KEY POINTS
- Remote areas face staff shortages, impacting education and healthcare.
- Government spending per student to reduce from Rs. 4,150 to 1,500.
- 55 colleges under review; low enrolment prompts outsourcing plan.
- BS programmes outdated, many students uninterested, staff shortages persist.
- 78 hospitals shortlisted; 72 to outsource in first phase.
- 16 performance indicators determine hospital outsourcing eligibility and quality.
- Fund release streamlined from 132 to 19 days for efficiency.
- KP faces critical staffing, infrastructure, and capacity gaps across sectors.
PESHAWAR, Pakistan: The Pakistan Tehreek-e-Insaf (PTI), which has governed Khyber Pakhtunkhwa since 2013 and long championed its reforms in health and education, now finds itself outsourcing hundreds of schools, colleges, and hospitals to private firms—an unusual step aimed at rescuing the very sectors it once claimed to have transformed.
This move puts the government between a rock and a hard place, trying to improve services while facing resistance from employees and logistical challenges.
Schools on shaky ground
The schools and hospitals shortlisted for outsourcing are mostly located in remote areas where employees refuse to serve for several reasons: due to security concerns, difficulties in educating their own children, or challenges faced by doctors in running their private clinics in those areas.
The official data shows that the total number of schools in Khyber Pakhtunkhwa are 34,784, with 5.94 million children enrolled—3.31 million are boys and 2.63 million girls. However, another 4.9 million children—between the ages of five and 16—remain out of school. Many schools have had fewer than 40 students enrolled for years, leaving them on shaky ground.
The provincial government has, therefore, shortlisted 4,147 schools—representing 11.92 per cent of the total schools—for outsourcing, with a plan to outsource 1,500 of them in the first phase.
Out of these, 2,313 are girls and 1,834 are boys schools. Of the 1,500 schools set to be outsourced, 500 are in merged districts, while 1,000 are in settled districts. According to Khyber Pakhtunkhwa Elementary and Secondary Education Secretary Khalid Khan, the outsourcing of 1,500 schools will be completed in phases over the next two years.
We will monitor the performance and then decide the way forward”– Khalid Khan, KP Elementary and Secondary Education Secretary, tells WE News English.
At present, the government spends Rs. 4,150 annually per student in these schools, but after outsourcing the cost is expected to reduce to Rs. 1,500. The private firms will also be bound to raise the student strength in each school to at least 240, ensuring institutions can keep their heads above water despite historical under-enrolment.
Outsourcing in phases
Among the total shortlisted schools, 1,443 schools are in Hazara (735 girls and 708 boys), 677 in Bannu (452 girls and 225 boys), and 574 in Kohat (337 girls and 237 boys). Dera Ismail Khan has 509 such schools (239 girls and 270 boys), Malakand has 475 (306 girls and 169 boys), Peshawar has 274 (138 girls and 136 boys), and Mardan has 193 (106 girls and 87 boys).
According to the Education Department, there are 14.2 million school-going children in the province. Of them, 4.2 million are enrolled in private schools or madrassahs, 5.9 million in government schools, while 4.1 million remain out of school. Elementary and Secondary Education currently consumes 17 per cent of the total provincial budget. Out of the Rs. 364 billion allocated, Rs. 346 billion goes to operational costs, while Rs. 18 billion is earmarked for development.
Officials say that in the next phase, the government will not construct new school buildings; instead, rented structures will be utilised. For flood-affected areas, where school infrastructure has been destroyed, prefabricated container classrooms will be provided. Additionally, under the rural accessibility plan, transport facilities will be arranged for girls if their school is located more than two kilometres away from the population.
Higher education challenges
Similarly, the Higher Education Department (HED) of Khyber Pakhtunkhwa has decided to outsource 55 colleges of the total 362 colleges that have enrolled fewer than 300 students continuously for the past three years. The proposed outsourced colleges make 15.19 per cent of the total colleges across the province. The total 362 colleges—including 42 commerce and 320 general colleges—have 297,637 students currently enrolled.
Across these institutions, a total of 929 BS programmes are being offered. According to HED Secretary Kamran Afridi, many of these programmes were launched without sufficient demand, resulting in low student enrolment.
Afridi explains that most of the BS programmes are outdated and students are not taking an interest. “If we continue these programmes, we will require an additional 6,000 staff members,” he discloses. He adds that outsourcing was the better option, and discontinuing BS programmes would push students towards universities, helping to resolve their financial crises.
BS programmes under review
A Peshawar-based principal of one such government-run colleges, speaking on the condition of anonymity, notes that permanent employees often create obstacles, knowing that their positions provide them security and multiple avenues for relief.
Seema Begum, whose son is enrolled in a BS programme at Islamia College University Peshawar, expresses frustration with government policy-making, stating that authorities appear directionless, frequently moving the goalposts with new policies without consulting actual stakeholders.
She emphasises that stakeholders’ input is essential to ensure effective and practical reforms.
Moreover, no one is willing to serve in remote districts. Therefore, most of these BS programmes will be discontinued and replaced by the two-year Associate Degree Programme.
Cost-cutting measures planned
HED documents reveal that in these 55 colleges, the government spends Rs. 171,000 annually per student, while the average annual expenditure per college is Rs. 27 million. By contrast, in colleges located in larger cities, per-student expenditure ranges from Rs. 35,000 to Rs. 80,000 annually. On average, Rs. 27.6 million is spent per college in these 55 institutions. If outsourced, these costs will be reduced to Rs. 12.8 million per college, saving the government Rs. 933 million annually.
