The pressure on service delivery systems is already evident. In education, the challenge is no longer only about access, but meaningful access. Pakistan has over 22-25 million out-of-school children, and literacy remains around 62 percent, leaving nearly 60 million people unable to read or write.^{1, 3} Even among those enrolled, learning outcomes remain weak. Rapid population growth means each successive cohort is larger than the last, yet investments in infrastructure, teachers, and curriculum reform have not kept pace. The result is a system that risks expanding access at the cost of quality.

These disparities are especially visible in rural, remote, and underserved communities, where schools often lack basic facilities, trained teachers, reliable electricity, and digital connectivity. Girls in marginalized districts continue to face significant barriers to schooling due to poverty, distance, insecurity, and social norms. Access to education therefore remains uneven across geography, gender, and income groups, despite constitutional guarantees under Article 25-A. Expanding enrolment without addressing inequities in quality and infrastructure risks reinforcing cycles of exclusion rather than reducing them.

The health sector tells a parallel story. Public spending remains under 3 percent of GDP, limiting the system’s ability to respond to rising demand.⁴ Pakistan’s under-five mortality rate, around 56 per 1,000 live births, remains significantly higher than regional peers. Meanwhile, the epidemiological burden is shifting: Communicable diseases persist, while non-communicable diseases such as diabetes, cardiovascular disease, and obesity continue to rise steadily. Urbanization is further intensifying pressure, particularly in informal settlements where service provision lags behind population growth. The system remains reactive, often prioritizing treatment over prevention.

The burden is particularly severe for rural and marginalized populations, where distance, affordability, and lack of health information continue to limit access to care. Primary healthcare systems remain overstretched, and shortages of healthcare workers in remote districts further deepen inequalities. Lady Health Workers continue to serve as a critical bridge between communities and the healthcare system, yet they themselves often operate with limited resources and support. Achieving Universal Health Coverage will therefore not only require expanding services, but ensuring equitable reach and quality across both urban and rural Pakistan.

Social protection systems, too, are under strain. Around 31 percent of youth are not in education, employment, or training, reflecting a disconnect between skills and labour market needs.² At the same time, approximately 23 percent of the population lives below the US$3/day poverty line.¹ Vulnerability is becoming more dynamic, shaped not only by income, but by climate shocks, inflation, food insecurity, and urban informality. The devastating floods of recent years demonstrated how quickly millions can fall into poverty when systems lack resilience and preparedness. Social protection programmes designed for static poverty profiles are struggling to adapt to increasingly complex and overlapping vulnerabilities.