February 27, 2013: The World Health Organization hosted a meeting of the Informal Consultation Group (ICG) of Experts on NCD on February 11-12 in the WHO Headquarter in Geneva. The meeting was held to review progress made in global initiatives for NCD prevention and control, to solicit inputs on WHO’s draft global action plan for NCD prevention and control 2013-20, and to discuss the possibilities and opportunities of NCD integration into the post-2015 UN development agenda. Our president, Dr. Sania Nishtar participated the meeting as a member of the ICG group of experts.
February 26, 2013: On February 25th, Heartfile Health Financing and Janum Network signed a Memorandum of Understanding on improving financial access to healthcare for patients suffering from obstetric fistula. Several commitments have been agreed upon by the two NGOs; the MoU can be accessed here.
February 19, 2013: World’s renowned experts, eminent scientists and academics have contributed towards the latest series of the Lancet, Series 4 on Non-communicable Diseases (NCDs), launched on February 11, 2013. The Series builds on the High Level Meeting on NCDs convened by the United Nations in 2011 and on its previous series in 2010, 2007 and 2005. The Series, coordinated by Robert Beaglehole, aims to bring more evidence in the public domain, as the post-2015 agenda planning is underway. It also proposes cost-effective interventions to accelerate progress to avert millions of deaths, worldwide, by 2025. In this Series, our president, Dr. Sania Nishtar co-authored a viewpoint, ‘Improving responsiveness of health systems to non-communicable diseases with Prof. Rifat Atun of Imperial College, London as the lead author. This paper focuses on developing health systems in response to non-communicable diseases in the midst of challenges incurred by them.
Rifat Atun, Shabbar Jaffar, Sania Nishtar, Felicia M Knaul, Mauricio L Barreto, Moffat Nyirenda, Nicholas Banatvala, Peter Piot. Improving responsiveness of health systems to non-communicable diseases. The Lancet, 12 February 2013: doi:10.1016/S0140-6736(13)60063-X
February 7, 2013: We are pleased to announce the launch of Heartfile’s eForum, (#HeartfileBlog) with commentaries, resources and updates on Pakistan-relevant health and population issues. In addition to being a discussion portal and serving as an archive, this forum will also serve as a sounding board for issues to be identified, which Heartfile subsequently plans to frame for deeper discussion through Webinars and its policy analysis stream of work. The eForum is a re-launch of the Pakistan Health Policy Forum, which was created in 2000 and is now being recalibrated to exploit the benefits of online connectivity and social media. The eForum Moderator, Mariam Malik can be contacted for further details in this regard.
Published in The News International on February 06, 2013:
Pakistan’s national and human security challenges have never been so pervasive. A war along the northern borders and relentless insurgency threatens the writ of the state, pitting law-enforcement agencies against people. Vested-interest groups exploit and deepen existing polarisation on ethnic, sectarian, political and religious fronts, resulting in carnage. These problems have created unprecedented pressures on an economy already plagued by serious structural problems, crippling power shortages and poor governance.
Human security and state security have become inextricably linked. Our unique pattern of polarisation has become a threat to state security. Compounding all these are sequential natural disasters, which have put the lives of millions at risk. The spiralling population too is becoming an overload, and with high levels of poverty and unemployment our youth has become vulnerable to exploitation.
Pakistan today stands very low in most international rankings. In a recent report comparing Asian countries, Pakistan’s health and education indicators have hit rock-bottom. Our ranking in the UNDP’s Human Development Index is 145 out of 187 countries. We are off-track in meeting the MDGs and have been ranked among the bottom two in the World Economic Forum’s Gender Gap rankings for the last six years.
Recent education rankings based on the proportion of girls who have never been in school, place us in the bottom 10 countries. The 2011 Household Integrated Economic Survey indicates a widening income gap between the rich and the poor; the list goes on. It is not just ‘outcome’ indicators but also the ‘process-level’ indicators that do not inspire confidence. We are slipping on transparency ratings, competitiveness rankings, doing-business inter-country measures and democracy indices.
