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Operation polio

January 29, 2011: Pakistan has launched an emergency plan to step-up efforts towards polio eradication after acknowledging that the country now runs the risk of becoming the last remaining reservoir of endemic poliovirus transmission in the world. This comment explores the nature of systemic constraints, which stand in the way of achieving that goal. Comments on the paper should be sent to sania@heartfile.org

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Operation polio

Published in The News International on January 29, 2011:

The government and opposition factions appear to be converging on a ten-point Agenda focused on eliminating some of the currently prevailing governance distortions in Pakistan. Articulated as a set of “Demands” by one particular opposition party, the points have been endorsed by others and have been admirably embraced by the incumbent federal government. The ten-points, per se, are non-controversial and there appears to be a broad consensus that action towards them will contribute positively in an environment where mistrust and malfunction are now deeply ingrained. This comment is aimed at explaining that whilst these points are significant stepping stones, and are important in their own right, they are nevertheless inadequate for addressing deeply rooted systemic issues, which can only be amenable to reform at a more fundamental level. Three points are being highlighted to elaborate this further.

Six of the ten demands center on eliminating corruption in one way or the other. The demands to dismiss Cabinet members and personnel in high offices with tainted credentials, dealing with culprits of the recent Hajj, banking, privatization and procurement scams and bringing perpetrators of the recent commodity hoardings to justice fall under this category. Additionally, the demand to implement the supreme courts’ verdict in the aftermath of the National Reconciliation Ordinance being regarded null and void also falls within this rubric.

There is a long standing history of attempts to address corruption through disciplinary and penalizing action in Pakistan. Whilst it is true that punitive action has its value as it sets an example and acts as a deterrent, it has its limitations. Political governments and decision makers, deeply entrenched in the spirit of camaraderie are reluctant to bring their peers to justice. With many opportunities to abuse discretionary powers, disciplinary efforts often take on politically-motivated overtures. Pakistan has made the mistake of focusing on corruption through the predominant focus on this approach for far too long. As a consequence, other more systemically effective means of garnering a culture of transparency in overall governance, have received little emphasis. More than punitive action, the key to anticorruption is to focus attention on building institutions and systems that limit opportunities of collusion, graft and arbitrage in the first place. An important aspect of this is mechanisms of oversight that can check discretionary powers, which create opaqueness in interpretation and variance in application of policies. There is potential within leveraging technology as a barrier against abuse and pilferage. Promoting market harnessing means of regulation, fostering competition to weaken economic interests and integrity-promoting measures in the bureaucracy are other entry points. The dividends of appropriate disclosure and freedom of information and safeguards against conflict of interest should additionally be brought to bear. Furthermore, one of the most effective anti-corruption strategies has to do with building safeguards against state capture and the legacy of patronage; this can be attempted by upholding democratic principles in governance so that the systemic manipulation by vested interest groups, which has become a governance norm in our country, can be circumvented.

Punitive actions being recommended as part of the Agenda, therefore, need to be supplemented with a greater emphasis on strengthening Pakistan’s key institutions in general and accountability mechanisms in particular and implementing the country’s National Anti Corruption Strategy, which seems to have gone into hibernation after its unveiling in 2002 and several successive attempts aimed at reviving it.

The second demand on the Agenda calls for the creation of an independent Accountability Commission. It is widely accepted that impartial and depoliticized accountability bodies can help advance the accountability/transparency agenda. However, the past performance of commissions in Pakistan has not been promising and nothing harvests the hope that the case is likely to be otherwise this time round.

Commissions tend to fall prey to capture and end up behaving quite similar to bureaucratic structures. There are additional issues with the proposed accountability commission. The law under which it is supposed to be created and which has been pending in the Parliament/ Ministry of Law for over a year has been criticized because of its glaring list of exclusions and loopholes, which can enable exploitation. Furthermore, accountability is a broader thread in governance and is not synonymous with anticorruption. As an attribute, it is also relevant to the performance and financial realms. The determinants of the fiscal policy related Demands on the Agenda can be explored further to highlight the reality that Pakistan’s systems of governance are bereft of any such effective structures. These demands relate to inflationary pressures, the energy crises, crowding out of fiscal space, sprawling size of the government and resulting expenditures. Each of these threads can be linked back to lack of effective mechanisms of accountability at the performance and financial levels.

