Pakistan Office Annual Report 2023

Islamabad, Following is the full text of United Nations International Children’s Emergency Fund Country Report

Update on the context and situation of children

Children in Pakistan continued to experience the negative effects of significant shifts in the political and socioeconomic landscape influenced by global and regional dynamics, including geopolitical tensions, contributing to a complex environment for child rights implementation. Conflicts such as the war between Russia and Ukraine pushed worldwide food and energy prices up, impacting consumers, particularly the underprivileged including those of Pakistan.

The economic downturn was exacerbated by the loss of infrastructure, businesses, crops, and livestock during the 2022 floods. This resulted in a surge in poverty levels (9.4 per cent increase as results of the recent floods), driven by increasing unemployment and inadequate wages to meet the rising cost of living. Economic disadvantage interacts with harmful gender and social norms depriving girls and women of information, quality social services and care practices. Pakistan’s population increased to 241.49 million (Census 2023) with an annual growth rate of 2.55 per cent and 61.18 per cent living in rural areas.

The economic challenges were multifaceted, including fiscal deficits, inflationary pressures, and external debt burdens. Pakistan’s gross domestic product (GDP) growth rate (purchasing power parity) fell to 0.3 per cent, compared to 6.1 per cent in 2022, while the fiscal deficit in July remained at 0.2 per cent of GDP, in line with the previous year. The inflation rate reached a record 38 per cent in May. As highlighted in COP28, Pakistan is highly vulnerable to the adverse effects of climate change and ranks 14 out of 163 countries in the children’s climate risk index of 2021.

Despite these challenges, the International Monetary Fund (IMF) Stand-By Arrangement secured in July provided external financing, averting a balance of payments crisis. The Fitch credit rating agency upgraded Pakistan’s long-term foreign currency issuer default rating to CCC from CCC-, signaling a positive development for a country grappling with a severe economic crisis. These economic constraints influenced the government’s ability to allocate resources for various sectors, including critical social services such as education, healthcare, and child protection (CP).

In the five-year period preceding the Pakistan Demographic and Health Survey (PDHS) survey of 2017-18, neonatal mortality was 42 deaths per 1,000 live births, infant mortality was 62 deaths per 1,000 live births, and under-5 mortality was 74 deaths per 1,000 live births. These rates imply that nearly one in 14 children die before reaching their first birthday and one in 16 children die before reaching their fifth birthday. The prevalence of malnutrition among children stands at 40.2 per cent experiencing stunting (12 million), 17.7 per cent facing wasting (five million), and 9.5 per cent (2.3 million) identified as being overweight. Adolescent girls bear a high burden of anemia, with 54.7 per cent affected, while 43 per cent of adult women also struggle with this nutritional challenge. Approximately 26.2 million children are out of school and three out of every four (75 per cent) 10- year-olds are unable to read and comprehend age-appropriate text.

Girls aged 5-16 experience a higher out-of-school rate at 52.6 per cent (13.8 million), underscoring barriers that hinder their educational participation. In comparison, boys face a relatively lower out-of-school rate of 47.3 per cent (12.4 million). In addition, just 18.9 per cent of three to five-year-olds nationally are enrolled in Early Childhood Education (ECE), curtailing access to early stimulation and learning opportunities for young children that is already minimal at the household level.

The completion rate in primary education stands at 67 per cent however, as students progress to lower secondary education, the completion rate decreases to 47 per cent, signifying a notable drop in educational continuity. The challenges become more pronounced in upper secondary education, where the completion rate further decreases to 23 per cent. Girls’ educational participation levels (enrolment, completion) lag behind that of boys especially at the primary level, in poor households, low-income rural areas and contexts affected by conflict or emergencies. Marginalised adolescents of all genders are structurally disadvantaged by poverty, poor quality services and discriminatory norms that limit their access to quality education and skill development, nutrition, protection, and employment opportunities.

Child marriage and adolescent pregnancy have negative consequences for the development and well-being of adolescent girls and their children. The percentage of women (aged 20–24) married or in union before the age of 18 years is 18.3 per cent compared to 4.7 per cent for men, highlighting a concerning prevalence of child marriages for girls. Birth registration for children under-5 years (U5) stands at 42.2 per cent, a modest increase of 15 percentage points from 27 per cent in 2007. The birth registration rate for children under-1 year old (U1) is even lower, currently at just 35 per cent. Consequently, the burden of unregistered children U1 and U5 is alarmingly high, making Pakistan the country with the highest number of unregistered children in South Asia as well as globally.

