultural Information Network, USDAForeign Agricultural Service.Government of Pakistan, Ministry of Statistics, Statistics Division, Pakistan Bureauof Statistics. 2017. Census – 2017 Pakistan, “Table -1: Provision Province WisePopulation by Sex and Rural/Urban.” Islamabad: Government of Pakistan,Ministry of Statistics, Statistics Division, Pakistan Bureau of Statistics.Government of Pakistan, Statistics Division, Population Census Organization.1998. 1998 Census Atlas of Sindh. Karachi: Government of Pakistan, StatisticsDivision, Population Census Organization.Government of Sindh, School Education & Literacy Department. n.d. “AboutUs” Available uction.jsp (accessed May 1,2017).Karachi Water and Sewerage Board. n.d. “Water Conservation.” Available at:http://www.kwsb.gos.pk/View.aspx?Page 33 (accessed May 1, 2017).
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Ministry of Finance, Government of Pakistan. 2015. Pakistan Economic Survey2014-15. Islamabad: Ministry of Finance, Government of Pakistan.National Institute of Population Studies (NIPS) Pakistan and ICF International.2013. Pakistan Demographic and Health Survey 2012-13. Islamabad andCalverton, Maryland: NIPS Pakistan and ICF International.Pakistan Bureau of Statistics. 2011a. “Land Utilization Statistics” (Sindh).Available at: urestatistics/publications/Agricultural Statistics of Pakistan 201011/tables/Table61.pdf (accessed November 1, 2016).Pakistan Bureau of Statistics. 2011b. “Wheat (Variety-Wise)” (Sindh). Availableat: ure statistics/publications/Agricultural Statistics of Pakistan 201011/tables/Table4.pdf(accessed November 1, 2016).Population Welfare Department, Government of Sindh. 2015. CostedImplementation Plan on Family Planning for Sindh (2015-2020). Sindh,Pakistan: Population Welfare Department.Sindh Board of Investment, Government of Sindh. 2017. “Sindh Economy.”Available at http://www.sbi.gos.pk/sindh-economy.php (accessed April 14,2017).Sindh Bureau of Statistics and UNICEF. 2015. Sindh Multiple Indicator ClusterSurvey 2014, Final Report. Karachi, Pakistan: Sindh Bureau of Statistics andUNICEF.World Bank. 2014. “World Development Indicators.” Available at: opment-indicators (accessedNovember 1, 2016).All photos Khaula Jamil 2017
CONTACT USHealth Policy Plus1331 Pennsylvania Ave NW, Suite 600Washington, DC umgroup.comCIP Secretariat1st Floor Sindh Blood Transfusion Authority,II Depot, Rafique Shaheed Rod, near JinnahPost Medical College, KarachiHealth Policy Plus (HP ) is a five-year cooperative agreement fundedby the U.S. Agency for International Development under AgreementNo. AID-OAA-A-15-00051, beginning August 28, 2015. HP isimplemented by Palladium, in collaboration with Avenir Health,Futures Group Global Outreach, Plan International USA, PopulationReference Bureau, RTI International, ThinkWell, and the White RibbonAlliance for Safe Motherhood.This publication was produced for review by the U.S. Agency forInternational Development. It was prepared by HP . The informationprovided in this document is not official U.S. Government informationand does not necessarily reflect the views or positions of the U.S.Agency for International Development or the U.S. Government.
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