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Tuberculosis Oped

Saving Women and Girls

Ending childhood obesity: a time for action

18th Amendment: five years on

Published in The News International on April 12, 2015: It has been five years since enactment of the 18th Amendment to the constitution of Pakistan and four years since the end of the term of several committees that were given the mandate to iron out related implementation issues. Despite progress, major issues still lurk that negatively impact performance of the federal and provincial governments. These issues need to be addressed urgently. Just for clarity, this comment refers only to the provincial autonomy-related covenants of the 18th Amendment and matters arising as a result of abolition of the concurrent legislative list. The comment underscores the need for an institutional arrangement to tackle post-18th Amendment issues, outlining several points. First, the amendment has created an ‘ambiguity’ in the employment status of thousands of federal functionaries, whose services were either placed with the provinces after abolition of several federal ministries and/or transfer of respective departments from federal to the provincial level or those that were transferred to other federal ministries. These functionaries have been placed in a lower hierarchy and are not entitled to the...

Ending childhood obesity: a multidimensional challenge

Peter Gluckman P, Nishtar S. Armstrong T. Ending childhood obesity: a multidimensional challenge. The Lancet 2015. DOI: http://dx.doi.org/10.1016/S0140-6736(15)60509-8 Accessible...

The drug pricing policy

Published in The News International on January 06, 2015: The drug pricing policy is on the prime minister’s table for the final approval. Three dimensions of pricing need to be segregated: 1) Initial price setting, either of originator brands of new chemical entities (NCE) or their generic substitutes; 2) rationalisation of prices of medicines currently in the market; and 3) grant of annual price increase. With regard to the first dimension, notwithstanding existing controversies, there is clarity in the policy direction since the prices of NCEs are to be fixed under the regional basket formula and that of generic substitutes, 30 percent less than the originator brand price. The third dimension can be debated, but from a policy stance its direction is clear as the annual price increase has been linked to the Consumer Price Index. The problem relates to the second point, where there are ambiguities and room for manoeuvrability. First, the government’s intention, evident in the title of the policy “to purge the system of discretion”, would be seriously undermined and the policy would paradoxically end up increasing the...

The healthcare universe

Published in The News International on December 13, 2014: Plunged in the corner of an orthopaedic ward in a hospital in Pakistan, ZU, a 19-year-old labourer struggles with pain and discomfort, his leg arched over a metal frame at 45 degrees. Two bricks hang from a cord tethered to a nail stuck deep in his lower thigh, preventing the fracture he sustained a week ago from misaligning. Every now and then he gazes at the door to see if his brother is back from the village with the money needed to fix his leg. The only goat they possessed had fetched half the amount needed to buy a surgically implantable nail, necessary to cement the bone. His brother had now gone back to the village to borrow the rest. He wonders if his fate will be the same as that of the man at the far end of the ward, who was taken back home in a similar situation after ten days in the hospital after his family was unable to buy the surgical implant needed to fix his fracture. ZU...

Brainstorming a better world

Published in The News International on November 19, 2014: For the last seven years, every November around 800 thought leaders from around the world convene in the United Arab Emirates for the World Economic Forum’s Summit on the Global Agenda. Knitted as a global knowledge network of around 80 Global Agenda Councils on a wide range of subjects, the event is widely recognised as the world’s largest brainstorming event. A handful of Pakistanis are also invited each year. Typically every year trends with regard to challenges and opportunities of the upcoming year come under discussion and are outlined in an accompanying report, the ‘Outlook on the Global Agenda’. This year, the Outlook Report released at the event outlined 10 ‘global trends’ or ‘key challenges’ facing the world over the next 12-18 months. These challenges were compiled and ranked using the Delphi method. The report ranked them in order of priority, but here I cluster them and reflect on their relevance to Pakistan. I will club the economic challenges, ‘deepening income inequality’ and ‘persistent jobless growth’ into one cluster. These topped the list...

Ministries: a review

Published in The News International on October 31, 2014: A special cabinet meeting has been scheduled for today (October 31) to conduct a performance review of all ministries, divisions and departments. In this context, I am offering some reflections from my tenure as federal minister in the interim government last year. These reflections relate to the systemic constraints, which in my opinion, stand in the way of effective governance and hence hamper the government’s performance. The frame of reference is government ministries and the issues highlighted are of a long-standing systemic nature. First, an objective assessment of performance is possible only when goals, time-bound outcome-based targets, and performance metrics have been pre-defined. None of these is the norm in ministries. Government functionaries usually do not have a clear sense of delivery with no clear terms of reference and measurable operational targets in the context of overall goals for a sector. Hence as a starting point, these need to be framed. My second observation relates to expectations regarding the government’s performance, which matters deeply since it determines the context in which all societal actors...

Privatisation imperatives

Published in The News International on August 07, 2014: Privatisation is subject to intensely polarised political discussions, which cloud important policy imperatives that need to be appreciated. Six points are being outlined in this respect. First, we must get the framing on privatisation right. Privatisation must not be viewed through the narrow lens of sale of state enterprise to bridge fiscal deficit. Privatisation is deeply linked to the fundamental question of the role of the state in the economy and is part of a broader economic liberalisation and deregulation agenda. It is one of the policy choices a government can espouse to make the private sector the engine of growth with the understanding that the role of the government is to provide an enabling policy, impartial oversight, and a level playing field for market entities. When a country such as Pakistan embarks on the broader deregulation path, it has to be prepared to overhaul its own institutional competencies within government. This is a long-term agenda. Far from political polarisation, political consensus is needed to go this route so that the course can...

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