Examining disability rates across age groups reveals a consistent prevalence, with 1.9 per cent for ages five-to- nine, 2.2 per cent for ages 10-14, and 2.4 per cent for ages 15-19 underscoring the need for inclusive policies and interventions to address the unique challenges faced by individuals with disabilities. Approximately 90.6 per cent of the population has access to basic drinking water services and 70.5 per cent of the population enjoys access to basic sanitation facilities.

The availability of basic hygiene services extends to around 84.7 per cent of the population. The score of 52.7 on the Universal Health Coverage (UHC) index indicates the substantial distance which remains to be covered to achieve comprehensive health coverage, urging sustained efforts for improvements in infrastructure, service delivery, and accessibility. Social protection secured prominence in IMF reviews which resulted in an increased allocation of PKRs 455 billion for Benazir Income Support Programme (BISP) in FY2023-24, up from PKRs 404 billion.

According to the World Economic Forum, Pakistan ranks 142nd out of 146 countries on the Global Gender Gap Index. This is compounded by cultural norms, lack of infrastructure for schools, gender stereotypes, discriminatory practices, socioeconomic factors, and inadequate access to quality healthcare services.

Major contributions and drivers of results

Child, Adolescents and Maternal Health

The neonatal Mortality Rate stands at 42 per 1,000 live births and the stillbirth rate at 31 per 1,000 live births. UNICEF provided crucial support to the National Newborn Survival Strategy by embedding integrated childhood illness management and essential packages of health services for the UHC initiative, which contributed to the UHC Service Coverage Index increased slightly from 52.0 in 2021 to 52.7 in 2023.

More children received protection from preventable diseases with the coverage of fully immunized children increasing from 66 per cent in 2018 to 77 per cent in 2022 and the number of zero dose children decreasing by 180,000, from 610,564 in 2021 to 431,000 in 2022 (WUENIC, 2022). UNICEF supported evening and weekend services, integrated outreach sessions in urban settings, and deployed 191 female vaccinators to address the issue of gender barriers. Additional trainings targeted 73 health service providers with Early Childhood Development (ECD) and National Oxygen therapy guidelines.

UNICEF’ s continued emergency preparedness and life-saving facility-based and outreach health services delivery in 41 flood affected districts, addressing issues like cholera, conjunctivitis, and COVID-19, flood-damaged health equipment, rehabilitating 104 health facilities and four warehouses supplying essential medicines and equipment to Lady Health Workers (LHW), whose curriculum was also revised to include non-communicable diseases. These initiatives and temporary health facilities aided over six million people. To boost climate-resilient healthcare UNICEF endorsed the installation of solar power in 112 healthcare facilities and supplied five oxygen plants in Punjab, Khyber Pakhtunkhwa (KP), and Balochistan.

Polio Eradication

UNICEF supported three national polio campaigns targeting more than 44 million children aged 0-59 months and achieving 99 per cent coverage in each campaign. Two sub-national activities (NIDs) and six outbreak responses (OBRs) were also conducted in endemic and outbreak areas as per the evolving epidemiology. UNICEF mobilized resources, procured, and distributed 210.7 million doses of oral polio vaccine for all the supplementary vaccination activities. Overall, 98.09 per cent of districts achieved over 95 per cent polio vaccination coverage as per the post campaign evaluations (PCE). The polio eradication programme has shown progress towards interrupting wild poliovirus transmission. Six wild poliovirus cases were reported, compared to 20 cases in 2022.

However, stopping transmission in the endemic area of South Khyber Pakhtunkhwa (SKP) continues to be a challenge due to demand-based boycotts, mistrust, fake finger marking, and security challenges. Despite the complex challenges, the UNICEF polio eradication program in partnership with the government partners and Law Enforcement Agencies (LEA), targeted advocacy and social behavior change (SBC) interventions which facilitated the resumption of the polio vaccination campaign in South Waziristan (Mehsud Belt) after a 16-month hiatus. Of the 677 reported community boycotts of polio vaccination, only 16 remain unresolved. Mass media campaigns, social media initiatives, and targeted community engagement activities, including involvement of political, religious, and tribal leaders, contributed to enhanced community trust, and led to about 42 per cent reduction in missed children due to caregiver refusal in the endemic districts.