If mechanisms to compel accountability existed and if disclosure and freedom of information laws had been implemented in their true spirit to assist with the accountability process, perhaps Pakistan’s debt burden would not have accumulated to this scale and its footprint on the lives of the common man in terms of inflationary pressures and scaled back social services would not have been this brutal. The blatant graft, which leads to massive bleeds from the system, may not have been so deeply entrenched crowding out the space for resources, which can touch the lives of a common man. The Public Sector Development Programme would not have continued to fund public sector enterprises and infrastructure projects with meager development resources at the cost of health and education while options to revitalize management and privatization for the former and private financing for the later existed. If accountability had been institutionalized, the energy czars would have not prioritized quick turnover thermal power plants over long term sustainable investments in hydel power projects; the common man would not have to bear the weight of massive load-shedding, which is having a domino effect on employment and the economy.  There is a long list of illustrative examples to highlight the manner in which lack of accountability at the decision making level has translated into the current mayhem. So, important as the agenda targets may be, it will take more than a Commission to set things on the right path.

The third aspect of the Agenda I would like to comment on is the Call for an independent Election Commission. Perhaps what the agenda should have stressed on additionally is also to expedite and support what is already in the pipeline. The NEWS on January 12 featured a seemingly non-descript but an important news item regarding the National Database Registration Authority’s efforts to install an electronic voting system and a law in the pipeline to enable that. Ideally this should be supplemented with other reforms to make the election process more facilitative for those that neither have the power nor the money to enter the run. Additionally the illiterate voter, currently beholden to feudal interests and dynamics of ‘biradrai’ will also have to be primed to the need for making the right choice. What Pakistan needs now is human capital in the right policy making roles with the hope that this will set key institutions on the pathway of recovery. The Agenda Demands need to be augmented to make headway in that direction.

The author is the founding president of the NGO think-tank, Heartfile. sania@heartfile.org




PLANNING MEETING FOR THE NCDS MOSCOW CONFERENCE

January 27, 2011: Sania Nishtar attends the planning meeting of the First Global Ministerial Conference on Health Lifestyles and NCD Control, which is to be held in Moscow in April later this year, as a member of the International Steering Committee. The planning meeting was held in Geneva, Switzerland on January 26-27 at the WHO headquarter in Geneva.




WORLD HEALTH REPORT 2010

January 25, 2011: The Proof-of-Concept paper for Heartfile’s Health Financing project has been published as one of the background papers to WHO’s World Health Report 2010: “Health systems financing, the path to universal coverage”. The paper can be downloaded. Comments on the paper should be sent to sania@heartfile.org




THE EMERGING MARKETS SYMPOSIUM AT OXFORD UNIVERSITY

January 16, 2011: Sania Nishtar attends the Oxford University hosted Emerging Markets Symposium on Urbanization, health and human security as a expert panelist and speaker. The symposium focuses on challenges for the emerging market countries.




H1N1 OUTBREAK IN PAKISTAN—LESSONS LEARNT

January 14, 2011: Compared to many other countries in Asia, the outbreak of Pandemic Influenza H1N1 2009 appeared to be of minor concern to Pakistan. Sania Nishtar analyzes the extent to which that notion was justified, the health system’s response to the outbreak and the capacity of the country to comply with WHO’s International Health Regulations 2005. The paper has been published by the RSIS Centre for Non-Traditional Security (NTS) Studies in Singapore, which coordinates the Consortium of Non-Traditional Security Studies in Asia (NTS-Asia). Heartfile has been actively involved in events organised by both the Centre as well as the Consortium. Comments on the paper should be sent to sania@heartfile.org. The paper can be downloaded




RISKS AND RESILIENCE

January 10, 2011: The enclosed comment on Risks and Resilience was published in the NEWS International on January 1, 2011 to mark the beginning of 2011—a befitting recognition of the importance of systemically interconnected risks and the manner in which they interplay with the well being of people in Pakistan. The imperative to step up capacity to deal with these risks has been flagged.




