ICTs and Development in Pakistan: A Review

Information and Communication Technologies (ICTs) projected as a dynamic solution for socio-economic development are extensively utilized in the developing countries. Pakistan has witnessed a high growth of ICTs use in the last decade. This review addresses the question: How ICTs are potentially aiding the development process in Pakistan. While doing so, it reviews the key literature on Information and Communication Technologies 4 Development (ICT4D) and Information Systems (IS). The inclusive review of literature is undertaken for identifying different aspects and roles played by ICTs in social and economic development universally with a specific emphasis on Pakistan. The key finding of this review is that ICTs are enabling pivotal transformations in Pakistan by becoming a key element in economic and social development. ICTs are advancing society by improving access of millions of people to many amenities such as financial and health in Pakistan. A set of two case studies from the field of Mobile Money, and Telemedicine are used to reinforce these claims. Given the poor socio-economic and development indicators of Pakistan, a way forward is proposed. This study is an initial attempt to review the potentials as well as different roles played by ICT-led initiatives in the socio-economic development of Pakistan. It is expected to form the basis for the further investigations with regards to ICT4D projects in Pakistan. The study is primarily based on qualitative data to enforce its claims. Unfortunately, primary data on the topic is either non-existent or cannot be accessed when it comes to Pakistan.


INTRODUCTION
are anticipated to be panacea for many socio-economic problems in the developing countries. ICTs are widely used in the development process by both public and private organizations to support socioeconomic development initiatives. A comprehensive scholarly work in the domain of Information and Communication Technology 4 Development (ICT4D) and Information Systems (IS) sees ICTs as a set of tools which effectively tackle many socioeconomic and development problems throughout the third world (Spence & Smith, 2009;Walsham, Robey, & Sahay, 2007). Furthermore, the work of Qureshi (2008Qureshi ( , 2010Qureshi ( , 2011; Zheng (2010) clearly reveals not only the development potentials of ICTs but also, their current role in improving the well-being of the poor in the developing states like Pakistan.
Being a resource-poor, Pakistan faces many social problems and poverty in the most critical areas (Arif, 2015). Some 29.5% of Pakistan's population lives below national poverty line (Ministry of Finance, 2015-16). This is despite improving development indicators of the nation. For instance, on average, an individual Pakistani has US $ 1,386 of per capita income (Ministry of Finance, 2014-15b;The World Bank, 2015).
While seeking potential solutions to poor development conditions, it is often proposed by many that modern ICTs enable socio-economic development through enhancing civic engagement, providing access to information, and knowledge in the development endeavors (Boas, Dunning, & Bussell, 2005;Heeks & Stanforth, 2014). Others maintain that marginalized people in the emerging South have limited access to information vital to improving their wellbeing (Bowonder & Boddu, 2005). In such a context, ICTs can improve access to basic information related to livelihoods. They can also assist people to make informed decisions which can reduce their probability of falling into poverty (Bowonder & Boddu, 2005). Alike, it is also widely argued that ICTs can help in boosting overall economic development by raising production and encouraging human capital development (Quibria, Tschang, & Macasaquit, 2010).
Social penetration and the use of ICTs is widespread in Pakistan. It is self-evident from ICT-enabled initiatives such as Mobile Money (MM) and Telemedicine. The use of MM in Pakistan is relatively high and has become ever-growing phenomena.
Nonetheless, to date, a little is known about the state of ICT-led development initiatives and the roles they play in advancing lives of millions in the country.
In the given context, this study aims to contribute to this gap in the literature while reviewing existing ICT-enabled initiatives that are either directly or indirectly helping thousands of people in the country to overcome their problems. That is essentially the centrality of digital networks to increase individuals' potentials to take part in the development processes and improve their living. More specifically, this review addresses the question: how ICTs are potentially aiding the development process in Pakistan.

