CSS 2026 Solved Pakistan Affairs Past Papers | The Performance of the Health and Education Sectors post 18th Amendment
The following question of CSS Pakistan Affairs 2026 is solved by Saweera Abid under the supervision of Miss Iqra Ali, Pakistan’s Best Pakistan Affairs Coach, on the guided pattern of Sir Syed Kazim Ali, which he taught to his students, scoring the highest marks in compulsory subjects for years. This solved past paper question is uploaded to help aspirants understand how to crack a topic or question, how to write relevantly, what coherence is, and how to include and connect ideas, opinions, and suggestions to score the maximum.
Question Breakdown
In this question, the examiner has asked to critically assess the performance of the health and education sector of Pakistan after being handed over to the provinces. It means you have to analyze it through the lens of provincial autonomy. The analyses involve the post-2010 developments while considering the performance of these sectors in the pre-2010 era under the federal government. You have to draw a comparative approach to complete the analyses. Besides, you can choose some leading indicators to compare the changes that have happened. It further helps you cope with the time constraints. A Structured answer helps you gain maximum marks while offering you the best use of time during the examination. The answer will follow the same pattern: Introduction, body paragraphs, and conclusion. As the answer is already a pure analysis, there is no need to add critical analyses separately.
Outline
1-Introduction
2-Devolution of Power to Provinces under the 18th Amendment
3-Pre-and Post-Amendment Analysis: Health Sector under Federal versus Provincial Government
- ✓ Performance Indicator-I: Service Delivery & Access
- ✓ Performance Indicator-II: Health outcomes
- ✓ Performance Indicator-III: Quality Care
- ✓ Performance Indicator-IV: Financial & Efficiency Metrics
- ✓ Performance Indicator-V: HR, Governance, and Transparency
- ✓ Performance Indicator-VI: Infrastructure and Supplies
4-Pre-and Post-Amendment Analysis: Education Sector under Federal versus Provincial Government
- ✓ Performance Indicator I: Access & Enrollment
- ✓ Performance Indicator II: Educational Outcomes
- ✓ Performance Indicator III: Inequity & Inclusion
- ✓ Performance Indicator IV: Governance & Finance
- ✓ Performance Indicator V: Infrastructure & Management
5-Critical Analysis: Formulation Versus Implementation
6-Conclusion
Answer to the Question
Introduction
The health and Education sector of a country is a foundation of its human capital, directly impacting its economy, bearing intergenerational benefits, reducing inequality and poverty, and ensuring good governance and social stability. They must be addressed together for national growth and development. In the case of Pakistan, health is not given a constitutional safeguard as a fundamental right, but education is via incorporating Article 25A into the Constitution of 1973. It is evident that provincial autonomy improves governance and improves the overall performance of a country, providing a way to a prominent growth and development. The 18th Amendment in the Constitution of 1973 in 2010 devolved significant financial and administrative authority to provinces, where the health and education sectors became subjects of provinces. Analysts compare pre- and post-Amendment performance of the sectors by analyzing key indicators to assess the benefits of long-demanded provincial autonomy. In this regard, pre- and post-amendment analysis showed mixed results in terms of improvement in efficacy. Despite noticeable growth at different levels, provinces still lag due to capacity gaps. Persistent provincial disparities lead to uneven growth, limiting the results at the national level. Thus, capacity gaps need to be fulfilled to unlock the true potential of the devolution of power.
Devolution of Power to Provinces under 18th Amendment
As discussed earlier, the 18th Amendment in the Constitution of 1973 implemented devolution of power in 2010 and granted provincial autonomy to the federating units. Both the health and Education sectors devolved under the plan, and jurisdiction is given to provinces. Now, provinces have control over policy and strategy, service delivery, and program implementation. In terms of education, provinces are given the power to create their own education policies, manage institutions, and devise curricula. Altogether, both sectors came under the control of provinces from the federal government. The motive of the devolution lies in the provision of better services and encouraging development at the national level.
