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Notes -
South Asia just has a level of inequality unimaginable to the rest of the world, with a small elite (in relative terms, they still consist of tens of millions of people) capable of developing nuclear weapons, running a space program, standing toe-to-toe with the West and East Asia in every field of intellectual achievement, and doing everything else you would expect of a developed nation (other than keeping the streets clear of filth) living alongside a much larger population still mired in conditions that range from "bad by Latin American standards" to "bad by Sub-Saharan African standards."
Pakistan has the additional challenge of many rural areas being inhabited by clannish groups that will violently resist any perceived imposition by outside forces on their tribal way of life, and as the ruling class is just barely holding together some semblance of a state with guns, duct tape, and prayers, it has more important things to worry about then e.g. getting polio vaccines to Khyber Pakhtunkhwa.
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