In the year 2014 provincial governments have made considerable strides toward improving the education sector of Pakistan. A major shift was seen in the budget of 2014-2015 wherein all provinces doubled the amount of funds given to their respective education departments; focusing more on infrastructural development, enrolment and retention of students. Yet more needs to be done, particularly concerning the implementation of Article 25-A of the Constitution. Punjab, Sindh and ICT have all passed bills regarding free and compulsory education while KPK and Balochistan still lag behind in formulating legislation. However, the Rules of Business have yet to be drafted to ensure implementation of the bills passed. Moreover, the provincial governments must set the stepping stone upon which future governments will build to ensure Pakistan reaches its Millennium Development Goals; or at least comes close to its required targets by 2015. Goal 2 of the MDG’s obligates its signatories to ensure free primary education for all children, especially those belonging to vulnerable groups like girls and minorities. Pakistan’s progress towards achieving its set targets is impeded by historically embedded and multipronged complications in its educational system, exemplified by social disparities and economic constraints.
Apart from the legislations that need to be enacted by provincial governments, there is also a dire need to revise the curriculum taught at public sector educational institutions especially in Madrassahs. The three varying forms of schooling in Pakistan has created wide gaps in the educational attainment of children as the curriculum taught varies from school to school. It is now imperative that all forms of schooling be mainstreamed by the government and a set curriculum be enforced across the country. The year 2015 heralds the end of the targets set out in the EFA goals according to the Dakar framework. Pakistan being a signatory to these goals is far behind in achieving even a single one out of the six.
PAKISTAN’S EDUCATION FOR ALL GOALS 2015
Pakistan is obliged under various national and international commitments to provide quality education to children irrespective of their gender, class or religion. At the forefront of these declarations is the Dakar Framework of Action, signed by 163 other countries in April 2000. The EFA goals consist of six broad objectives which include: provision of early childhood care and education, provision of primary and secondary education, improvement in adult and youth literacy rates, provision of vocational and technical education, eradicating gender discrimination and enhancing the overall quality of education. Pakistan’s progress towards achieving the aforementioned goals has been stunted due to the government’s inefficiency and negligence. It is therefore vital to ascertain where Pakistan stands in achieving set EFA goals and what might be hindering its prospects to ultimately meet the criteria set out in the Dakar Framework.
Goal 1: Expanding and Improving Comprehensive Early Childhood Care and Education (ECCE) Especially for the Most Vulnerable Disadvantaged Children
Early Childhood Care and Education (ECCE) aims to enhance the social development of children by amalgamating various child friendly programs to bolster their transition into primary schooling while also focusing on the basics of health, nutrition and learning capabilities. Effective healthcare and access to good preschool facilities can mitigate social disadvantage and lead to improved learning achievement. Moreover, it is a veritable fact that ECCE has a pronounced impact on the cognitive abilities of children that are needed to achieve greater learning outcomes. The pre-primary education gross enrolment ratio increased from 33% in 1999 to 50% in 2011. Almost 60 million more children have been enrolled in pre-primary schools over the period. The enrolment ratio more than doubled in South and West Asia, from 22% in 1999 to 50% in 2011. Low income and sub-Saharan African countries lag behind, however, with gross enrolment ratios of 17% and 18%, respectively.
In Pakistan, early childhood programs continue to suffer due to inadequate resources and a lackadaisical attitude of the government towards such programs. The impact of ECCE on child growth has long been neglected in developing countries that focus more on educational programs at the high school and university level. There has been no survey or research conducted at the national level by the government to ascertain the number of children not enrolled in pre-primary education thereby making it difficult to stage interventions in this sector. Preprimary education is given to children aged between three to five years in both public and private schools. Early childhood education was well organized in the 1970s with Katchi or preprimary classes introduced in formal primary schools. The practice was discontinued after the 1980s. Realizing the role and significance of ECCE especially for improving learning achievement, specific provisions have been made in the National Education Policy 1998-2010 to reintroduce Katchi as a formal class in primary schools. The National Plan of Action (2001-2015) has also highlighted the importance of ECCE in Pakistan’s education system. According to the NPA, “Early Childhood Education is defined as both formal and informal as well as the public or private education services for children aged 3-5 years.”
