Pakistan's rural network reaches 56 million — and nobody knows

From Moscow to Mardan: a childhood built for this work

The episode opens with Muzamil framing the conversation around two pressures bearing down on Pakistan simultaneously — an economic crisis that the UN projects could push five to eight million more people into poverty, and a broader regional shift that makes rural development not just a welfare question but a strategic one. To explore both, he brings in Shandana Khan, CEO of the Rural Support Programmes Network, and Meena Iqbal, Program Manager for RSPN’s nutrition program in Sindh.

Shandana’s early life is, in itself, a kind of accidental training for the work she would spend her career doing. Born in Rawalpindi to a family from Mardan, she spent her childhood moving across countries as her father served in Pakistan’s civil and then foreign service. She attended a Russian-language school in Moscow at age seven — “every subject in Russian” — before moving to Geneva, then Bangladesh, then Delhi, and finally Cambridge. The exposure was relentless. In Bangladesh in 1979, just eight years after the war, she found no hostility toward Pakistanis. In Delhi, studying political science at Jesus and Mary College, she found the academic atmosphere open and the cultural distance from Pakistan smaller than expected. “North India and Pakistan, especially Punjab and Sindh — this is very similar,” she tells Muzamil.

What the childhood produced was not just cosmopolitanism but a specific sensitivity to how people organize themselves under difficult conditions. The Soviet Union, she recalls, carried a cultural richness — ballet, puppet shows, ice circus — rooted in revolutionary values of equality and women’s advancement, even if the system ultimately could not sustain itself. That early encounter with the idea that a society could be deliberately organized around the welfare of its poorest members would resurface, years later, in the mountains of Gilgit-Baltistan.

The moment in 1985 that decided everything

Shandana did not plan to work in rural development. The decision crystallized during a visit to the Aga Khan Rural Support Programme in 1985, while she was still a student. She walked into a village meeting and saw something she had never seen before: senior management sitting on the ground in a circle while community members gave them feedback about what was missing in their lives.

“When I saw that,” she says, “I decided in 1985 that I had to come here and do this — because this was so extraordinary. These people were telling you themselves what they needed, and the program was basically supporting them. It was not saying: we know everything, we have come to improve your life, we will tell you what you need and how you need it.”

After completing her BA at Cambridge in 1990, she returned and told AKRSP’s head, Shoaib Sultan Khan, that she wanted to join. He pushed back — the terrain was difficult, flights were unreliable, electricity could be out for three days at a stretch. She read it as a challenge. He relented, and she spent four years based in Gilgit. She describes it as the best experience of her life — better than Switzerland, Russia, or India. She traveled alone into remote valleys, stayed with field teams, and watched communities build irrigation channels and plant cherry orchards with their own hands. The cherries now sold across Pakistan trace back to rootstock AKRSP brought from France and grafted onto local trees in the early 1990s. “I am talking about ‘94. This is 2023. When I go back now, I remember that all of this started from such small things.”

Social mobilization: a method, not an invention

A significant portion of the conversation is devoted to explaining what “rural support” actually means — and what it does not mean. Muzamil presses Shandana on the intellectual origins of the model, and she is precise about it.

The principles of social mobilization — how to organize people, how to conduct dialogue, what conditions to set before a program begins — were not invented by AKRSP. They were developed by Akhtar Hameed Khan in Comilla, then East Pakistan, in the 1960s, and applied in urban Karachi through the Orangi Pilot Project. Shoaib Sultan Khan, who would go on to build AKRSP, was a student of Akhtar Hameed Khan. “He keeps saying: I am just a copycat. I didn’t invent this.”

The model has a specific logic. Before any program begins, a community must form an organization, elect an honest leader from among themselves, include women, include the poorest members, and open a savings account. Every household writes a micro-investment plan. Only then does the RSP begin to work with them. “These are the conditions: if you want to work with us, you have to do this first. Show us you can do it. And then we will tell you what we can do.”

The discipline extends to how field workers behave. Staff are trained not to eat or drink tea in the homes of poor communities — not because of arrogance, but because it places a burden on people who can barely afford it. If someone at the back of a room is silent, you ask them directly rather than letting the village elder dominate. “There is a whole way of interaction.”

Muzamil draws a parallel to the polarization visible on social media, where urban Pakistanis encounter rural or peri-urban voices and respond with contempt rather than curiosity. Shandana agrees: the same principle applies. You cannot change people by screaming at them or defining their reality for them. You work with them, not against them.

Treating 33,000 children: what PINS actually does

Meena Iqbal takes over to explain the Program for Improved Nutrition in Sindh, which operates across ten districts with European Union funding and the collaboration of Sindh’s Department of Health.