The polio programme maintained overall high vaccine acceptance with the percentage of children aged 0-59 months who are missing vaccinations due to refusal being only 0.11 per cent (65,635 children), compared to 0.83 per cent (71,823 children) during 2022. Reaching refusal families and building trust through influencers remained a successful strategy that helped achieve >90 per cent coverage of recorded missed children on average during all campaigns conducted.

Child, Adolescents and Maternal Nutrition and Development (ECD)

UNICEF enhanced optimal nutrition for mothers and children by mainstreaming the management of wasting programmes in about 3,978 facilities (35 per cent) of the primary healthcare facilities, compared to the 3,336 facilities (30 per cent in 2022). The inclusion of Severe Acute Malnutrition (SAM) treatment and SBC under the BISP Nashounuma, unlocking of Nutrition Match Fund (NMF) and rollout of the simplified protocols for the management of wasting, helped treat severely wasted 253,612 boys and 307,247 girls with Ready to Use Therapeutic Foods (RUTF).

Severely wasted children treated with RUTF with UNICEF support increased by over 74 per cent from 315,302 in 2022 to 560,849. As a result of UNICEF support, 35.9 million children 6-59 months old received Vitamin A supplement, 2.5 million mothers received Iron and Folic Acid (IFA)/ Multiple Micronutrient Supplementation (MMS), while 4.4 million caregivers were reached with Infant and Young Child Feeding (IYCF) messages.

UNICEF revived the enactment of Breast Milk Substitutes (BMS), continued its support on the Baby Friendly Hospital Initiative (BFHI), food fortification bills, and a review of curricula for in-services training on nutrition and Parenting, ECD. UNICEF coordinated the nutrition sector humanitarian and development programmes including the United Nations Sustainable Development Cooperation Framework’ s (UNSDCF) nutrition subgroup and ECD coordination mechanics. UNICEF coordinated nutrition information management, including the development and integration of nutrition indicators in the DHIS-2, and conducted Standardized Monitoring and Assessment of Relief and Transitions (SMART) Surveys in 12 prioritized districts for evidence generation for advocacy, resource mobilization, and informed programming.

Over 800,000 adolescent girls received Weekly IFA tablets, while partnership with the education sector is ongoing for the screening, counseling, referral, and deworming of children using school platforms, and with advocacy against the advertisement of overprocessed food and beverages in school premises.

UNICEF supported functional multisectoral ECD and nutrition coordination that resulted in the approval of Umbrella PC-1 for nutrition and ECD, engagement of business in family-friendly policies and environment, mainstreaming ECD in emergency, introducing ‘project play’ and rolling out the parenting program to 122 districts compared to 28 districts in 2022 that resulted in engaging 0.7 million parents and caregivers on ECD and managed to reach 2.3 million targeted population through digital media.

WASH, Climate Change and Disaster Risk Reduction

To ensure equitable provision of climate-resilient, gender-responsive WASH services, aligned with Sustainable Development Goal (SDG) 6, UNICEF strategically prioritized system strengthening through policy reviews, sector coordination enhancement, and capacity building at federal and provincial levels. UNICEF also facilitated nationwide Bi-annual Climate Risk Informed Joint Sector Reviews in collaboration with Public Health and Engineering Department (PHED) and various government departments.

A comprehensive study on the WASH regulation gap, guided by the WASH Regulation Analysis tool, emphasized a human rights-based approach, as a result provincial and federal government departments became aware of the gaps in legislations which limit their role for obligating CR WASH rights and started planning priority legislative actions. Irrigation department of KP province in collaboration with PHED, Local Government and Rural Development (LG and RD) and Law and Justice department spearheaded an action plan for regulating the service delivery, building capacity of existing regulator and filling the legislation gaps, to be implemented in 2024. UNICEF collaborated on localizing the WASH Facility Improvement Tool (FIT) and evaluated the previous programme system strengthening, shaping key priorities for 2024.

UNICEF ensured basic sanitation for 374,405 people (189,701 men and 184,704 women), Open Defecation Free (ODF) status in 38 villages reaching 83,670 people (41,000 men, and 42,670 women), water supply for 2,387,751 people (1,169,181 men and 1,218,570 women), hygiene services for 239,458 people (117,334 men and 122,124 women), and hygiene promotion for 1,431,413 people (730,021 men and 701,392 women).

