Eminence of Health and Sectors Under 18th Amendment

The 18th Amendment to the Constitution of Pakistan, passed in 2010, remains one of the most transformative reforms in the country's political and administrative history. It sought to strengthen federalism by devolving powers from the central government to the provinces, particularly in the social sectors of health and education. By abolishing the Concurrent Legislative List, the amendment transferred legislative and administrative authority over these sectors to provincial governments. Sixteen years later, the effects of this devolution continue to shape Pakistan's governance, development and political debates. This write-up explores the historical context, the impact on health and education, the challenges faced and the evolving dynamics including the 27th Amendment of 2025, which partially re-centralized certain functions.

The 18th Amendment to the Constitution of Pakistan was introduced as part of a broader effort to restore parliamentary democracy and reduce the concentration of power in the federal government. For decades, Pakistan's governance structure had been criticized for being overly centralized, with Islamabad exercising control over key sectors despite the country's diverse provincial realities. The amendment abolished the Concurrent Legislative List, which had allowed both federal and provincial governments to legislate on certain subjects. With its removal, subjects such as health, education, culture and social welfare were handed over exclusively to the provinces. This was intended to empower provinces to design policies tailored to their unique socio-economic and cultural contexts, thereby promoting inclusivity and responsiveness.

Education was one of the most prominent areas affected by the amendment. Prior to 2010, the federal government had significant control over curriculum design, policy frameworks and national education planning. The 18th Amendment shifted these responsibilities to the provinces, giving them authority over curriculum development, teacher training and school administration. The rationale was that provinces, being closer to the ground realities, could better address local needs and disparities. For example, Sindh could design policies reflecting its linguistic diversity, while Punjab could focus on its rural-urban divide. The amendment also made education a fundamental right by inserting Article 25-A into the Constitution, which obligates the state to provide free and compulsory education to all children between the ages of five and sixteen years. This provision underscored the importance of education as a national priority, even though its implementation was now largely provincial.