August 28, 2009: Dr. Sania Nishtar attends PepsiCo Global Health Policy meeting in New York, USA, on August 27-28, 2009. Attends the meeting as a member of PepsiCo’s Global Health Advisory Committee.
August 22, 2009: A viewpoint titled ‘Nuancing national security’ by Sania Nishtar has been published in The News International. Full text is accessible at Viewpoints
This is a commemorative comment to mark Pakistan’s 62nd independence day. The point that is being made is that security is a holistic concept, which includes socio-economic and environmental, demographic, food, water, and health security aspects. Therefore the need for a broader vision of security is needed in Pakistan
Published in The News International on August 22, 2009:
Reaffirming the commitment to national security can be a befitting commemoration of the country’s 62nd Independence Day. National security is defined as “the requirement to maintain the survival of the nation-state through the use of economic, military and political power and the exercise of diplomacy”. Conventional national security measures include maintaining effective armed forces and intelligence services, implementing civil defence and emergency preparedness measures and investments in critical infrastructure—all of them significantly important. However, security also has another dimension centered on human security as defined by the United Nations, according to which security scopes beyond state security to encompass other dimensions such as economic security, food security, environmental security, personal security and health security. Within Pakistan’s context, two other dimensions of security are additionally relevant—energy security and demographic security.
Sustainable state security is dependent on human security. A brief analysis of human security challenges in Pakistan’s context can help to underscore the magnitude of the problem and the importance of robust policies and institutions and effective governance in order to deal with these challenges.
First, Pakistan faces many challenges with respect to economic security as a result of a number of domestic and international factors. Despite some economic gains in the last decade, the level of human deprivation and poverty has increased. Several domestic issues—high food inflation, under-performing industrial and business sectors due to the global recession and crippling power shortages; fiscal pressures due to intensification of the war; deteriorating investment climate due to the internal security environment—have created unprecedented pressures on the economy. The global commodity and financial crises have further compounded the situation—in particular, the impact of the latter on trade and constrained resource mobilization options. While some sound macro-economic polices are currently being pursued, to address these challenges, experts are raising concerns about the rationale of others; the expected pressure on Pakistan’s import bill and trade balance because of increased import of oil to feed new power generators is notable in this regard.
Secondly, energy is the lifeline of economic development. Pakistan’s current 3000 MW shortfall is a stark reminder of institutional and political impediments. The former with respect to the colossal line losses and the latter in relation to politicization of major hydropower projects, given that 85% of the country’s estimated 40,000 MW potential remains untapped. Both these issues merit urgent attention. The government therefore needs to act at various levels to ensure energy security. In particular, affordable alternative energy options should be explored, in view of their inexhaustible nature, green imprint, prospects of off-grid maintenance and potential of delivery through the market.
Thirdly, the importance of water security can hardly be over-emphasized for a country with an agriculture-based economy. Pakistan depends on the Indus River Basin—the backbone of the country’s economy and the world’s largest contiguous irrigated system—to provide 90% of food production and 25% of GDP. However, this massive infrastructure is deteriorating and is plagued by issues related to diversion of water, competition between the provinces, inefficiencies of use and problems with irrigation and drainage. There is need for action at several levels—reforms to address underlying institutional weaknesses, investments throughout the system in order to rehabilitate critical assets, and an effective diplomatic intervention in relation to the Indus Water Treaty.
Fourthly, food security, which includes dimensions of availability, access and distribution, is of vital importance given its impact on economic growth, human health and productivity as well as political stability. The food insecurity-poverty nexus is pervasive in Pakistan. The report of the Task Force on Food Security recently set up by the government, has drawn attention to the diversity of responses needed to address this challenge and has underscored the importance of achieving an average agricultural growth rate of at least 4% per-anum in the next decade, an equitable system of food procurement, storage and distribution and effective safety net arrangements, in addition to other measures ranging from terms of trade, agriculture credit to institutional capacity for research, as being important in this regard. Effective governance capacity will be critical to implementing these important recommendations.