WASH services were ensured in 349 schools and 163 healthcare facilities. In humanitarian efforts including flood response, 1,286,504 people (656,117 men and 630,387 women) received safe water, 18,469 people (9,419 men and 9,050 women) gained access to basic sanitation, and 1,630,431 people (831,520 men and 798,911 women) received hygiene promotion sessions. Additionally, 786,709 girls and women were reached with Menstrual Health and Hygiene (MHH) needs in emergencies.

UNICEF supported climate change policies, addressing water scarcity, mainstreaming climate change in education, enhancing youth engagement, improving urban environments, and strengthening disaster risk management. UNICEF also played a key role in Nationally Determined Contributions (NDC) monitoring, conducted assessments, and engaged youth in climate action, seconding a national NDCs coordinator to Ministry of Climate Change (MoCC) for successful provincial implementation of action plans.

The ‘COP in my City’ initiative, spanning nine major cities, led to a gender-balanced youth delegation including 10 young people that actively participated in COP28. UNICEF, in collaboration with MoCC, organized eight ‘COP In My City’ events across major cities ahead of COP28, and which featured in a side event during the COP28. These events provided a platform for over 1,500 youth delegates to showcase their understanding of climate change and engage in debates on critical climate change priorities. This meaningful youth participation was presented as a model for involvement in the main COP28.

Learning and Skills

UNICEF addressed both access and learning challenges in education by supporting gender sensitive empirical evidence on school dropouts, school language, Early Learning Development Assessment Standards, gender-responsive budgeting, and improved provincial education data systems. This enabled government to improve strategic planning and monitoring of education service delivery. UNICEF provided crucial coordination to the education sector through various platforms. At national level, UNICEF supported the coordination of the Education Sector Working Group (ESWG)-EiE focusing on the Education 2022 floods response, the Education Cannot Wait (ECW) Multi-Year Resilience Programme (MYRP) and the Regional Response Plan (RRP) for Afghan Refugees.

Additionally, UNICEF’ s coordination efforts extended to supporting the implementation of provincial sector plans and policies, thereby contributing to the overall enhancement of the education sector. UNICEF programming to redress gender inequalities and remove structural barriers to education directly provided access to quality pre-primary and primary education to 533,085 children (half of them girls); expanded alternative learning programmes (ALPs), established temporary learning facilities in flood affected districts, and improved the learning environments at pre- and primary level schools such as enhanced capacity of 32,436 School Management Committee members (44 per cent female) and provision of school supplies and teaching and learning materials.

Foundational learning was improved through higher quality ECE services for 99,433 children (51 per cent girls); and targeted instruction on Foundational Literacy and Numeracy reached 93,941 children (49 per cent girls).

UNICEF-supported interventions allowed enhanced opportunities for education at post-primary level for 181,547 children and adolescents (61 per cent girls), through alternative learning pathways, afternoon schools, and non-formal skills development components, across all provinces. At the middle level, UNICEF leveraged digital technologies to benefit 12,322 adolescents in Balochistan, KP, and Sindh through the Sindh Learning Passport supporting access to digital content, remote teaching on specialized subjects to address the non-availability of teachers at the middle school level and enhancement of 21st century skills.

Child Protection

UNICEF supported 7,271 children (3,471 girls, 3,800 boys) at risk and survivors of child protection violations through ongoing support to the government and Civil Society Organization (CSO) partners to expend and strengthen case management and referral services, including via 25 district Child Protection Units (CPU) and the deployment of PRIMERO in four provinces. Strategic efforts to enhance the social service workforce for child protection gained momentum, with more than 2,200 personnel undergoing training and coaching to strengthen their capacities.

Significant milestones include the deployment of a large cohort of case workers and a partnership with the University of Bradford to develop tailored training in Sindh as part of the flood response, and the establishment of a Training Centre in KP, poised to facilitate continuous career development for CPU staff. UNICEF partnered with 13 CSOs nationwide to provide Mental Health and Psychosocial Support (MHPSS) to 392,711 children and caregivers (123,175 girls, 122,477 boys, 93,049 women, 54,010 men), including through innovative MHPSS models such as the Self-care and Hope through Adolescent led Mental health and Psychosocial Support (SHAMS), an adolescent led MHPSS programme. UNICEF continued to expand the reach of Gender Based Violence (GBV) mitigation, prevention and response intervention and reached 220,085 women and girls.