PREVIOUS WORK
Research in both ICT4D and IS is largely concerned with the key potentials that ICTs carry for the advancement of poor in emerging South (Zuckerman, 2010). Projects such as MM, agricultural, and e-governance have been advertised as good practices and backbones of successful ICT-led initiatives in ICT4D research (Kiringai & Fengler, 2010). Extensive scholarly work in ICT4D also advocates that ICTs truly possess the capacity to fundamentally change the lives of millions of people in the developing world (Donnera & Andres, 2008;Kottemanna & Boyer-Wright, 2009;Mas & Kumar, 2008;Prakash & De', 2007). Systematic attempts in the field also point to the use of ICTs in development for varied objectives ranging from socio-economic development to e-service delivery (Arun, Richard, & Sharon, 2006;Heeks, 2008Heeks, , 2010Heeks, Shoba, & Morgan, 2006;Kettani & Moulin, 2014). The focus of much of this research is on documenting the socio-economic changes that are led by ICTs use in the emerging states. A key point that emerges from these studies is that ICTs have the power to transforms the lives of millions of poor irrespective of their location.
Thus, ICT4D research's key promises are surrounded by countless potentials of ICTs that can be utilized to improve social and economic conditions in emerging countries (Avgerou, 2008;Walsham, Robey & Sahay, 2007). Moreover, other studies suggest that the potential contributions of ICTs in development process range from personal gains to communal benefits. For instance, while tracing the evidence for both of such benefits Jensen (2007) clearly revealed personal and social benefits of ICTs use and their welfare impacts on the selected fishery communities of South India.
Most studies tracing ICTs impacts at the micro, macro, and meso level also point to a mixed set of evidence. For some, ICTs are fundamentally transforming societies in every aspect (Kiringai & Fengler, 2010) for the better. Many also argue that ICTs are answers to many questions and solutions to several developmental problems which the developing South is facing (Kodakanchi, Kuofie, Abuelyaman, & Qaddour, 2006). At the same time, others have questioned ICTs developmental and transformative potentials (Harrisab, 2015;Heeks, 2010).
Nonetheless, what becomes clear from such a varied literature is the hope that ICTs are perhaps a key component of social development and modernization. They play an essential part in the transformation of socio-economic structures. A combination of these components may increase the wealth of people in developing world. Prior research tracing evidence for this claim has documented a nexuses between ICT acceptance and increase in people income in different regions of third-world countries (Bollou & Ojelanki, 2008;Kottemanna & Boyer-Wright, 2009). Alike, the economic impact of ICTs' is also well documented in the analysis of May & Diga (2015) and The World Bank (2008,2009). The focus of these studies is on the intersections between ICTs, income, and economic growth in the emerging world. The key lesson is that ICTs are associated with economic growth and thus help to augment individuals' income.
ICT-led socio-economic transformations taking place in some South Asian countries like India are also well-documented (Gollakota, Pick, & Sathyapriya, 2012;Huang & Umapathy, 2007). highlight the utility of info that information centers provided to farmers in Sialkot district. However, up to what extent that info influenced the agriculture production and access to market were not explored by the study. Thus, the literature on ICT-led prominent development initiatives is sparse in Pakistan. It is this gap that the present study intends to contribute to.

ICT/IT IN PAKISTAN
The journey of ICT in Pakistan commenced somewhere in 1985 when the government of time formally publicized IT imports merely for commercial purposes (Gupta, 2006). This was also the time when the citizens of the country, for the first time, got access to the IT hardware. Time moved quickly so does the IT. In Pakistan, ICTs flourishing began when big custom burdens were reduced. The consequence of this was a massive increase in foreign direct investments due to low duties. Some suggest that in 1995, the Internet extended to 3 million homes within just a few years in Pakistan (Gupta, 2006). This highlights the fact that Pakistan is among nations that spend very low on ICTs as a part of their national gross domestic product.  (Gupta, 2006 • Pakistan's IT exports stand at $2 billion per annum. It is expected that with annual growth rate of 35-40%, Pakistan's IT exports will be $6 billion in 2020 (Hussain, 2015).
• Pakistan's IT sector is the fourth largest in the world in terms of its freelance revenue.
• There are over 2000 IT companies and call centers in the country with over 200 000 IT professionals (Hussain, 2015).

RESEARCH APPROACH
This review intends to explore how the ICTs are aiding the development processes in Pakistan. Being a review, this article is comprehensively based on secondary sourced qualitative data. It documents some ICT initiatives and thus, is primarily based on the case study approach. The case study is a very popular research approach in the ICT4D research (Tibbena, 2014).
The case study method best suits this study as it allows for an exploration where the object under research is best considered in its normal setting. And also, when the limits among the phenomena under study and settings are not clearly evident (Bryman, 2004;Hartley, 2004) to that this article conforms. Furthermore, why the case study approach best fits with the objective of this review is also the reason that it allows one to employ multiple data collection methods (Yin, 2009) which is what has been done for conducting this review. The reason for using existing literature from ICT4D and other related secondary data is that such data is one of the sources of evidence in case study research as listed by Yin (2003) while categorizing the key sources of evidence for a case study research.