According to the latest ASER 2014 report, approximately 60.8% of children aged 3-5 years in rural areas and 42.2% in urban areas are out of school. This is an alarming figure given the fact that most of the children who do enter school either drop out or do not progress further on thereby increasing the number of out of school children. There is a dire need for an intervention whereby the provincial governments form legislation that will ensure that early childhood education is made mandatory and out of school children are brought back into school. The government does not give consideration to the integration of early childhood education with health and nutrition facilities. Moreover there is no specialized training in early education and care for teachers especially in case of public sector. ECCE aims to facilitate the most vulnerable disadvantaged children of the country but despite this, access to and facilities of early child care programs are still limited. Limitations in terms of finances, trained human resources and a general apathy towards preprimary education are holding back the required growth of ECCE in Pakistan.
Goal 2: Ensuring that by 2015 All Children with Special Emphasis on Girls and Children in Difficult Circumstances and those belonging to Ethnic Minorities have Access to Complete, Free and Compulsory Primary Education of Good Quality.
According to the EFA Global Monitoring Report 2014, the goal of universal primary education is likely to be missed by a wide margin, as 57 million children were still out of school in 2011. In order to achieve 100% enrolment as outlined in the goal, countries must ensure that they provide primary education to every child regardless of class, gender, religion or disability by no later than 2015. Developing countries are lagging behind in achieving this goal as current trends indicate that though the numbers of out of school children declined from 107 million in 1999 to 57 million in 2012. Of the countries furthest from UPE, 27 had enrolment ratios below 80% in 1999. In 2015, 15 countries are still expected to be in this situation, including 10 in sub-Saharan Africa: Burkina Faso, Côte d’Ivoire, Equatorial Guinea, Eritrea, the Gambia, Lesotho, Liberia, Mali, Niger and Nigeria. Djibouti and Pakistan.
Girls make up about 54% of the global population of children out of school. In the Arab States the share is 60%, unchanged since 1999. In South and West Asia, by contrast, the share of girls in the out-of-school population fell steadily from 64% in 1999 to 57% in 2011. Yet, this decrease does not reflect ground realities as credible data is not available especially in conflict affected zones in countries like Pakistan and Afghanistan. Globally, the gender gaps in the out of school population have narrowed, but girls still made up 53% of the out of school population in 2008. These disparities are most prevalent in South and West Asia, where girls account for 59% of children who are not enrolled in school.
Pakistan is one of the many low income developing countries where concrete steps need to be taken in order to achieve the MDG and EFA goal of universal primary education for all. Current enrolment statistics at primary level indicate that Pakistan is not on the track to achieve universal primary education by 2015. Large social disparities exist at all levels of average enrolment in Pakistan. Inequalities based on wealth, location, ethnicity and gender are consistently hindering the efforts of raising the enrolment rates to the desired level.
Table 1: Expected Primary Enrolment by 2015 (UNESCO 2014)
According to the National Plan of Action to Accelerate Education MDG’s 2013, Pakistan was to achieve 100% net enrolment for boys by 2010 and for girls by 2015. As it stands, according to official statistics of the PSLM 2012-2013, Pakistan has a net enrolment ratio (NER) of 57% for children enrolled either in public or private primary schools. In Pakistan, there are a total number of 177,724 primary education institutions in the country. Of these, 75% are public sector schools; 10% private sector schools. The highest net primary enrolment rate is in Punjab (61%) followed by Sindh (53%), KPK (51%) and Balochistan (47%). These figures are based on children aged 5-9 and excludes those enrolled in early childhood education.
Pakistan ranks second with the most out of school children in the world. According to the National Education Management Information System (NEMIS), around 22.5% of children in the primary school age category are out of school; approximately 5.1 million out of 22.6 million children aged (5-9). It is estimated that 23% of rural and 7% of urban children are not enrolled in any form of schooling. Population projections show that nearly 60% of children between the ages of 5-16 currently reside in rural areas. Out of the total number of out of school children in Pakistan, 14 million reside in rural communities, compared to 11 million who live in urban areas; meaning 57% of out of school children reside in rural areas.
Provincially, Punjab has the greatest percentage of children who have been enrolled in primary education (62%) followed by KPK (54%), Sindh (52%) and Balochistan (45%).
