What is the situation on ground?
Sindh has a population of 50.4 million people (23 percent of the country¡¯s population) and generates 27 percent of Pakistan¡¯s GDP. Almost half of Sindh¡¯s population lives in rural areas and about 37 percent of the rural population lives below the poverty line¡ªhigher than the Pakistan average. Poverty rates are much higher in some flood-affected districts, reaching 53.4 percent in Badin district. Flood-affected areas in Sindh have some of the highest stunting rates in the country, reflecting limited access to sanitation facilities and clean water. Food insecurity and associated malnutrition are prevalent, with high figures among the poorest, and are expected to worsen due to flooding. Key gender disparities in Sindh relate to access and utilization of Maternal, Newborn and Child Healthcare (MNCH) services; early childhood development and education opportunities for the extremely poor and women-headed households; lack of skills training programs for vulnerable young women; and access to both finance and job placement interventions for young woman.
What is the impact of the floods in Sindh?
Vast areas in Sindh suffered prolonged inundation lasting several weeks with floodwater accumulating from other parts of the country following glacial melt in the mountainous north and record monsoon rains nationwide. Stagnant water in several districts gave rise to skin, gastric, and mosquito-borne diseases. Emergency rehabilitation is essential to help people affected by the floods recover and rebuild their lives and livelihoods.
What are the challenges facing the Sindh?
Sindh has deep-seated inequalities and significant gaps in social protection (SP) service delivery due to fragmentation of interventions, inadequate coverage and leakage, and administrative inefficiencies. Food insecurity, malnutrition and stunting are prevalent in Sindh, especially among the poorest, and all these are expected to worsen due to the floods. Exposure to these multiple risks reduces children¡¯s chances of meeting developmental milestones on time. According to the Pakistan Demographic Health Survey report, the stunting rate in Sindh is 49.9 percent, the highest in Pakistan. Malnutrition and poverty are significantly correlated in Sindh. In rural Sindh, women remain highly vulnerable to higher maternal mortality due to unsatisfactory family planning services and utilization, and high levels of low skilled birth attendance. Despite the federal and provincial governments¡¯ efforts to increase availability and use of critical health services for mothers, newborns and young children, there remained significant deficits in the use of these services, mainly among poor women. Disruptions to livelihoods and lost income in the wake of the floods could cause more people to forego health services, which could lead to unsatisfactory child development and unhealthier pregnancies.
How will the project address the situation In Sindh?
will strengthen Sindh SP delivery systems through supporting the Sindh SP Authority (SPA), and by promoting increased utilization of maternal and newborn child health services through Conditional Cash Transfers (CCTs), particularly in the wake of service disruption after the floods. The Project will focus on birth and the first 1,000 days of child¡¯s development, where risks and needs are high but programmatic responses are weak. It is also part of the package of World Bank operations designed to support the rehabilitation and reconstruction response to the floods, and to build resilience to climate-related shocks.
Who will benefit from the project?
The CCTs will be available to the poorest 15 districts of Sindh, selected based on the Multidimensional Poverty Index, and cover 65 percent of the total flood-affected union councils in the province to help mitigate flood impacts, particularly food insecurity, and monetary constraints for continuous utilization of maternal and children health services. The Project will prioritize poor and vulnerable women and children from the selected districts of Sindh, directly benefiting 1.3 million mothers and their children born during the five-year project period. The project will offer a total of PKR 30,000 (US$136) for a period of approximately three years (first 1,000 days) to cover basic costs of utilizing Maternal, Newborn and Child Healthcare services. The transfer amount of PKR 1,500 (US$6.8) per visit is expected to help families cover basic transportation costs and other private costs, such as, missing a day of work that could affect health services utilization.