ll Pakistan’s national vision documents and development plans - from industrialisation and CPEC to digital transformation and successive IMF programmes - have rested on an unexamined assumption: the availability of a healthy and educated workforce to carry those out.

After decades of consistent lack of recognition and inadequate investment, that assumption is finally being challenged. The country that regularly boasts of its ‘youth bulge’ as a demographic dividend has quietly allowed its youngest generation to become its most neglected constituency.

That neglect was visible in the most literal sense on August 26, when a fire swept through the neonatal nursery of the Pakistan Institute of Medical Sciences in Islamabad, killing at least 14 newborns. Grieving parents have alleged that the nursery lacked round-the-clock staff and that its door was locked when the fire broke out. However, this was not an isolated lapse. Fire-safety notices had reportedly been issued to the PIMS for seven consecutive years without resolution. The failure is not down to a shortage of money or attention alone; it is a persistent failure to use the resources to provide functioning, accountable service delivery.

Progress

Household Integrated Economic Survey, released alongside the Economic Survey 2025-26, showed some progress. The number of out-of-school children fell from 38 percent in 2023 to 28 percent in 2025, with every province recording a decline. It is worth acknowledging that the Punjab has brought its out-of-school children rate down to 21 percent. However, strip away the headline and the picture darkens. Roughly 20 million children remain unserved. In Balochistan, even after its steepest improvement, 45 percent of the children remain out of school. Girls continue to lag boys by a wide margin. Close to one in three girls of school-age are not enrolled. In many parts of Balochistan the figure runs higher. Government spending on education has fallen well below the 4-6 percent of GDP recommended internationally, even after the declaration of a national emergency.

Education is only half the story. Pakistan carries one of the highest child stunting burdens in the world, with national surveys putting chronic malnutrition among children under five at roughly 40 percent - above 50 percent in some parts of Sindh. Current food security assessments count well over 2.7 million children aged six months to five years suffering from acute malnutrition across Sindh, Khyber Pakhtunkhwa and Balochistan. Hundreds of thousands in the ‘severe’ category that carries clear risk of death.

A governance failure

It is convenient for the governments to treat child welfare as the domain of the UNICEF, Save the Children and Social Welfare Departments to be addressed through donor-funded pilots and NGOs rather than as core state responsibility. That framing has been a significant part of the problem. A child stunted before he is two years old, carries cognitive and physical deficits for life. A girl left out of school is not a data point to be corrected with a stipend scheme; she is a citizen the state has already failed. Also, retention, not just enrollment, is the real test.

Public institutions have built roads, dams and transmission lines with donor financing and technical assistance from the World Bank and the ADB. However, similar institutional discipline has not been consistently applied to human capital development. Nutrition, early childhood education, and maternal health rarely command the sustained multi-year financing or the inter-agency coordination that a highway project can take for granted, even though the economic case is arguably stronger.

Shared failure

It is tempting to blame a single actor. The uncomfortable truth is that governments, donors and charities have all failed children. Those failures reinforce rather than offset one another.

Health and education became provincial/ local government subjects after the 18th Amendment. However, the provinces inherited the mandate without adequate fiscal or technical capacity, producing wildly uneven outcomes with no strong federal backstop. Budgets show where priorities actually sit: education spending fell even after a National Education Emergency was declared in 2024 — the recurring pattern is announcement-heavy, financing-light.

Donors have mostly applied project-cycle thinking to a generational problem. World Bank, the ADB and the UN-agency financing typically runs in three-to-five-year cycles built around disbursement targets. The model is suited to a bridge or a power plant but not to nutrition or early-childhood outcomes that take a decade to show results. Much of Pakistan’s child-nutrition and education policy architecture remains donor-funded rather than owned by a government body. Momentum evaporates the moment a funding cycle ends. The donors are also not immune to their own accountability failures: an estimated $4 million was misappropriated from a $6.2 million UNICEF school rehabilitation project in Khyber Pakhtunkhwa.

It is convenient to treat child welfare as the domain of the UNICEF, Save the Children and Social Welfare Departments, to be addressed through donor-funded pilots and NGOs rather than as a core state responsibility.