Pre-and Post-Amendment Analysis: Health Sector under Federal versus Provincial Government
- ✓ Performance Indicator-I: Service Delivery & Access
To begin, the performance analysis of service delivery and access can be accessed by checking the following indicators: outpatient visits, emergency response, and institutional deliveries. In this regard, the National Health Accounts of 2009 show centralized and limited data availability. However, low institutional delivery rates showed the lagging performance of the Health Sector under the federal government. However, the post- Amendment performance analysis of these indicators showed mixed/ slight improvement. For illustration, improved data systems, such as DHIS in Khyber Pakhtunkhwa (KP) and institutional deliveries, showed little empowerment. In terms of expenditure, the performance remained poor, and the sector faced catastrophic expenditure
- ✓ Performance Indicator-II: Health outcomes
Next, the performance analysis in terms of health outcomes can be accessed by checking Infant and Maternal Mortality Rates (IMR & MMR), disease burden, and life expectancy. Pre-Amendment health outcomes in terms of nutrition and service coverage showed Pakistan lagging behind peer countries. However, post-Amendment indicators showed slight improvement, and the country lagged below international standards. According to the report of Georank, an independent open data project that analyzes raw global statistics and aggregates data to enable consistent country-to-country comparisons and rankings, the average life expectancy rate in Pakistan in 2013 was 65.1 years compared to 64.4 years in 2010. Besides, the statistics provided by the World Bank Group show a mortality rate of 6.9% in 2013 compared to 7.3% in 2010 per 1000 live births, demonstrating a slight improvement after handing over the subjects to provincial governments. Similarly, MMR per 100,000 live births remained at 0.22% compared to 0.24% in 2010. It is imperative to mention here that improvement in performance varies from province to province, pertaining to the acute inter-provincial economic disparities.
- ✓ Performance Indicator-III: Quality Care
Besides, no clear improvement is seen in terms of quality care analyzed through checking the following indicators: patient satisfaction, medical error rates, and clinical adherence. Pre-Amendment performance analysis showed the dominance of private in services with limited regulation. No clear improvement is seen after devolution of power, and the private sector dominated the leading services, whereas regulation and quality care remained the leading challenges. According to Hafiz Syed Mohsin Abbas, as stated in the article titled The Role of State Capacity and Socio-Economic Determinants on Health Quality and Its Access in Pakistan (1990–2019), health care facilities are fractionally improving from 2008 to 2019. Ratios of Population to doctors and nurses are improving from 1229 to 925 and from 2547 to 1938, respectively, which depicts a positive picture of Pakistan’s health conditions.
- ✓ Performance Indicator-IV: Financial & Efficiency Metrics
Turning the cursor to financial and efficiency metrics, the following indicators: total health budget, OOP expenditure, and budget execution can be checked to compare pre- and post-Amendment conditions. In the case of pre-Amendment Pakistan, indicators and metrics showed low spending of ~2.6% of GDP, the lowest in South Asia. However, mixed improvement is shown in post-Amendment financial investments. For example, the Sindh budget is increased for development, but inequality persisted, and OOP remained very high. Overall budget expenditure remained at 2.43% of GDP in 2010; however, post-Amendment showed a slight decrease 2.42% of the GDP, but substantial gains were noticed in the following years, reaching to 2.99 in the year 2021.
- ✓ Performance Indicator-V: HR, Governance, and Transparency
Next, performance analysis of Human Resource accessed through the indicators: doctor/population ratio, nurse/population ratio, absenteeism, and governance and transparency accessed through procurement cycle, corruption complaints, and public budgets showed improvement after devolution of power in 2010. According to the report of the World Bank Group, physicians per 1000 people reached 1.2 in 2021 as compared to 0.4 in 2010, showcasing mixed improvement. As far as governance and transparency are concerned, the pre-Amendment scenario showed high centralization, ad-hoc decision-making, and weak accountability as compared to the post-Amendment devolution of power, but traditional priority-setting persisted, and uniform policy enforcement remained weak. In addition, fragmented coordination demonstrated mixed results in terms of improvement at the broader level.
- ✓ Performance Indicator-VI: Infrastructure and Supplies
Last, pre- and post-Amendment health sector analysis in terms of infrastructure development and supplies management showed no improvement. The analysis drawn on the leading indicators: percentage (%) of facilities with essential meds, functioning equipment, and clean water, showed weak supply chains and poor infrastructure in the pre-Amendment scenario. However, infrastructure has fractionally improved after devolution of power, but quality remains a concern at the provincial level, especially in the marginalized areas.
Pre-and Post-Amendment Analysis: Education Sector under Federal versus Provincial Government
The following points provide the analysis of the performance of the education sector accessed through analysis leading indicators of growth and development.
- ✓ Performance Indicator I: Access & Enrollment
To initiate, access, and enrollment in terms of Net Enrollment Rate (NER) at primary & secondary levels show improvement after devolution of power to provincial governments. The education sector under the federal government has witnessed the establishment of a baseline, but lower private sector engagement limits its true potential. However, the post-Amendment scenario witnessed considerable improvement in primary NER (>20% average increase) and more modest gains are seen at the secondary (>8%) level.