Through UNICEF support, 760 Community Based Child Protection Committees were created or supported and serve as important vehicles to mobilize community responses to child protection concerns and enhance referrals to CP services. Over 11,435 parents and caregivers (3,907 males and 7,528 females) were reached through positive parenting programmes and almost four million people reached with information on child protection risks and available services as part of the flood response in 2023. In partnership with Pakistan Telecommunication Authority (PTA) and Telenor, UNICEF launched a massive social media campaign on technology facilitated sexual abuse and exploitation of adolescents across Pakistan and a total of 24.1 million users have been reached so far.

The child labor survey in KP was completed and Pakistan became the only country in South Asia to join the Disrupting Harm programme to generate evidence on child online sexual exploitation and abuse. UNICEF and International Labour Organization (ILO) are supporting the translation of evidence into policy and costed action planning for Punjab and Gilgit-Baltistan (GB), where Child Labour Surveys (CLS) were completed. Policy outlines have been agreed with the respective governments. CP policies have been finalized across Pakistan and alternative care reforms have begun with a gap analysis presented to the governments in Sindh, Punjab and KP.

UNICEF continues to engage with National Commission on the Rights of the Child (NCRC) to strengthen its capacities and supported its participation in the first-ever CRI regional consultation in South Asia. As a result, children consultations were held across the country with active participation from the young minds on various child rights violations feeding into the regional Joint CRI action plan. The major shift has been in Birth Registration programming as informed by SDG Civil Registration and Vital Statistics (CRVS) side-event focusing on health interoperability, fee waivers and business process simplification, in close collaboration with National Database and Registration Authority (NADRA). An agreement was reached with all provincial and territorial governments to start implementing the health-interoperable birth registration model by ensuring the registration of newborns.

Social Policy and Social Protection

UNICEF’s approach to Social Policy and Social Protection encompassed legislative reforms, direct interventions, collaboration with partners, digital innovations, and active participation in policy dialogues, all geared toward achieving positive outcomes in social protection and child well-being. A key focus was on influencing comprehensive reforms at legislative, constitutional, and operational levels to establish inclusive and shock-responsive social protection systems aligned with SDGs at the national and provincial levels.

Direct interventions included UNICEF’s leadership in conceptualizing the cash plus pilot project, targeting vulnerable groups such as children from families with disabilities and pregnant women and children under-five at the federal level. This initiative aimed to provide essential cash top-ups, enhancing socioeconomic support. UNICEF leadership resulted in BISP’s establishing cash transfer coordination group co-chaired by UNICEF, offering strategic technical assistance in coordination, digital monitoring innovations, and alignment with provincial social protection programs. Collaboration with GIZ focused on promoting women’s empowerment through digital and financial literacy.

In collaboration with BISP, UNICEF provided technological support through leveraging technology to streamline and improve the efficiency of delivering financial assistance by introducing digital tools for enhanced targeting, recording, and disbursement of cash grants to approximately nine million children and adolescents. The integration of digital solutions facilitated a more precise identification of beneficiaries and ensured a smoother and more transparent distribution of cash grants, ultimately contributing to the positive outcomes for the targeted population. UNICEF’s provided technical assistance in consolidating and reviewing the National Socio-Economic Registry (NSER) data to streamline information for 34 million households living below the poverty line.

Research and Evaluation

In the face of challenges presented by floods, UNICEF took proactive measures by conducting three vital surveys namely needs assessment, rapid care and feeding assessment, and child protection rapid needs assessment in flood-affected areas aimed at enhancing evidence-based planning, and were instrumental in gathering critical information in flood-affected areas. By employing evidence-based planning, UNICEF has been able to tailor its interventions more precisely to address the identified needs and challenges in the flood-affected regions. The findings facilitated shaping programmatic strategies, ensuring that resources are allocated effectively, and interventions are targeted where they are most needed.

UNICEF’ s evaluation efforts resulted in the Formative Evaluation of ALP Models and Centres, and the End-Term Evaluation of the Pneumonia and Diarrhea Project which achieving a ‘highly satisfactory’ rating in quality. The Summative Evaluation of the Digital Birth Registration (DBR) Project received a rating of ‘Satisfactory’ by Global Evaluation Reports Oversight System (GEROS). The findings from the DBR evaluation played a crucial role in shaping policies, leading to the implementation of free birth registration for children in Sindh, with a government allocation of PKR 30 million for fee waivers.