Energy, water and food security are interlinked with environmental security. Pakistan suffers many conventional environmental threats—water deficits, desertification, deforestation, soil erosion—in addition to the environmental impact of industrial effluents, municipal wastes, agricultural residues, and rampant and outdoor and indoor pollution in the face of poor implementation of the National Environmental Quality Standards. These play havoc with people’s health and have also been the subject of progressive public interest litigation concerning protection of the environment, in Pakistan, as has been alluded to in these columns on July 25, 2009. The projected impact of climate change, unfortunately, is expected to add to these challenges by adversely impacting the ecosystem—the natural water storage capacity of glaciers and monsoon patterns—adding further to the existing water, food and energy insecurity.
The fifth human security challenge relates to health security and threats from emerging and reemerging infections and public health emergencies of national and international concern, which can be biological or chemical in nature—terrorism related or accidental. In the last decade, SARS and Avian Flu caused significant social and economic losses. Evidence of virus entrenchment in Pakistan has been documented by the World Health Organization in its report ‘Human cases of Avian influenza-A (H5N1) in NWFP, Pakistan’, where a chain of transmission beginning with poultry-to-human transmission followed by probable human-to-human transmission was luckily un-sustained. The current unfolding of the Swine flu pandemic is dangerous as there is no way of predicting virus behaviors. Pakistan must put in place effective mechanisms, to comply with International Health Regulations 2005, to ensure that it is capable of thwarting these and other related threats.
The sixth security concern relates to demographic security. Pakistan is the sixth most populous country in the world with a rapidly burgeoning base of the population pyramid. There are two ways of looking at this situation. The abortive version of the Poverty Reduction Strategy Paper II, which was placed in the public domain for stakeholder inputs in 2005-06 envisaged this to be an opportunity and referred to it as the population dividend. However, this dividend in the face of many human and state security threats can also become a dangerous overload and fall prey to exploitation in extremist hands in a deeply polarized environment.
State and human security dimensions are therefore interrelated. Water and energy insecurity and political and civic instability, all of which are manifestations of poor governance, lead to economic and food insecurity; both of these have implications for poverty and deprivation; these in turn have a causal linkage with conflict and violence in a society. That in turn negatively impacts economic and human development and a vicious cycle is established.
Unless we deal with these problems holistically we will not be able to overcome state security challenges, which by itself has acquired many complicated dimensions in recent years. Pakistan’s national security institutional arrangements must therefore take all these threats into account.
Pakistan’s history of national security institutions is marked by four events. The National Security Council envisaged through the Order 14 of 1985, scrapped by the 8th Amendment; the 1997 Council on Defense and Security, which never convened; the structure proposed by the foreign office in February 1999, which could not come to fruition; and the National Security Council of 2004. Any new national security institutional framework, must pay careful attention to the interconnectedness of state security with economic and other dimensions of human security and ensure appropriate linkages between various domains. Ideally these should be reflected in the terms of reference, substantive functions and composition of the national security framework.
The author is the founder and president of the NGO think-tank, Heartfile. E mail: email@example.com
August 15, 2009: A viewpoint titled ‘Anti-corruption reform’ by Sania Nishtar has been published in The News International on August 15, 2009. Full text is accessible at viewpoints
Context: Transparency International’s report featuring citizens’ perceptions on the level of corruption has just been released. There are many viewpoints circulating about the methodology adopted. This comment aims to outline the challenges in corruption empirics. It also underscores the salience of anti-corruption reforms.
Published in The News International on August 15, 2009:
The release of Transparency International’s National Corruption Perception Survey, 2009, which assessed citizens’ perceptions as to the level of corruption in the four provinces of Pakistan, has sparked a debate about the prevalence of corruption in the country and the inter-provincial variations in the reported pattern.
First of all, it is important to appreciate that corruption assessment is a challenging area in governance diagnostics because of definitional ambiguities, complexities in categorisation, overlap of forms and its linkage with the cultural and social milieu, within which activities are perceived as being corruptive. Most of the commonly used methods for corruption assessment globally—of which perception surveys, expert opinions and measurements of indices of corruption, are the commonest—have their limitations. Perception surveys can be influenced by actual events surrounding data collection, whereas expert evaluations can be biased. There are other more robust methods for corruption assessment such as forensic investigations, economically modelled estimates and expenditure tracking surveys. However, these are usually not regarded appropriate for broad-based countrywide assessments owing to cost and time constraints. Perception surveys and expert opinions therefore, remain the globally accepted assessment tools.