Why is this the case? What has gone wrong? Why can’t we get our act together? Although a number of factors contribute to this quagmire, it is the misuse and abuse of three attributes of state governance that is the root cause of many of the problems we face today – politics, democracy, and accountability are the most widely misunderstood words in the country.
Politics refers to matters relating to the organisation of the affairs of the state. It is also considered analogous to the process of steering a country where a government assumes the controls of a ship. If politics is the art of navigating the ship of state, then fashioning the signs by which a steersman should steer is a function of political parties. This is where the key problem lies. Political institutions have a specific role, which centres on nurturing human resource and the strategies for the purpose of organising the running of the state and its organisations.
Since politics is also about gaining control of representative institutions, it can be understood that some level of power struggle and rivalries will be inherent to its functioning. Although Pakistan is not unique in the domination of power-play in politics, it is certainly exceptional in relation to the manner in which it has become integrated with the executive’s functioning with decision-makers reaping the benefits of incumbency for re-election. Not only is this detrimental for governance, it has also eroded the capacity of political institutions with cult- and clan-based control.
The second misunderstood attribute is democracy. Democracy is not just about ‘majority rule’; it is rather an amalgamation of many attributes. It is a set of institutional arrangements or constitutional devices. By this measure, Pakistan has achieved some progress since the 18th constitutional amendment has restored the constitution to its pre-military character. But that is not enough, since democracy is also about individual and institutional behaviours, characterised by respect for separation of powers and regard for evidence in decision-making.
As a value, democracy is closely related to liberty, equality, freedom and rights. Governments should be democratic not just in an institutional but also a social sense with attention to individual liberties, human rights and social justice. We must not rattle popular vote as a measure of democracy; we also must not regard as ‘democratic’ the ‘consensus’ between political factions over decisions that are mutually beneficial and driven by the status quo. Democracy has to mainstream the voice of all, and must uphold everyone’s interest as well.
The third misnomer is ‘accountability’, which in Pakistan is considered to be synonymous with political exploitation, as illustrated by past history of accountability institutions. Accountability in state governance is quite different from that. Pakistan’s politicisation of governance, rampant graft and a blatant disregard for merit are the causes of its quagmire. Tracked back, many of these problems have their origins in a lack of mechanisms that compel accountability. As a result of limited accountability, poor governance, mismanagement, inefficiencies and malpractices have become pervasive.
The thread of each adverse outcome in Pakistan today lies in a bad decision or deliberate oversight. From the burgeoning debt burden, the spiralling fiscal deficit, the energy quagmire, poor human development to the manner in which extremism has taken root in Pakistan, a chain of individuals in public decision-making roles can be held responsible, but are hardly ever held responsible. The accountability apparatus does not have the ability to engage in politically-blind operations. If we continue to regard responsibility, answerability, blameworthiness, liability and other attributes of account-giving, low level of importance that they have been receiving, governance will further deteriorate and we will continue to spiral downwards.
But it is not just the public system which is at fault. People are also to be blamed when they collude with the tax administration and circumvent procedures, when they are complicit with regulators in allocation of subsidies, licenses, quotas and price ceilings, or when they are in cahoots with public-sector procuring agencies, or are party to institutionalised pilfering now so characteristic of public functioning. Given the strategic significance of accountability, it is ironic that it has not been a legislative priority. Several iterations of an accountability bill have been in the legislative process. Perhaps it should be the first priority of a democratic government to get such a framework in order.
Pakistan is a country with enormous potential. While some pillars of the state suffer from malaise, the society continues to show remarkable resilience. The country is amply rich in natural resources, norms, the structure of organisations and institutions, even though they do not function well. Being a large market it offers huge investment potential. What is needed is some semblance of governance, and a certain level of policy predictability and consistency. Pakistan certainly has the ability to take off if its leadership commits to upholding the right principles in politics, democracy and accountability.
The writer is the founding president of the NGO think tank, Heartfile. Email: email@example.com