Birth registration desks were established in health facilities in Karachi and Hyderabad, facilitating the issuance of birth registration certificates to newborns and children under-5. In Punjab, the Birth Registration campaigns became a regular feature of the Local Government and Community Development Department (LG and CDD) activities, organizing annual 10-day campaign annually across 36 districts. Under this campaign, a total of 262,959 children were registered, comprising 136,242 boys and 126,717 girls.


UNICEF Pakistan incorporated gender-responsive programming across WASH, Nutrition, Education, Child Protection, Health, and Planning, Monitoring and Data (PMD) at Country Office (CO) and Field Office (FO) levels to address harmful gender norms. This support helped strengthen CO programming on inclusive, age-sensitive and gender-responsive social protection, education, WASH, child protection, and nutrition programs. UNICEF is well positioned within UN, Gender Thematic Group and Inter Agency Group on Gender and Development (INGAD), amplifying the collective efforts towards fostering gender equality and empowerment. Strengthened partnership with girls network- Pakistan Girls Guide Association, reaching out to more than 130,000 girls.

In addition, UNICEF has been actively engaged in collaborative efforts with the UN Gender Theme Group (GTG) towards the establishment of a National Gender and Child Data Portal. This initiative reflects a concerted commitment to centralizing and enhancing data collection and dissemination concerning gender and child-related information. By fostering this collaboration, UNICEF aims to bolster the availability and accessibility of vital data, thereby empowering evidence-based policymaking and interventions that prioritize gender equality and child-centric approaches.

UN Collaboration and Other Partnerships

UNICEF has been collaborating with key stakeholders nationally and internationally, including but not limited to leading the Basic Social Services outcomes under the UNSDCF with 12 other UN agencies and the disability working group. UNICEF is leading the subgroup on Gender and Data in the Gender Theme Group (GTG) the core coordination structure on gender equality and advisory body to UNCT. The GTG has prepared a time-bound action plan on Gender Equality and Women Empowerment (GEWE) 2022-25 and produced the gender parity report for the UN system in Pakistan.


With the World Health Organization (WHO) and the United Nations Populations Fund (UNFPA) UNICEF supported the Government to develop the Every Newborn Action Plan – Ending Preventable Maternal Mortality planning. On the immunization front, UNICEF teamed up with WHO, Bill and Melinda Gates Foundation, Centre for Disease Control and Prevention (CDC), World Bank (WB), and various international and national non-governmental organizations (NGOs) and community-based organizations. These partnerships have been instrumental in addressing diverse aspects of maternal and newborn health, emergency response, and immunization interventions. The involvement of multiple organizations and the integration of different programs made interventions holistic leading to improve healthcare outcomes.

Nutrition and ECD

Federal and Provincial Planning, Health and Poverty Alleviation Ministries and Departments are the main government entities UNICEF partners with for Nutrition and ECD efforts. The World Food Programme (WFP), WHO and the Food and Agriculture Organization (FAO) are the major UN partners for the scale up of the BISP Nashunoma humanitarian response and development, and strengthening food security and nutrition monitoring system.

International and national NGOs, including Action Against Hunger (ACF), Shifa foundation, People’ s Primary Healthcare Initiative (PPHI), Medical Emergencies Resilience Foundation (MERF), Commissionerate of Afghan Refugees, and Qatar Charity were instrumental for the emergency response community-based nutrition programming and rollout of Key Family Care Practices (KFCP), while the Global Alliance for Improved Nutrition (GAIN), Nutrition International and National Fortification Alliance were key partners for large scale food fortification.

Academic institutes, such as Khyber Medical University played key roles in strengthening pre-services training on Nutrition and ECD, while the Pakistan ECD Alliance, Agha Khan University, University of Lahore, Allama Iqbal Open University and Rupani Foundation remained instrumental for capacity strengthening on ECD.


UNICEF technical support for large programmes funded by donors including the Global Partnership of Education, European Union (EU), ECW, Norway and The Netherlands, contributed to improved teacher training, programmes for out of school children, strengthened data systems, foundational literacy and numeracy initiatives, gender responsive budgeting.

Coordination and technical support to the Federal Education Ministry led to finalization of the Joint Needs Assessment of children affected by 2022 floods.


In the WASH Programme, UNICEF established new strategic partnerships with International Centre for Integrated Mountain Development (ICIMOD), International Water Management Institute, Ministry of Water Resources (MoWR) , Pakistan Council of Research in Water Resources, LG and RD in PAK and GB, as well as PAK’ s Physical Planning and Housing (PP and H) department.

