Background The lack of reliable tobacco healthcare and economic cost estimates leaves the tobacco industry undertaxed and thriving in Pakistan and makes the country as one of the top tobacco-consuming nations. To facilitate effective tobacco tax policymaking, this study estimates the economic cost of smoking-attributable diseases and deaths in Pakistan. Methods A nationally representative sample survey of 13 000 households was administered to gather the data required to estimate different cost components of smoking-attributable diseases through the prevalence-based approach. Findings The total smoking-attributable economic cost of all diseases and deaths in Pakistan in the year 2018–2019 for persons aged 35 years or older is 615.07 billion ($3.85 billion). Similarly, three major diseases, namely cancer, cardiovascular disease and respiratory disease, along with associated deaths, cost the nation PKR437.8 billion ($2.7 billion) of which 77% is the indirect cost. The three major diseases make 71% of the total estimated cost, nearly two-thirds of which is borne by rural residents, nine-tenth by males and more than four-fifths by the citizens in the 35–64 years age group. Conclusion The total annual economic costs of all smoking-attributable diseases and deaths and those of the three major diseases equal 1.6% and 1.15% of Pakistan’s gross domestic product, respectively. The tax contribution of tobacco sector is merely 20% of the total estimated cost. The finding of huge economic and health costs of smoking makes a convincing case for policymakers to realise the true value of the industry’s contribution and raise tobacco taxes to the level of full cost recovery.

The basic objective of the irrigation reforms, i.e., participatory irrigation management in Pakistan, was a better economic and financial management of irrigation service delivery, equity in water distribution, and better environmental outcome. The aim of this study was to assess the optimism with the reforms package that has actually delivered expected outcomes. For this purpose, this study used a cross-sectional dataset of 567 farmers in five selected Area Water Boards (AWBs) of Punjab and Sindh provinces of Pakistan. Important institutional features including compliance, adaptiveness, clarity of objectives, good interaction, and appropriate scale, were modeled through structural equation modeling on the overall performance assessment of water use associations from a farmer’s perspective. Results suggested that clear objectives, adaptiveness, scale, and compliance show a strong relationship with an overall assessment of performance. While good interaction has not impacted significantly with an overall performance assessment. The impact of institutional feature on the overall performance assessment depends on the nature of performance considered, e.g., drivers of the economic performance of a farmer organization may not be the same as the drivers of its environmental performance. Besides offering insights on specific drivers that matter for a particular dimension of the institutional performance of farmer organizations, the study suggests that participatory irrigation management institutions are still in infancy even after decades of their introduction, and just creating institutions is neither mandatory nor sufficient. Furthermore, the institutional designs are considered critical for the success of participatory institutions. Therefore, there is a need to consider the conformity of the strategies with the existing norms and compliance to the on-going procedures.

The influence of gender in participatory irrigation management reforms has been the subject of significant research in the past. Whilst there is some understanding of what hinders women and marginalized groups from participating in irrigation management, there is limited understanding of how male and female farmers vary in their perceptions on the effectiveness of participation in irrigation affairs. There is also limited understanding around the interaction on gender and the overall success of participatory irrigation management programs. Based on the information obtained from 128 households surveyed through separate male and female questionnaires in Pakistan in 2018 (Sindh and Punjab provinces), we studied the country’s experience in engaging gender into its participatory irrigation management program. We found there was a significant difference in participatory irrigation management perceptions across both gender and locational jurisdiction. Overall, women generally perceive the performance and impact of farmer organizations to be significantly less effective than men. Our study emphasizes the importance of putting findings in a historical context to inform the theory, policy, and practice of mainstreaming gender into irrigation management.