Dr. Sania Nishtar receives global innovation award. The Friday Times. August 26-September 1, 2011




Anti-corruption strategies

Published in The News International on January 05, 2011:

The government and opposition factions appear to be converging on a ten-point Agenda focused on eliminating some of the currently prevailing governance distortions in Pakistan. Articulated as a set of “Demands” by one particular opposition party, the points have been endorsed by others and have been admirably embraced by the incumbent federal government. The ten-points, per se, are non-controversial and there appears to be a broad consensus that action towards them will contribute positively in an environment where mistrust and malfunction are now deeply ingrained. This comment is aimed at explaining that whilst these points are significant stepping stones, and are important in their own right, they are nevertheless inadequate for addressing deeply rooted systemic issues, which can only be amenable to reform at a more fundamental level. Three points are being highlighted to elaborate this further.

Six of the ten demands center on eliminating corruption in one way or the other. The demands to dismiss Cabinet members and personnel in high offices with tainted credentials, dealing with culprits of the recent Hajj, banking, privatization and procurement scams and bringing perpetrators of the recent commodity hoardings to justice fall under this category. Additionally, the demand to implement the supreme courts’ verdict in the aftermath of the National Reconciliation Ordinance being regarded null and void also falls within this rubric.

There is a long standing history of attempts to address corruption through disciplinary and penalizing action in Pakistan. Whilst it is true that punitive action has its value as it sets an example and acts as a deterrent, it has its limitations. Political governments and decision makers, deeply entrenched in the spirit of camaraderie are reluctant to bring their peers to justice. With many opportunities to abuse discretionary powers, disciplinary efforts often take on politically-motivated overtures. Pakistan has made the mistake of focusing on corruption through the predominant focus on this approach for far too long. As a consequence, other more systemically effective means of garnering a culture of transparency in overall governance, have received little emphasis. More than punitive action, the key to anticorruption is to focus attention on building institutions and systems that limit opportunities of collusion, graft and arbitrage in the first place. An important aspect of this is mechanisms of oversight that can check discretionary powers, which create opaqueness in interpretation and variance in application of policies. There is potential within leveraging technology as a barrier against abuse and pilferage. Promoting market harnessing means of regulation, fostering competition to weaken economic interests and integrity-promoting measures in the bureaucracy are other entry points. The dividends of appropriate disclosure and freedom of information and safeguards against conflict of interest should additionally be brought to bear. Furthermore, one of the most effective anti-corruption strategies has to do with building safeguards against state capture and the legacy of patronage; this can be attempted by upholding democratic principles in governance so that the systemic manipulation by vested interest groups, which has become a governance norm in our country, can be circumvented.

Punitive actions being recommended as part of the Agenda, therefore, need to be supplemented with a greater emphasis on strengthening Pakistan’s key institutions in general and accountability mechanisms in particular and implementing the country’s National Anti Corruption Strategy, which seems to have gone into hibernation after its unveiling in 2002 and several successive attempts aimed at reviving it.

The second demand on the Agenda calls for the creation of an independent Accountability Commission. It is widely accepted that impartial and depoliticized accountability bodies can help advance the accountability/transparency agenda. However, the past performance of commissions in Pakistan has not been promising and nothing harvests the hope that the case is likely to be otherwise this time round.

Commissions tend to fall prey to capture and end up behaving quite similar to bureaucratic structures. There are additional issues with the proposed accountability commission. The law under which it is supposed to be created and which has been pending in the Parliament/ Ministry of Law for over a year has been criticized because of its glaring list of exclusions and loopholes, which can enable exploitation. Furthermore, accountability is a broader thread in governance and is not synonymous with anticorruption. As an attribute, it is also relevant to the performance and financial realms. The determinants of the fiscal policy related Demands on the Agenda can be explored further to highlight the reality that Pakistan’s systems of governance are bereft of any such effective structures. These demands relate to inflationary pressures, the energy crises, crowding out of fiscal space, sprawling size of the government and resulting expenditures. Each of these threads can be linked back to lack of effective mechanisms of accountability at the performance and financial levels.