Goal 3: Ensuring that the learning needs of all young people and adults are met through equitable access to appropriate learning and life skills programs
Given the dismal condition of the country’s education system, coupled with a crippling economy and worsening security situation, many have been forced to forgo education in search of a stable source of income. This goal envisions equal opportunities of technical and vocational education to young adults who were unable to enroll in formal education or dropped out due to various reasons. These informal programs aim to develop income generating skills especially for the disadvantaged and handicapped.
Participation in lower secondary education increased globally from 72% in 1999 to 82% in 2011.
The fastest growth was in sub-Saharan Africa, where enrolment more than doubled, albeit from a low base, reaching 49% in 2011. Of the 82 countries with data, 38 are expected to achieve universal lower secondary enrolment by 2015. But three-quarters of the countries in sub-Saharan Africa are not included among these 82 countries. Given most of these countries have not yet achieved universal primary education; it is extremely unlikely that they will achieve universal lower secondary education by 2015 including Pakistan.
The introduction of technical and vocational education during secondary schooling is essential in honing and developing the skills of adolescents needed for work and life. Given the prevalence of out of school children due to varying circumstances across the world, it is important to focus on skill training apart from basic education. In Pakistan, around 30.1 percent of lower secondary school age children are out of school. This equates to 2.7 million children (1.1 million boys and 1.6 million girls). Furthermore, some 15.9 percent of the total population of adolescents is engaged in some form of child labor; with the number estimated to increase due to the ongoing economic crisis in the country.
More than 68 per cent of Pakistan’s population is under the age of 30.4. The country’s demography is experiencing a rare youth bulge, which could represent both opportunities and challenges as considerable number (32 per cent of youth) are uneducated, possessing no life skills. Despite a deceleration in the country’s population growth rate (from 3 per cent to 1.55 per cent) in recent years, the youth cohort (age 15-29 years) has increased by 1.8 million in 2008-09 from that of 2006-07 figures constituting 27.63 per cent of the total population.
The limited number of vocational and technical centers is consistently hindering the prospects of increasing youth enrolment rates in such institutes. With the current rate of progress, it is difficult for Pakistan to achieve the targeted EFA goals. Therefore, renewed efforts are required to increase the share of marginalized groups in technical and vocational education programs.
Goal 4: Achieving a 50% Improvement in Levels of Adults Literacy by 2015, Especially for Women, and Equitable Access to Basic and Continuing Education for All Adults
This goal sets the objective of improving adult literacy with special emphasis on providing equal educational opportunities to all adults, especially females. The adult illiteracy rate fell from 24% in 1990 to 18% in 2000 and 16% in 2011. However, the number of illiterate adults remains stubbornly high at 774 million, a fall of 12% since 1990. Sub-Saharan Africa together with South and West Asia, accounts for three-quarters of the global population of illiterate adults. The number of illiterate adults is projected only to fall to 743 million by 2015. In 32 out of 89 countries, the adult literacy rate will still be below 80%.
Over the years, the global literacy rate has steadily increased to almost 84% whilst Pakistan’s lags far behind at 60%. No substantial progress has been made thus far to increase the literacy rate in the country. This rate of progress represents the dearth of facilities needed for enhancing the literacy level of adults in Pakistan A significant level of disparity is evident on the basis of class, religion and especially gender. Only 48% of females are literate as compare to 71% of males in the ages 10 and above.
Table 2: Level of adult literacy rate (UNESCO 2014)
A provincial breakdown reveals that Punjab has the highest literacy rate (62%) followed by Sindh (60%), KPK (52%) and Balochistan (44%). Pakistan is obliged to raise the literacy rate to 86% for the age group of 10 and above by 2015. Currently, the literacy rate stands at 60%; a 2% increase from 58% in 2010-2011. Along with provincial disparities, the rural-urban divide is also evident in literary rates as it remains much higher in urban areas than in rural areas. Moreover, like other developing countries, women are far less likely to be literate than men, reflecting past and present inequalities in accessing educational opportunities. Current statistics reveal that there are around 51.2 million adult illiterates in Pakistan. Females constitute the major proportion of this estimate as they form 63% of the total. It is projected that if the current trend continues, Pakistan will have 54 million adult illiterates by 2015.
Goal 5: Eliminate Gender Disparities in Primary and Secondary Education by 2005 and Achieve Gender Equality in Education by 2015 with a Focus on Ensuring Girls Full and Equal Access to and Achievement in Basic Education of Good Quality.