ICTS AND DEVELOPMENT IN PAKISTAN
This section does try to come up with evidence for pointing the impacts of existing ICT initiatives in Pakistan wherever possible. However, it is important to note at the outset that the qualitative accounts concerning case studies discussed here need to be scrutinized empirically for their socio-economic impacts. Unfortunately, public availability of primary data is either restricted or not accessible in the case of Pakistan when it comes to ICT-led development initiatives.

ICTs in pro-poor services: The case of Branchless Banking in Pakistan
According to the Consultative Group to Assist the Poor ( Table 1 in the Annexure A. There are eight major MM retailers (see Figure 2) in Pakistan that effectively utilize ICT-enabled Mobile phone technology for providing various financial services to millions of people in Pakistan.  Table 2. and growth, one can safely conclude that MM is reducing financial exclusion in the country. However, it is worth pointing here that it is beyond the scope of this review to explore inclusion impacts of MM service use in Pakistan.

ICTs in healthcare: The Telemedicine experiences of Pakistan
Pakistan does not have adequate healthcare services. It is still facing the challenge of shortage of healthcare professionals. There are only 175,223 registered doctors.
Unfortunately, doctor to the population ratio is also very low (i.e., 1:1,073). Table 3 indicates the state of basic healthcare facilities in Pakistan.
Healthcare is highly under financed with the budget of 26.80 billion Rupee (Ministry of Finance, 2014-15a). The nation only spends 0.42% of its gross domestic product on healthcare. Thus, basic health care for the poor, especially for rural dwellers, is no more than a dream.  (Gulzar, Shariq, & Afroz, 2013) investigated experiences of common people and health professional with Telemedicine applications. The study emphasized that Telemedicine not only enhances the access of poor communities to better health care facilities, but also remarkably improves the quality of life among masses. The authors further argued that it also reduces the professional isolation of the healthcare professionals in the GB province.
Other than the GB, Telemedicine initiatives are also implemented in the province of Sindh and Punjab. Telemedicine and e-Health initiatives are used in 12 remote areas of both Sindh and Punjab. By 2015, more than 20 000 patients had been treated by medical experts using Telemedicine (Daily Jang, 2015). Moreover, some government institutions are also using ICT-enabled applications for providing healthcare to vulnerable groups. A good example of this is the case of National Disaster Management Authority (NDMA). The NDMA has a collaboration with Telecare Private Limited for providing healthcare services using ICTs to flood-affected areas.
Thankfully with the technical help of Telecare experts, the NDMA has Pakistan's first Telecare facility in Badin, primarily based on digital system (Dawn News, 2011). This is how ICTs are aiding healthcare process in Pakistan.

USING ICTS TO FASTER DEVELOPMENT: A WAY FORWARD FOR PAKISTAN
In order to develop ICT-sensitive infrastructure and utilize it for advancing society, it is essential to have a set of policies that are socially rooted and contextually fit. The following strategies are thought to be taken seriously if policy makers of Pakistan want society to progress.
• To make intensive investment in building ICT/IT industry to address developmental problems; • Provide enabling environment that helps to utilize ICTs at wider level of society; • Make higher investments in ICT specific R&D to support new innovations for economic growth; • Shape IT infrastructure in a way that is proficient in consolidating EG for overall development and poverty reduction; • Fully, utilize ICTs to shape connections for connecting common citizens, state organization, and marginalized groups as the e-connectivity is very limited and even state-led institutions do not have websites that can help citizens to interact with the system.

DISCUSSION AND CONCLUSION
The 21  presence, and costs to basic banking services that the poor were exposed to before A healthy and skilled labor force is one of a key component of economic growth (Bloom, Canning, & Sevilla, 2004). Inadequate health care infrastructure, lack of resources, and a limited number of healthcare professionals for the provision of basic health services in Pakistan remains a major challenge. For meeting healthcare needs of people, ICTs are being utilized in the health sector of Pakistan since 2004.
Telemedicine experiences in Gilgit, Punjab and Sindh providence suggests that ICTs have a wider coverage and are improving access of the poor to basic health services.
In a nutshell, the preceding literature and the case studies discussed above clearly indicate that ICTs are effectively supporting the development processes in Pakistan.
Further systematic attempts in the areas discussed are highly desirable. Future studies may focus on how ICT-enabled MM is helping to achieve financial inclusion in Pakistan. They may also focus on how MM financial innovation is aiding poor in the country.