- ✓ Performance Indicator II: Educational Outcomes
Next, education outcomes before and after the Amendment show stagnant growth. Based on literacy rate and learning quality, the pre-18th Amendment showed that Pakistan lagged behind its regional peers. However, minor growth in literacy is recorded after devolution of power to provincial authorities, where the national DEPIx score reached to 53.46%, demonstrating Low Performance. As far as learning quality is concerned, indicators of performance analysis revealed that only 23% of Grade 5 children can read age-appropriate text following the devolution of power in 2010.
- ✓ Performance Indicator III: Inequity & Inclusion
As far as inequity and inclusion are concerned, pre- and post-Amendment performance analysis showed a worsened situation where the crisis remained persistent. Based on the following indicators: out-of-school children (OOSC), gender parity, and provincial disparities, significant disparities existed in the pre-Amendment time period. However, the post-Amendment scenario showed a worsened situation with 26.9 million children out of schools, whereas KPK and Sindh witnessed a more lingering crisis.
- ✓ Performance Indicator IV: Governance & Finance
Jumping to the next, governance and finance spending in the pre- and post-Amendment era show mixed results. Based on the analysis of the leading indicators, namely education budget, policy autonomy, and capacity, post-Amendment witnessed a rise in public spending of around 2% of GDP, which is below the global average spending rate. Capacity gaps and a lack of expertise in policy formulation limit the true potential of devolution of power to provinces.
- ✓ Performance Indicator V: Infrastructure & Management
Last, infrastructure development and management remained limited in the pre- and post-Amendment era. Based on the leading indicators, namely school facilities, teacher availability, and data systems, pre-Amendment performance is marred by centralized bureaucratic systems. However, post-Amendment analysis revealed uneven progress due to capacity issues and governance gaps, whereas provincial disparities worsened it. In the case of KPK, the province performed better in governance metrics, but corruption remains a leading issue in all provinces.
Critical Analysis: Formulation Versus Implementation
In an analysis, capacity gaps at the provincial level limit the true potential of the decentralization- led performance growth. The 18th Amendment in the Constitution of 1973 devolved the authority to provinces to design policies and curricula, but capacity gaps limit its implementation. Provincial disparities are seen in the growth factor, as in the case of KPK and Sindh, a shortage of policy experts, limited financial resources, and political interference, which hindered effective reforms. However, higher education handled under the Higher Education Commission (HEC) remained centralized, leaving provinces under limited authority. As far as the health sector is concerned, an increase in allocations improves the sector, but persistent inequality and financial burden are still intact.
Conclusion
To conclude, although the 18th Amendment in the Constitution of 1973 in 2010 devolved significant financial and administrative authority to provinces, where the health and education sectors became subjects of provinces, pre- and post- Amendment analysis showed mixed results in terms of improvement in efficacy. Despite noticeable growth at different levels, provinces still lag due to capacity gaps. As the motive behind the devolution lies in the provision of better services and encouraging development at the national level, capacity gaps need to be fulfilled to unlock the true potential of the devolution of power.
CSS 2026 Solved Pakistan Affairs
| 2- | Conduct a Comprehensive Appraisal of the Similarities and Differences Between Iqbal’s Philosophical Ideas and Jinnah’s Political Interpretation of the Pakistan Ideology. |
| 3- | “The Instability in Afghanistan Continues to Influence Pakistan’s Internal Security, Regional Diplomacy, and Counter Terrorism Strategy”. Critically Examine the Above Statement and Suggest Policy Measures to Address the Issue/Challenge. |
| 4- | To What Extent Does the 27th Constitutional Amendment Strengthen or Weaken Constitutionalism and Rule of Law in Pakistan? Justify Your Stance with Valid Arguments. |
| 5- | Critically Assess How Youth Perspectives, Digital Activism, and Civil Society Movements are Influencing Civil-Military Relations. |
| 6- | Undertake a Concise Assessment of the Key Economic Challenges Currently Confronting Pakistan. Illustrate How the IMF’s Conditions Can Shape the Country’s Path Towards Economic Stabilization and Long-Term Financial Sustainability? |
| 7- | “The Unresolved Kashmir Issue Exposes the Inherent Weakness in the United Nations Security Council’s Architecture.” Critically Examine the Role of the UNSC in Resolving the Kashmir Issue |
| 8- | Critically Assess the Performance of the Health and Education Sectors after Being Handed Over to the Provinces Under the 18th Amendment and Suggest a Way Forward. |
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