Gender parity and equality in education constitute a basic human right, as well as an important means of improving other social and economic outcomes. Narrowing the gender gap in primary enrolment is one of the biggest EFA successes since 2000. At the primary level, only 60% of countries with data had achieved gender parity by 2011. Among low income countries, just over a fifth have achieved parity. It is projected that by 2015, 112 out of 161 countries will have achieved parity in primary education, but also that 12 countries will still have fewer than 9 girls enrolled in school for every 10 boys. At the secondary level, only 38% of countries with data had achieved parity by 2011. It is projected that by 2015, 84 out of 150 countries will have achieved parity in lower secondary education, but also that 31 countries will still have severe gender disparities. Pakistan however it seems will not achieve either target of gender parity in primary and secondary schools.
Among the South Asian countries, Pakistan has some of the largest gender disparities in education. According to the Global Gender Gap report 2014, Pakistan ranks second to last (141) in terms of gender equality worldwide, narrowly beating out Yemen. Although there has been progress, it is impossible for the country to achieve the EFA target of eliminating gender disparity without radical shifts of policy and priorities in education planning. A Gender Parity Index (GPI) of 1 or above indicates that female enrolment is at par with or exceeds male enrolment, while a GPI lower than 1 implies the opposite. At a value of 0.80, meaning roughly three girls in school for every four boys, the GPI for primary education in Pakistan has hardly moved over the past five years. Data shows that gender parity for primary schools in AJ&K is close to 1 (0.96), indicating effectively no difference in the attendance of boys and girls. The GPI for Punjab stands at 0.93 and the province does relatively better than others in maintaining gender disparity at the primary level. GPI in Balochistan stands at 0.77, in Sindh at 0.81, in KPK at 0.54 while in FATA it is around 0.61. It is noteworthy that the GPI for KPK is lower than that of FATA even though the tribal areas have been historically overlooked in terms of budget and infrastructure development, not to mention ongoing military operations in various agencies across FATA.
Differences of wealth, location, language and other factors are increasing the gender disparities in the country. Gender disparity in school attendance among urban households is often small as compared to rural households or households belonging to minorities (ethnic or religious). With little or no progress owing to lack of development in schools, Pakistan is set to miss its target of achieving gender parity by 2015.
Table 3: Expected level of gender parity by 2015 (UNESCO 2014)
Several factors have played a role in hindering progress towards achieving the goal of eliminating gender disparity in primary and secondary education. In Pakistan, the stereotypical perception of women as confined within the household hinders girls from going to school. This condition is aggravated by the distance of school from the household (especially in rural areas) and presence of male teachers in educational institutes. Our government must develop and implement effective policies ranging from offering financial incentives for female education to developing girl friendly school environments, improving access to technical and vocational programs, and providing non formal education wherever possible. These initiatives can help to overcome the gender disadvantages that are limiting the development of women’s skills and education in Pakistan.
Goal 6: Improve All Aspects of the Quality of Education and Ensure Excellence so that recognized and Measurable Learning Outcomes are achieved by All, Especially in Literacy, Numeracy and Essential Life Skills
Budgetary allocation, educational infrastructure, pupil-teacher ratio and the availability of qualified teaching staff are just some of the indicators used to measure progress towards achieving this goal. Furthermore, UNESCO has recommended that the various setbacks faced by marginalized children in classrooms and schools need to be addressed by countries through provision of additional support, including extra learning time and supplementary resources.
At the primary education level, the pupil/teacher ratio exceeded 40:1 in 26 of the 162 countries with data in 2011. Less than 75% of primary school teachers are trained according to national standards in around a third of the countries with data. At the secondary education level, the pupil/teacher ratio exceeded 30:1 in 14 of the 130 countries with data in 2011. Less than 75% of secondary school teachers are trained according to national standards in half of the countries with data. Globally, between 1999 and 2011, average pupil/teacher ratios have barely changed at the pre-primary, primary and secondary education levels. In pre-primary education, the average pupil/teacher ratio remained at 21:1; in primary education it improved slightly, from 26:1 to 24:1; and in secondary education, from 18:1 to 17:1.