PINS has three components. The third — nutrition-sensitive — addresses the indirect causes of malnutrition: water and sanitation, kitchen gardening, fish farming, and livestock. Diarrhea in children under five, caused largely by unsafe water and poor hygiene, fell from 32.6% to 17.4% over four years in the program areas. Women in the 15–49 age group have increased the number of food groups they consume by roughly 20%.

The second component — nutrition-specific — is direct treatment. RSPN trained 791 women from the communities of Dadu and Jamshoro to screen children using mid-upper-arm circumference measurement. Those women referred severely malnourished children to 93 outpatient therapeutic treatment sites, each covering one union council. Children admitted to the program receive RUTF — ready-to-use therapeutic food, a peanut-based supplement with added vitamins and minerals — calibrated to their weight. They are enrolled for two months with follow-ups every two weeks.

Meena gives a concrete example: a girl named Suhana, fifteen months old, whose father was a daily-wage worker. At admission, her mid-upper-arm circumference was 8.5 centimeters — severely acute malnutrition. At discharge, two months later, it was 12.1 centimeters. “The impact is very quick,” Muzamil observes. “This is emergency treatment,” Meena confirms. Across Dadu and Jamshoro, the program has treated 33,000 children to date.

The first component of PINS is advocacy — informing government decision-makers about the scale of the problem and the multi-sectoral response it requires.

Family planning: demand exists, service does not

Later in the discussion, Muzamil raises population management — citing Pakistan’s fertility rate and the arithmetic reality that GDP growth below population growth means the average person is getting poorer in real terms. He asks Shandana how rural communities actually respond to family planning.

Her answer is unambiguous. The demand is there. In a ten-district program running since 2017, contraceptive use rose from 11% to 52%. “Why? Because awareness came about which method to use, where to find it, and the service reached people.” The bottleneck is not culture or religion — it is the absence of supply.

She describes a visit to Rawalpindi’s Dhoke Rata area, where RSPN runs husband schools funded by UNFPA. A young cleric stood up and told the men present that he himself had three children, spaced deliberately, and that their religion instructs them on how to raise children well — not just how many to have. He then pointed out that most of them recite the Quran in Arabic without understanding it, and suggested they read a translation. “I told him: come with us across Pakistan and deliver this message.”

In Balochistan, RSPN once prepared 12,000 couples for family planning. There was no service available for them. “The government has no money to buy contraceptives. Look at the priorities.” Shandana is direct: family planning, alongside education, is the most important intervention available. The government’s messaging on it is nearly absent.

8.6 million organized households — and a visibility problem

Muzamil pushes on what he sees as the central paradox of the conversation: RSPN has built, over four decades, a network of organized community organizations with direct outreach to 56 million people. It was the first point of call for COVID rations and flood relief. Yet most Pakistanis have never heard of it.

Shandana does not deflect. “We are the biggest humanitarian network in the country and, as you said, we are not very good at projecting this.” She acknowledges that after every major disaster — the 2005 earthquake, the Swat IDP crisis, the 2010 floods, the 2022 floods — RSPN is on the ground first, but the public communication of that work is weak. There is no streamlined channel for Pakistani private donors to contribute and receive feedback on where their money went.

The structural argument she makes is sharper than a fundraising pitch. The network of 8,600 community organizations is, in her framing, a hardware layer. Any government service — health, education, nutrition, forestry, family planning — can run through it as software. If a district forest officer wants 50,000 trees planted, the community organizations can mobilize the labor. If a health department wants polio vaccines administered, the organization heads will bring the children. “It’s not that the government doesn’t know. During COVID, the first point of call was RSPs and NGOs: how do we get this to the poorest? We had the list. We had the organized outreach.”

What is missing is a regulatory change that makes this the default mode of service delivery rather than an ad hoc arrangement dependent on individual district officers who happen to be motivated.

Islands of success, not a national formula

By the end of the conversation, Muzamil asks Shandana to look forward to 2050. She does not offer optimism as a performance. She repeats a phrase she attributes to her chairman, Shoaib Sultan Khan, who learned it from Akhtar Hameed Khan: build islands of success.

“You can’t change the world, but you can do what you can. These RSPs are, at least in the communities, islands of success. If these islands increase and they network with each other, and if the government supports this, it can be transformative.”

She draws the Bangladesh comparison carefully. BRAC reduced average family size from six children in 1971 to two today — not through coercion but through a government that was fully on board with the narrative and provided services while NGOs provided outreach. “I am afraid this is missing in our country.”

The economic situation makes the urgency acute. Preliminary analysis in South Balochistan’s Kech district shows that households whose incomes rose by 11–16% through RSPN programs are now barely keeping their heads above water after inflation running near 50% and the 2022 floods. “The good work that communities did — then we were assessing how many latrines damaged, how many water schemes damaged.” The gains are fragile. The infrastructure, if the government chooses to use it, is not.