Charities and NGOs were never built to be the foundation. Civil society groups can fill some gaps left by the state, but they operate with limited resources and inconsistent coordination. Dozens of organizations run parallel, uncoordinated interventions in the same districts instead of feeding a single referral and case-management system, so that children fall through the gaps. Because most of this work depends on foreign funding cycles, continuity of care is hostage to donor priorities.

These are not three separate failures. It is single failure — the absence of durable, funded, end-to-end ownership of a child’s outcome - repeated at three levels. The state defers to donors and NGOs when convenient; donors fund pilots the state never absorbs into its recurring budget; NGOs patch what neither will fully commit to. Child protection and welfare cannot rest on charity or donor goodwill. It requires a publicly funded, coordinated system under one institutional framework.

Control of funds

Pakistan has not lacked allocations for child health, education and nutrition. It has lacked the control to ensure that those funds reach a classroom, a clinic or a child.

Government funds:

The Auditor General’s reports read like a running ledger of loss rather than delivery. A 2025-26 audit of federal health-linked bodies alone uncovered Rs 3.41 billion in irregularities, fraud, embezzlement and procurement violations. Out of that only Rs 127.27 million was recovered. The Punjab audit flagged over Rs 1 trillion in irregularities across expenditure accounts, including fraud, overpayments and unauthorised retention of public funds in the Punjab. In Balochistan, a Public Accounts Committee review of a single provincial hospital found Rs 30 million in questionably procured medicines and Rs 22.83 million in unaccounted drugs, with no inspection reports or stock registers to explain where they went. In one Rawalpindi case, an audit flagged Rs 264 million in embezzlement; five years on, no one has been held responsible.

Donor funds:

An Auditor General review found that of the Rs 156.5 billion in Global Fund assistance managed by the Health Ministry between 2015 and 2023, over Rs 122 billion was lost, misused or left underutilised, due to weak oversight, expired medicines and stalled projects. Pakistan’s Global Fund programme was then placed under the donor’s Additional Safeguard Policy, a formal designation for high-risk recipients. A UNICEF-implemented school rehabilitation project in Khyber Pakhtunkhwa, funded by seven donor countries, lost an estimated $4 million of its $6.2 million budget to misappropriation.

Charity and NGO funds: Charitable giving largely escapes systematic audit. Following disasters, waves of newly formed, unregistered organizations have set up roadside donation points including, pointedly, using children with collection boxes. Authorities admit that there is no real mechanism to monitor these organisations or where funds go.

The most common failure is diversion, not absence. Audit reports show that the money for children’s welfare rarely runs out. It is typically retained outside the treasury, spent on unrelated procurement, left in dormant accounts or written off as “underutilised”- a euphemism that spans everything from bad planning to theft.

Financial oversight structures exist on paper but consistently fail at the enforcement stage.

Credible response

A credible national response would treat child welfare the way Pakistan treats a strategic infrastructure priority - with dedicated financing, provincial accountability and multi-year targets that survive a change of government. That means:

Protected budget lines for nutrition and primary education that are not the first casualty of fiscal tightening.

Targeting resources to where out-of-school children actually are: interior Sindh, south Punjab and Balochistan.

Treating maternal nutrition and the first 1,000 days of a child’s life as a health-system priority on par with any communicable disease programme.

Provincial-level accountability mechanisms, given that education and health are devolved subjects.

Mandatory recovery and prosecution timelines attached to every Auditor General finding involving child health, nutrition or education funds so that flagged irregularities. A finding without a consequence is not oversight; it is documentation of failure.

Pakistan does not lack the technical expertise to design adequate interventions; it has done comparable institutional reform in passport and national ID governance, safe city projects, metro projects, financial systems etc. What has been missing is the political will to treat children as the country’s primary long-term asset rather than a line item to be trimmed when the fiscal space tightens. A country that keeps deferring investment in its children is not preparing for its future, it is quietly mortgaging it.

The writer, a public policy expert, is the chief executive officer of Governance and Advocacy Foundation for Sustainable Development.