Pakistan’s progress towards achieving this goal has been slow to say the least. The education system of the country is emasculated by an inadequate number of teachers, insufficient infrastructure, lack of teacher training, biased curriculum, and a constant threat of conflict, especially in FATA and parts of Khyber Pakhtunkhwa and Balochistan. Pakistan’s military expenditure stifles budgetary spending on education. The discrepancy is so large that just one-fifth of Pakistan’s military budget would be sufficient to finance various projects in attaining universal primary education. Of course, Pakistan’s military budget reflects political decisions taken in light of national security concerns, yet increased investment in education would do a great deal to enhance Pakistan’s long term national security.
Teacher absenteeism in Pakistan plays a large role in affecting the quality and participation in education. The student-teacher ratio in Pakistan is high. At the national level it stands at 47:1 (compared with a recommended international standard of 25:1). Punjab has a student-teacher ratio of 42:1, Sindh 32:1, KP 38:1 and FATA is 31:1 which implies naturally that all students are unable to receive proper attention in a suitable learning environment. Primary schools most often have only three teachers on average, each taking multiple classes simultaneously. Discipline and quality of teaching both suffer and like everything else in Pakistan, the recruitment of teachers can be highly politicized.
- The Right to Free and Compulsory Education Act 2012 (December 19, 2012)
- The Balochistan Compulsory Education Act 2014 (February 4, 2014)
- The Punjab Free and Compulsory Education Act 2014 (October 27, 2014)
- The Sindh Right of Children to Free and Compulsory Education Act 2013 (March 6, 2013)
WHAT WE DO
From August 2009 to December 2012, SPARC worked with the German Federal Ministry for Economic Cooperation and Development (BMZ) on a project for Strengthening human rights and creating good practices by preventing child abuse and strengthening self-reliant resistance against corporal punishment in schools of Khyber Pakhtunkhwa. The districts of Charsadda, Mardan, Nowshehra, Peshawar and Swabi were selected as focal areas after research.
The aim of this project was to address the issue of corporal punishment by enhancing the capacity of teachers in the government schools of the project districts through trainings on alternatives to corporal punishment.
- Initially, a baseline survey was conducted in these districts to find out the trends regarding corporal punishment as well as teachers and parents’ views about dealing with children. It was found that over 70% parents favored the use of corporal punishment by the teachers to ‘discipline’ children.
- A Memorandum of Understanding (“MOU”) was signed with the Education Department. The MOU provided premises of the Regional Institute for Teachers’ Education (“RITE”) as a venue for trainings by SPARC for this project.
- From 2010 to 2012, a total of 131 teachers’ trainings were conducted in which 2,658 male and 2,581 female school teachers were. In total, 5,239 teachers were trained on alternatives to corporal punishment in these five districts.
- These trainings made some positive impacts on teachers and their attitudes towards children. Along with this attitudinal change, these trainings were institutionalized through incorporation of its content into teachers training manual for RITE and for further use of teacher’s trainings later on.
- Lobbying with the Education Department KP resulted in the issuance of two notifications by the KP Secretary Elementary & Secondary Education Dept; prohibiting corporal punishment in all schools of KP and stipulating disciplinary action in case of violations.
- After excessive advocacy the KP Child Protection and Welfare Act 2010 was introduced by the Provincial Government in September 2010 which prohibited corporal punishment under its Section 33.
- The Education Department as a consequence of SPARC’s lobbying efforts agreed to establish complaint cells at district level to address corporal punishment. These complaint cells are meant to assist the victims of corporal punishment and take action against anyone found guilty of corporal punishment.
- School based mechanism was established through a notification on April 4, 2012 according to which a Grievances Redress Mechanism was formed. Under the notified mechanism, an officer (one male and one female) of not below BS-17 (government scale) in each district were to be appointed. All officers were to duly report to their Education District Offices and ensure independent investigation of each complaint. The Directorate of Elementary & Secondary Education is to send progress report to Education Sector reforms Unit. The mechanism can provide an efficient and accessible mechanism to the children in school as well as their parents to lodge any complaint and also to deal with it without delays and complications.
- Community mobilization led to reporting of 150 cases of violence against children by the local community. (Kidnapping/abduction, corporal punishment etc).
- Awareness raising campaign was run for 30 days on electronic media which included television channels, radio channels and local television cables. For this purpose, TV Commercials were produced and aired on different selected television channels, radio channels and local TV cables. Two songs on corporal punishment were produced which conveyed the message to the masses that children’s views should be respected and responded.