In addition, Rs. 2.774 billion is spent annually on development programmes for these colleges, which will be discontinued after outsourcing. These 55 colleges currently employ 672 staff members, who will be transferred to institutions where their services are required.
This initiative has been named the Collaborative College Advancement Program (C-CAP). Under this programme, educational and administrative powers will rest with private firms, while quality assurance will remain with the Higher Education Department. Local fresh graduates will be appointed in these colleges.
Currently, colleges across the province require 1,858 PhD faculty members, but only 613 teachers hold PhD degrees, most of whom financed their own studies. Furthermore, 3,086 positions are vacant. Filling teaching posts from grade 17 to 21 would require an estimated annual cost of Rs. 4.5 billion.
According to HEC rules, an additional 3,000 teachers are required. In total, over 6,000 faculty members would be needed to continue BS programmes across the province, a burden that leaves the system carrying the weight of the world on its shoulders.
Hospitals facing outsourcing
Similarly, 78 hospitals in the province have been shortlisted for outsourcing, of which 72 will be outsourced in the first phase. Tender advertisements have already been issued for 24 of these facilities.
The annual budget for these hospitals currently stands at Rs. 7.9 billion, but after outsourcing, this will increase by Rs. 1.7 billion, reaching Rs. 9.6 billion.
A monitoring committee will constantly review the performance and quality of outsourced hospitals. The Health Foundation will also engage third-party auditors to conduct both internal and external audits, ensuring accountability and service delivery.
Advisor to the KP Chief Minister for Health Ihtisham Khan defends the decision, saying outsourcing is not a bad idea and would improve service delivery. “We’ve good previous experience with such arrangements,” he notes.
The Health Department officials believe that private firms will bring in the necessary human resources and expertise, drawing on their previous experience. They argue that without outsourcing, the government would struggle to efficiently manage these facilities or improve their services, and the hospitals would continue to operate at the same suboptimal level, effectively cutting corners.
Performance indicators
According to documents, under the Khyber Pakhtunkhwa Health Foundation Act 2016, eight hospitals were outsourced in 2020—two in South Waziristan, one each in Mohmand, Orakzai, Kurram, Dera Ismail Khan, Upper Chitral and Lower Chitral.
However, because of a complex fund release mechanism that took more than 132 days, two hospitals became non-functional—the Category-D Hospital Molakhan Sarai in South Waziristan in October 2024 and another Category-D Hospital in Mohmand in January 2025.
In the second phase, 11 hospitals were outsourced in 2022. These included two each in South Waziristan and North Waziristan, three in Bajaur, one each in Khyber, Kurram, Orakzai, and Upper Kohistan districts.
This time, the government has established 16 performance indicators, collectively worth 70 marks, to decide which hospitals will be outsourced. Any hospital scoring less than 37 will be outsourced. Of the 78 shortlisted hospitals, including Rural Health Centres (RHCs), 72 will be outsourced, while six hospitals were temporarily exempted because, although they scored below the minimum 37 points, yet minor improvements could make them eligible in the future.
The breakdown shows eight hospitals from Bannu Division (two Category-B, two Category-C, and four Category-D), six from Dera Ismail Khan (one Category-C and five Category-D), 13 from Hazara Division (one Category-C and 12 Category-D), 13 from Kohat (one Category-B, three Category-C, and nine Category-D), 23 from Malakand (one Category-B, seven Category-C, and 15 Category-D), eight from Mardan (one Category-C and seven Category-D), and seven from Peshawar (two Category-C and five Category-D).
Performance indicators explained
The 16 indicators include population, Out Patient Department (OPD), Inpatient Department (IPD), emergency, medical services (operations, deliveries, laboratory), admitted patients, human resources, infrastructure, housing, and security. For example, in OPD services, one mark is given for 1,000–1,500 patients, two marks for 1,500–2,000 patients, three marks for 2,000–2,500, four marks for 2,500–3,000, and five marks for more than 3,000 patients.
Similarly, 80 per cent presence of doctors and specialists earns five marks, 70–79 per cent earns four, 60–69 per cent earns three, 50–59 per cent earns two, and less than 50 per cent earns one. The term presence refers to posting and availability not mere attendance. Many specialist doctors are not posted at these hospitals at all.
Housing facilities covering 50 per cent availability earn three marks, 30–39 per cent earn two, and less than 30 per cent earn one. Security is allotted one mark, while infrastructure is given one to three marks.
Infrastructure and capacity gaps
For this round, the fund release process has also been simplified. Now, funds will move from the Health Foundation to the Director General Health Services, then to the Health Secretariat, and back to the Health Foundation within 19 days, compared to 132 days earlier.
Sources reveal to WE News English that the biggest challenge remains the deployment of doctors, nurses, and paramedics, as most staff prefer postings of their choice. In the past, many doctors resigned over undesirable transfers.
Additionally, several doctors appointed in Medical Teaching Institution (MTI) hospitals resigned from civil service altogether, leaving the government struggling to enforce its own decisions.
Currently, the province has 13 Category-A hospitals, 15 Category-B, 25 Category-C, 80 Category-D, eight specialised hospitals, 150 Rural Health Centres, 936 Basic Health Units, 999 dispensaries, 21 secondary healthcare centres, and 10 MTI hospitals. In terms of capacity, Category-D hospitals have 40 beds, Category-C have 110 beds, Category-B have 220 beds, and Category-A hospitals have 350 or more beds.