Collaborations with non-traditional government partners, such as Irrigation and Law and Justice departments, facilitated WASH-Reg studies. Engagement with Ministry of National Health Services, Regulations and Coordination (MoNHSRC) and Ministry of Federal Education and Professional Training (FEPT) accelerated WASH in healthcare facilities and schools.

UNICEF influenced significant WASH investments with International Finance Institutions, prioritizing pro-poor considerations. Collaborating with Ministry of Health (MoH), MoWR, MoCC, WB, Asian Development Bank (ADB), Japan International Cooperation Agency (JICA), Korean International Cooperation Agency (KICA), Asian Infrastructure Investment Bank (AIIB) and sector partners supported the Government of Pakistan in WASH system strengthening for improved service delivery in Urban, Small, and Medium Cities, as well as Rural areas.

Child Protection

UNICEF partnerships with PTA, Telenor, and UNICEF Innocenti led to advancement in the COP agenda in Pakistan. On birth registration front, NCRC, NADRA and the Health Ministry have been fundamental in advocacy efforts to have a health-interoperable birth registration system. Collaboration with ILO is certainly crucial to move strategically on the child labor agenda.

The partnership with Child Protection and Welfare Bureau (CPWB) in Punjab and its keen interest on the finalization of CP policy has been instrumental in moving the policy to the Cabinet for approval. Partnerships with National and provincial Commissions on the child marriage agenda were also established. Partnerships with Government entities responsible for Child Protection, including CPWB, KPCWCPC, MOHR and Social Welfare Departments played a pivotal role in implementing CP case management and referral services in the provinces and territories, along with deepened collaborations with health and police departments for referrals.

Collaborations with organizations like School of Leadership, International Rescue Committee (IRC), Drugs and Narcotics Educational Services for Humanity (DANESH), and Sanjh Preet expanded services, particularly in GBV and MHPSS. Collaboration with technical experts, such as Oxford Policy Management (OPM), strengthened the approach to case management and the Global Child Protection Area of Responsibility (CP-AOR) for Joint Needs Assessment.

UNICEF as the co-chair of the UNCT PSEA Network, lead and supported to establish two PSEA Provincial Networks in Punjab and Sindh. Since the beginning of the response, 6,112,436 people including 2,506,691 children (1,252,057 girls, 1,254,634 boys, 1,813,362 women, and 1,792,383 men) in UNICEF-supported project implementation sites have been reached with PSEA messages, including the safe and accessible SEA reporting. In addition, 13,149 frontline workers (5,686 women and 7,463 men) have been trained on PSEA through online mandatory trainings and face-to-face training sessions.

In the area of Social Protection, key collaborations emphasized a multisectoral approach with entities such as the World Bank, UN agencies, and development partners including GIZ and the EU. Collaborations extended to governmental bodies including Ministry of Planning, Development and Special Initiatives, Ministry of Finance and Revenue, Ministry of Poverty Alleviation and Social Safety Division, Ministry of Poverty, Social welfare, and Bait ul Mall departments, Benazir Income Support Programme BISP, and Pakistan Institute of Development Economics. These partnerships played a crucial role in fortifying social protection systems and building capacity in the public sector, contributing to collective policy advocacy, technical facilitation, and amplifying UNICEF’s influence on key child rights issues.

Lessons Learned and Innovations

Domestic resources and strong advocacy are key to improved investment in nutrition and ECD: As part of public financing for nutrition and ECD, UNICEF’ s co-funding under the NMF unlocked domestic resources worth about US $5.6 million from Sindh and Punjab provincial governments for the procurement of RUTF, subsequently raising the NMF ceiling for Pakistan from the US $1.3 million in 2022 to US $10 million in 2023.

Despite its relatively small scale compared to the overall needs, it has successfully incentivized domestic resources for the procurement of MMS, marking Pakistan as the first country to mobilize public funds specifically for MMS. Similarly, as a result of advocacy, 404.34 million PKR is allocated from Public sector funds for Parenting-ECD embedded in the recently approved Umbrella PC1 of total worth 8583.000 PKR in Million for 36 high prioritized districts. This is the first kind of public sector allocation for ECD in Pakistan.

Strategic engagement of professional associations (such as Pakistan Paediatrics Association (PPA)), is crucial in the advocacy and legislation of acts that protect nutrition, as evidenced by the ‘Sindh Protection and Promotion of Breastfeeding and Young Children Nutrition Act’ 2023.