If mechanisms to compel accountability existed and if disclosure and freedom of information laws had been implemented in their true spirit to assist with the accountability process, perhaps Pakistan’s debt burden would not have accumulated to this scale and its footprint on the lives of the common man in terms of inflationary pressures and scaled back social services would not have been this brutal. The blatant graft, which leads to massive bleeds from the system, may not have been so deeply entrenched crowding out the space for resources, which can touch the lives of a common man. The Public Sector Development Programme would not have continued to fund public sector enterprises and infrastructure projects with meager development resources at the cost of health and education while options to revitalize management and privatization for the former and private financing for the later existed. If accountability had been institutionalized, the energy czars would have not prioritized quick turnover thermal power plants over long term sustainable investments in hydel power projects; the common man would not have to bear the weight of massive load-shedding, which is having a domino effect on employment and the economy.  There is a long list of illustrative examples to highlight the manner in which lack of accountability at the decision making level has translated into the current mayhem. So, important as the agenda targets may be, it will take more than a Commission to set things on the right path.

The third aspect of the Agenda I would like to comment on is the Call for an independent Election Commission. Perhaps what the agenda should have stressed on additionally is also to expedite and support what is already in the pipeline. The NEWS on January 12 featured a seemingly non-descript but an important news item regarding the National Database Registration Authority’s efforts to install an electronic voting system and a law in the pipeline to enable that. Ideally this should be supplemented with other reforms to make the election process more facilitative for those that neither have the power nor the money to enter the run. Additionally the illiterate voter, currently beholden to feudal interests and dynamics of ‘biradrai’ will also have to be primed to the need for making the right choice. What Pakistan needs now is human capital in the right policy making roles with the hope that this will set key institutions on the pathway of recovery. The Agenda Demands need to be augmented to make headway in that direction.

The author is the founding president of the NGO think-tank, Heartfile. sania@heartfile.org




THE VANISHING MINISTRY

January 03, 2011: Under the 18th Amendment to the Constitution of Pakistan, a number of ‘state subjects’ inclusive of health have been devolved to the provinces in an attempt to enhance provincial autonomy in Pakistan’s federating system. As a corollary, it has been pronounced that the Federal Ministry of Health doesn’t need to exist anymore. Within that context, this comment underscores the salience of the federal Ministry of Health’s role and cautions against its abolition




Risks and resilience

Published in The News International on January 01, 2011:

At the recent meeting of the Global Agenda Council of the World Economic Forum in Dubai some of the top issues in the global risk landscape and their possible mitigates were highlights. Ironically, a few of us from Pakistan could relate to most systemic risks as being endemic to our sovereign environment, each of them inextricably multi-dimensional in their scope. As global experts underscored the salience of effective governance structures, accountability, and clarity in multi-stakeholder concerted action as the means of addressing these risks, one could not help reflect on ones own constraints within that space.

Reflecting on these risks and the mechanisms that can ensure institutional and population resilience is part of what one should be doing at the turn of the decade.

Against the backdrop of mayhem caused by Iceland’s Volcano and the recent unexpected weather on Christmas Eve, probably the beginnings of manifestations of the “inconvenient truth”, the agenda of climate change and the modest progress achieved in Cancun are now a major point of reflection, globally. Pakistan has recently learnt some bitter lessons which drove home the importance of natural calamities and their inter-linkages with climate change. The widespread inundation and damage consequent to the 2010 floods may not have received the support it deserved from the international community particularly vis-à-vis Haiti earthquake and the earlier Tsunami, it nevertheless speaks volumes about resilience of the poor in the riverside communities of the Indus river. The response of the domestic and expatriate Pakistanis was additionally indicative of community resilience. The same cannot be said for the systems of governance though. Our disaster management systems need significant injection of resources and capacity building in order to be effective.