Transparency International conventionally employs perception surveys. For its cross country comparative assessments, the World Bank utilises a composite indicator, which draws on data from perception surveys and expert opinions, whereas country rankings of the World Economic Forum are based on competitiveness reports from the respective countries. All of these data sources yield information on Pakistan regularly and consistently underscore the magnitude of the problem, as in many other developing countries.
Perception surveys from Pakistan-based organisations, such as the Pakistan Institute of Development Economics (PIDE) and Gallup, reinforce these trends. From time to time there is a tendency, particularly with incoming governments, to engage in forensic investigations of corruption charges against individuals as part of an effort to compel accountability and counter corruption. In many cases these have ended in long drawn judicial scuffles. What is more important is to take stock of broadly representative evidence, and recognise the magnitude of the problem as a first step towards building corrective and pre-emptive measures.
Corruption can be prevalent in any domain—in the political, state, business and NGO systems. Anti-corruption reform, therefore, is a complicated animal with many inter-related attributes, designed to address the determinants of corruption at various levels—frail governance structures of state institutions, weak political systems, thriving black markets and institutionalised patterns of collusion that sustain procurement graft. The list can go on. In an ideal world three requirements should be met in order for anti-corruption reform to be implemented.
One, a truly democratic dispensation, not just in the sense of majority rule but also in terms of striking the right balance between constitutionally-mandated institutions that uphold democratic values and democratic behaviours of consensus building and decision making. Two, a superior judiciary which remains un-politicised and a subordinate judiciary free from financial corruption; and, three, an executive that does not abuse the power of discretion and applies policies evenly. If these requirements are met, specific sectoral anti-corruption measures can be institutionalised with great success. Expecting all these things to happen all at once in the short term may be unrealistic. Pragmatically speaking, therefore, the government should focus on a few high potential anti-corruption measures on the premise that these would have a knock-on effect and catalyse action in the other areas, just as an open and relatively free media has had in recent years. The importance of six priority actions is being underscored in this regard.
First, Pakistan needs to fulfil its commitment as a signatory to the United Nations Convention Against Corruption (UNCAC) by revitalising the National Anti-Corruption Strategy which, despite its weakness, is a coherent framework and can be the basis of consensus-driven concrete plans of actions in terms of intra-agency sub-strategies. High-level political commitment is needed to revitalise this agenda and include its specific targets into the monitoring framework of ministries and government departments.
Secondly, there is the need for substantive changes in the legal anti-corruption and accountability frameworks. Currently, three draft proposals relating to the future of the National Accountability Bureau (NAB) are under consideration by the National Assembly’s Standing Committee on Law and Justice. One of these, the Holders of Public Offices Bill, 2009, intends to repeal the National Accountability Ordinance (NAO) and replace the NAB with an Accountability Commission. The writer has raised a number of issues in relation to the proposed changes envisaged through the statute in these columns on Jan 27 and May 25, emphasising the need to ensure independence of institutional arrangements and conference of a status that is immune from exploitation through political interference.
There are also many other concerns relating to this legal framework, particularly with regard to preferential treatment and other issues emerging as a result of its implementation, specifically in relation to strengthening the mandate of the FIA while it remains, in its present shape, an institution with many weaknesses. A robust legal and institutional anti-corruption framework can bring great value to mainstreaming transparency in state functioning.
Thirdly, some key oversight institutions should be strengthened—in particular, the Public Accounts Committee and the AG’s office. Recent improvements in the AG’s office should be sustained and further built upon. The potential within the Public Accounts Committee can be harnessed with the leader of opposition in its chair, albeit with the right technical inputs and civil-society engagement. The Public Accounts Committees also exist within the framework of the local government system but have not been made to function as a tool for strengthening district oversight and accountability. Although their fate is dependant on the overall decision relating to the local government system, every effort should be made to retain and strengthen institutional frameworks that can compel accountability.
Fourthly, rather than the punitive, investigative and sanctions-oriented approach to dealing with corruption in the private sector, the focus should be on leveraging the potential within competitiveness to counter organised vested interests and ensure that businesses have a level playing field. Pakistan’s Competition Commission should be incentivised to act as an active engine in order to build safeguards in the market environment.