UNICEF Pakistan piloted ECD – Project Play, an initiative that repurposes the cardboard packaging of nutritional supplements into play materials to stimulate children aged 6–59 months, being treated for and in recovery from wasting, especially during emergencies. The positive experience and lessons learned led to the inclusion of Project Play as a main tool in the recently released Global Nutrition Cluster guidance on maximizing ECD in nutrition emergencies.

Lessons learned on transitional schools, ALPs that are crucial in addressing the out-of-school and continuity in the development and humanitarian situations in Pakistan and required sustained funds and investment to ensure their continuation at large scale.

Promising Foundational Learning approaches: UNICEF supported the implementation of a Foundational Literacy and Numeracy model for public schools to address the learning poverty. Initial very promising results, suggest that an enhanced focus on foundational learning has great potential to address the learning crisis.

Strong advocacy with government and policy dialogue leveraging the relevant stakeholders led to sustainable results on sensitive priorities. UNICEF’ s efforts in advocating and sensitizing relevant entities to ‘Period Poverty’ led to impactful policy dialogues and submissions for tax reforms, to support marginalized girls’ and women’ s access to menstruation materials.

Galvanizing and strong coordination with UN and Human Rights Institutes are very good platforms to address sensitive issues such as child marriage in Pakistan: The collaboration on child marriage with other UN agencies under the umbrella of National Commission on the Status of Women served as an effective platform for joining hands for the prevention of child marriage. Such approach has created a momentum around child marriage prevention, and with Pakistan being on the path to be included in the global child marriage initiative.

Customized approach at provincial level is key in planning for social protection results at decentralized: Customizing rolling work plans and training for provincial partners emphasized adaptability to local contexts, optimizing costs, and improving efficiency in social protection programs. Clear role delineation and reduced duplication led to innovative implementation highlighting that streamlined stakeholder engagement is vital for collaborative success and sustainable resource utilization.

UNICEF Pakistan’s flagship SUCCESS (Scaling Up Convergence and Coverage of Essential Social Services) initiative implements innovative convergent programming through the integration of evidence-based, high-impact interventions and solutions for best practice in a full package of holistic care; to save lives and enable the thriving of the most deprived women and children, in targeted districts integrated within existing programs with innovative Nurturing Care Centres of Excellence approach.

Innovative interventions complemented with digital technology to address the shortage of teachers in middle schools in remote locations in KP and Balochistan, and provision of English language and 21st century skills to adolescent girls, reached 5,430 girls. In Phase II of this Programme, UNICEF will expand the duration of activities to support training for three full academic cycles of learning and training, thereby increasing the impact of the activity. In addition to the 70 schools targeted by Phase I of this Programme, 30 additional schools will be added in three districts in Balochistan (Quetta, Pishin and Killah Abdullah).

Piloting nature-based groundwater recharge and decentralized wastewater treatment facilities enhanced knowledge among government counterparts, and that further revealed that additional institutional capacity strengthening for effective planning for water scarcity was required.

“COP in My City” events with an incentive to participate in COP28 events across Pakistan was found to be a key innovative platform in encouraging a large number of youths to participate in climate action with an effect on creating awareness on climate change to the wider population through social and mainstream media coverage.

Innovative interventions on MHPSS to reach adolescents and their caregivers, including digital and face-to-face engagement approaches under the banner of SHAMS has had an effect on the engagement of adolescents on a highly stigmaitized issue. The programme will expand in 2024 to reach more adolescents in vulnerable communities.

Child Protection launched a new application for monitoring attendance in safe spaces for enhanced quality of reporting. This is the first of its kind globally and has the potential for replication in other humanitarian contexts.

The Inter-Agency Implementing Partnership (IP) Working Group, in line with the global Inter- Agency IP Working Group, UNICEF lead and establish the IA IP Working Group to support UN agencies in implementing the UN Harmonized IP Protocol in Pakistan. Conducting joint SEA risk assessments and implementing capacity strengthening and improvement plans with CSOs has been facilitated by UNICEF’s strategic leadership.

Traditionally, BISP relied on human resources for the crucial task of data collection in the realm of social protection. UNICEF facilitated the adoption of technology, introducing digital platforms for the recording and monitoring of information within the social protection realm. This shift towards technological solutions enhanced the efficiency of data collection and provided a more streamlined and accurate method for monitoring and managing social protection programs.