Someone once very appropriately stated: “half of Pakistan is seismically active and the rest is flood prone” may I add that nearly all is vulnerable to terrorist attacks. Terrorism featured prominently as a global threat. Pakistan is at the epicenter. Water and food insecurity are other internationally-recognized global risks; both are inherent to the problems the country faces and are deeply interlinked. Health security and the threats of emerging and reemerging infections loom large as global risks; Pakistan’s underreporting of H1N1 during the crisis in 2009 points to lack of responsiveness and hence failure on its part to comply with International Health Regulations, 205. It is easy to draw up an inventory of risks, but sobering to gain insights into the manner in which state capacity has been eroded over time to respond to these challenges.

In the economic sphere, global deliberations now centre on slow moving risks exacerbated by the financial crisis and global economic downturn, the costs and consequences of public bail outs, systemic loop holes in the global financial system, the impact of the crisis in making people risk averse which stymies recovery and the need for enhancing global resilience in a globally interconnected economy. Our worries in the economic sphere are sharper and fairly mundane. The grinding resource constraints and severely crowded out development budget are realities in an environment where there are many competing priorities: the unrelenting energy crisis, the cost of waging a war and fighting insurgency, the massive need for rebuilding in the aftermath of the 2010 floods, to mention a few. The deepening fiscal deficit and the new formula for federal fiscalism, which according to an expert economist “has sown the seeds of fiscal indiscipline”, inadvertently, I would add, are sobering.  In such an environment, the lack of institutional resilience is evident in some key trends: in particular, the unrelenting inability of economic managers to implement the RGT reform, levy long overdue taxes on the ‘privileged sectors’ and address constrains that stand in the way of reforming public sector enterprises that continue to incur massive unnecessary losses from the fiscal system. Slow mobilization of development assistance and the stalemate over the IMF negotiations also mirror impediments to institutional resilience despite the presence of some credible economic managers within the system. These are ominous signs and indicate that injecting individual capacities in the system, though important in its own right, is not enough; a major overhaul of systems of governance is due.

While institutions may not be responsive and resilient, people are and have become so. They are enduring the fall out of the recession, bearing the brunt of unemployment, putting up with the crippling power shortages in severe temperatures, holding out in the face of food price inflation and soaring cost of utilities with painful and unprecedented endurance. The tacit suffering is now frequently changing color with street protests commoner than they were before. These outbursts can spark out of hand if institutional capacity to respond is not stepped up.

The recent notion and expectation that the 18th amendment and the 7th NFC will be a means of addressing these problems are founded on a well-conceived premise, but theoretically so. Decentralization of power to sub-state units can indeed open avenues for accelerating progress in social service delivery and enhancing public sector effectiveness by bringing those responsible for delivering services, close to intended beneficiaries and making them accountable. However, in reality provinces lack fiscal discipline and are plagued by pervasive collusion and state capture. The lack of progress in the accountability legislation and many other transparency promoting measures, prevailing views on the local government system, which resort to moving the pendulum towards strengthening provincial central control and away from district devolution and community oversight do not auger well for strengthening democratic governance in provinces. The risk of crony appointments and procurement graft will in all likelihood increase if checks and balances are not mainstreamed.

Institutional resilience with respect to individual and community risks is another important dimension. With many ministries related to the social sectors in the process of being devolved to the provinces over the next six months—inclusive of health, education, social welfare, Zakat, etc.—the mechanisms, which can enable that are in a flux. Perhaps the most ominous risk and one not very clearly appreciated in international circles is the risk that population trends pose in countries like ours.  With a rapidly burgeoning base of the population pyramid, limited economic opportunities, and scarce welfare systems, there is a risk that people will increasingly fall prey to extremist ideologies.

Pakistan may not be the only country where the dark shadow of interconnected systemic risks loom and where the imperative to be institutionally resilient stands tall. However, it is certainly one of the few countries where the interconnectedness of risks and the progressive erosion of institutional capacity to respond are most clearly manifested.  The pendulum of resilience must shift from individuals and communities to institutions and the state.  People are stretched to capacity and may not be able to withstand stresses for very long.

The author is the founding president of the NGO think-tank, Heartfile. sania@heartfile.org