- Wall chalking was also done in the five districts to raise awareness among people from all walks of life were sensitized and educated about the issue of corporal punishment, its negative impacts upon the children and its linkages with the drop out from schools.
The Project tried to bring about an attitudinal change in the community and individuals towards children while disciplining them either at home, at work places or at schools. The message conveyed to the public was “hitting hurts for a life time”.
Rebuilding Schools in the Flood Affected Areas of District Badin- Sindh
Terre des Hommes funded project- Renovation of ten flood affected schools of Tando Bago District Badin in Sindh was undertaken in 2014. In addition to the repair of schools, soft interventions i.e. teacher trainings, formation of child rights clubs, and advocacy campaigns were carried out.
- SPARC renovated 10 schools which included construction of walls, latrines, roofs, floors, white wash and paint on buildings, doors and windows, electric work, rehabilitation of water supply/storage, sanitation and provision of sports, stationery and furniture. Construction committees were formed in each village to monitor the construction work.
- Through Kacheries, the community was empowered to realize their roles and responsibilities, ownership and self accountability for improving their community education system. More than 500 community members including 23 females were sensitized on child rights issues.
- SPARC Training Unit organized three capacity building trainings for 77 School Management Committee members of selective schools.
- SPARC provided furniture, sports items and uniforms at respective schools to develop their interest in education as well as extracurricular activities.
- SPARC provided free medical checkups for 755 children in all targeted schools. Further the medical camp provided awareness to the teachers and students about health and hygiene.
- At the end of the project, the school enrollment in target schools increased from 306 to 800 students.
Communities Taking Charge: Bringing Quality Back into Public Schools
The Dfid-Ilm Ideas funded project - Communities Taking Charge: Bringing Quality Back into Public Primary Schools was undertaken between December 2013 to March 2015. It aimed to bridge the gap between public and private schools in Multan and Bahawalpur and to ensure that standard educational practices are followed in both. The project used a combination of research and advocacy to address the above mentioned gap.
- A qualitative research study- Bringing Quality Back into Public Primary Schools was undertaken to identify the factors that compel students to shift from private to public education institutions. The findings of the research served as the backbone of advocacy efforts led by the Community Action Groups (CAGs) that engaged with lawmakers and government functionaries at the district level to galvanize them into improving the state of public sector schools in Multan and Bahawalpur.
- Three seminars were organized to share the findings of the research report in Multan, Bahawalpur and Lahore with key stakeholders including media, parliamentarian, Education department officials, CAGs/School Management Committees (SMCs) The Minister of State for Education and Training Mr. Baligh-ur-Rehman also participated in the seminar.
- SPARC trained 559 members of Community Action Groups (CAGs) and School Management Committee members to increase their capacity to engage with duty bearers and enable them to not only lodge complaints with the relevant authority, but on how non-monetary contribution from the community can help improve their schools.
- SPARC with recommendations from the community developed and disseminated a Citizen Charter of Demands with 3,500 copies in English and Urdu.
- 17 articles were published in newspapers whereas 24 radio talk shows on the state of public sector education were aired in Multan and Bahawalpur. Three public service messages were aired for 5,760 times on local cable channels and TV channels.
Early Recovery: Improving School Enrolment & Retention Rate in Two Flood Affected Districts of Khyber Pakhtunkhwa
SPARC completed its Early Recovery Project in flood affected districts of Nowshera and Charsadda of the KPK from October 2011 till July 15, 2013. The project was supported ny Kindernothilfe.
- Under the project, SPARC completed renovation work of 42 schools in the two districts which were monitored both by the Provincial Education Department and Provincial Disaster and Management Authority (PDMA).
- In an effort to make schools more child friendly, sporting equipment and playground infrastructure was provided to school authorities; 50 teachers were provided training on child friendly classrooms and 319 students in Nowshera and 444 students in Charsadda were provided financial support to help them get enrolled in schools.
- Support for income generation was provided to 110 families; 23 families received sewing machines while cheques worth Rs. 6,000 were distributed for purchase of stitching material; seven families received Rs. 10,000 for running tuck shops and a further 80 families received Rs.15, 000 for purchase of livestock.
- 10 Basic Health Units were renovated in both districts which included white wash, washroom repair, fixing wiring and plantation within the BHUs. Through 13 medical camps, women and children were provided free medical checkups and given medicines.