In the fifth place, a twin agenda relevant to the executive branch of the state can help to achieve efficiency whilst at the same time act as a safeguard against collusion. Critical investments are needed in technological applications in the management and public expenditure tracking streams. Alongside, some initial steps must also be taken to promote integrity at the executive level; although civil service reforms is a long-drawn agenda and while the system eagerly awaits the much-needed deeply rooted action in this area, improvements can be made by ensuring respect for merit and tenure security and improving accountability of decision making.
Lastly, it is important to review the Freedom of Information Law, 2002. Freedom of information is not about media freedom. It has to do with access to information and disclosure which can enable public discourse. The right to information is a crucial underpinning of participatory democracy. Promotion of open government and maximum disclosure can be the single most important step towards eliminating corruption. If this is coupled with the right awareness-building measures for citizens that empower them with knowledge of what laws mean and the implications of information on their lives, sustained improvement with respect to transparency in governance can be expected over time.
The author is the founding president of the health sector NGO think tank, Heartfile. E mail: firstname.lastname@example.org
August 08, 2009: A viewpoint titled ‘Devolution reform’ by Sania Nishtar has been published in The News International. Full text is accessible at Viewpoints
Context: The fate of the devolution initiative (local government system) is undecided and is impacting the functioning of every sector including health. Opinions are based on anecdotal reports, perceptions and observations. This comment is aimed at drawing attention to the need for impartiality and evidence-guiding decision making in relation to a way forward.
Published in The News International on August 08, 2009:
The fate of the devolution initiative is likely to be decided by the end of this year, regardless of the presidential sanction to the provincial draft proposal—currently in the pipeline—given that the Local Government Ordinance will stand omitted from the Sixth Schedule of the Constitution, after six years of passage of the 17th Amendment in December 2009. A turf battle is imminent in the wake of the most likely decision; provincial governments have already stated that they will completely abolish the current system whereas proponents of the devolution initiative, citing 140-A of the Constitution and terming appointment of the administrators, unconstitutional are likely to turn to courts. The beginnings of that scuffle are already evident. The ensuing impasse is likely to have implications for the working of the government, the development of democracy, the mandate of the judicial system and citizen’s empowerment—all at the grass roots level, where government matters to the poor and marginalized.
Within this context, this comment is aimed at drawing attention to the need for impartiality and evidence-guided decision making in relation to a way forward. A comparative evaluation of impact of the local government system vis-à-vis the divisional system in relation to social, fiscal, administrative and political outcomes can yield important evidence, which can inform policy. Although a case control assessment was not part of the design of the devolution initiative, as the reform was implemented all over the country at one time, evaluations and assessments conducted subsequently can yield meaningful information. The Federal Bureau of Statistics conducts yearly surveys, such as the Pakistan Social and Living Standards Measurement Survey (PSLM); this can yield evidence of impact and social outcome trends overtime, before and after implementation of the devolution initiative. Sequential surveys of the Center for Poverty Reduction (CPRID) and CIET (social audit surveys in 2002 and 2004) can yield similar information. There is a vast body of evidence in the ‘pre’ and ‘post’ studies on local revenue by Provincial Finance Commissions. It is important to triangulate information from all these sources to assess impact on outcomes and outputs, before coming to any conclusions.
The devolution initiative was not perfect; but scrapping something as major as this without a thorough analysis, would be unwarranted. Devolution and decentralization is a complex process involving transfer of authority and a range of transformations in the public sector; effective implementation of the reform necessitates adequate capacity to understand and the ability to garner support of stakeholders to implement changes in a complex environment. The National Reconstruction Bureau was mandated to develop norms, standards and guidelines, which could have assisted with the change, but there appeared to be limited will to operationalize such changes in Pakistan in the true spirit. Additionally many prevailing systemic issues were an impediment to its implementation; some of these merit a mention.
First, the Local Government System was theoretically designed to be a departure from the post-colonial style of district and divisional administration to a paradigm of grass roots governance with the expectation that power will be in the hands of the elected representatives from a grass roots base. Devolution/decentralization of government was meant to open avenues for accelerating progress in social service delivery and enhance public sector effectiveness by bringing those responsible for delivering services close to intended beneficiaries and making them accountable. The system was also expected to allow local voice to set priorities, encourage innovation and improve efficiency of resource allocation. These were important envisaged endpoints. In actual effect, anecdotal evidence and observations from the field show that the performance of the local governments fell across a spectrum—from good at one extreme to poor at the other. Of course, there can be no generalizations, but observations in some districts were indicative of improvements, primarily as a result of increase in resources and their timely utilization; the latter enabled by a decentralized system of planning and decision-making. In many other districts, however, that wasn’t the case and the initiative fell prey to elite capture and Pakistan’s feudal-dominated grass roots politics. The fact that the Nazim was in fact selected to be elected by an assembly that he/she was not an elected member of, was one of the most significant weakness of the system and opened avenues for patronage, in some districts. This coupled with poor application of the mechanism to hold the Nazim accountable, led to abuse of the system and fueled graft in some districts. This embittered the provincial administrations even further who already alienated by the loss of administrative levers now found that another layer of government had access to public resources; this threatened individual interests in a system where collusion is deeply institutionalized. In some poorly performing districts, the dynamics of control also did not desirably change at the grass roots level and the potential within the initiative to strengthen the societal political culture and empower citizens, could not be fully harnessed. It would be interesting to see how these core weaknesses are addressed, by the current political dispensation, when/as it gets to making changes.
Secondly, the system attempted to abolish the divisional tier and empowered districts by granting them financial and administrative autonomy. Although empowering the districts was a desirable step, abolition of the divisional administrative and technical hierarchy had implications at various levels—in particular, capacity at the level of federal/provincial institutions to handle data and information, which had not been sifted and/or consolidated at an intermediate level. These implications could not be adequately addressed as the devolution initiative got implemented. With careful attention to capacity building at both ends, some level of incremental progress could have been made. Thirdly, the system abolished Executive Magistracy. Although the approach was in line with the constitutional provision to ensure independence of the judiciary, it created a gap at the local level, as concomitant investments were not made to bridge prevailing gaps in the judicial system.
Some conclusions can be drawn from this account. First and foremost, it must be recognized that a system mandated to restructure the local political and administrative arrangements cannot be fully successful if the central systemic issues in state functioning and political systems continue to prevail. Restructuring the system of governance and political dispensation at the district level should therefore be accompanied by the much-needed reform of the political, judicial and broader public resource management systems, at the federal and provincial levels, in order to be effective.
Secondly, administrative restructuring should never be used as a lever to consolidate the administrative and political power base and a basis for controlling resources and using power for patronage, but as a means of strengthening grass roots democracy and a mechanism for effective delivery of services. Thirdly, existing evidence points to specific action in certain areas. For example, the issue of strengthening accountability and capacity at multiple levels and the possibility of crafting a useful divisional role, particularly with reference to technical functions needs to be carefully taken into consideration. Similarly, there is the need to make use of the sizable allocations for Community Citizens Boards as an instrument to empower local communities and strengthen avenues for demand side financing to support grass roots development.
The current opinions about the governance reform are largely based on anecdotal reports, personal and group perceptions and isolated observations, which have been widely generalized and in some cases also politicized. In charting a way forward, provinces must refrain from making sweeping changes; the answer is not in scraping the current system and installing something de novo, but using evidence to shape policy in order to create the optimal balance between authority, responsibility and accountability. In many ways this will be a test of leadership capacity at the provincial level. Provinces have the right to restructure the local government system according to the mandate in Article 140-A, which seeks to implement Article 32 of the Principles of Policy. But that prerogative needs to be exercised with great prudence.
The author is the founding president of the health sector NGO think tank, Heartfile. E mail: email@example.com
August 01, 2009: The Lancet has published a comment on the important subject of the role of the private sector in health systems. Members of the Working Group on the role of private sector in health systems of the Rockefeller Foundation were co-authors. Reference:
Lagomarsino G, de Ferranti D, Pablos-Mendez A, Nachuk S, Nishtar S, Wibulpolprasert S. Public stewardship of mixed health systems. Lancet 2009 Nov 7;374(9701): 1577-8