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View Points

The White Paper and the question of aid effectiveness

Published in The News International on April 11, 2009: The White House has recently released a White Paper on U.S. policy to Afghanistan and Pakistan, articulating a number of geo-political and development imperatives for the region. This comment will focus only on the dimension related to development assistance within the contemporary realm of aid effectiveness. The US policy paper outlines a strategy centered on stepping up economic support to Pakistan; the importance of this has also been reiterated by President Obama's three-pronged call for increasing development assistance for the country in his speech on March 27, 2009 and is evidenced by support signaled for the bipartisan Kerry-Lugar Bill and the Cantwell-Hollen-Hoekstra Bills and endorsement of support for Pakistan to the 'Friends of Pakistan' who are scheduled to meet in Japan later this month. The policy statement has made some bold and honest admissions. For one, it has recognized that aid has remained "Ill-organized and significantly under-resourced in some areas a large portion of development assistance ends up being spent on international consultants and overhead, and virtually no impact assessments have...

The fight against spurious drugs

Published in The News International on February 14, 2009: The issue of spurious drugs has been in the spotlight for some time now beginning with the suo moto action by the Supreme Court in 2007 and the subsequent regulatory actions by the then government to the more recent creation of a sub-committee of the Senate's Standing Committee on Interior. The problem has elicited strong reactions by several governments—severe but fleeting and short-lived. The idea here is neither to analyze individual decisions nor to delve into their motivation but to explain that the presence of spurious drugs in the market is a manifestation of erosion of capacity to regulate and govern. Just as fever indicates systemic infection and changing temperatures herald climate change, the presence of spurious drugs signal the presence of deep-seated issues relating to oversight. The energy crises, episodic shortages of essential commodities such as sugar and wheat are also likewise a reflection either of absence of accountability of decision making or exploitation of regulatory prerogatives and ensuing graft at several levels—each of these is a core issue of governance...

Restructuring and reforming NAB

Published in The News International on January 27, 2009: The government is on its way to revamping the country's accountability infrastructure and statutes. It is evident from a review of news postings in early January, that the National Accountability Bureau (NAB) will be replaced with an Independent Accountability Commission (IAC) with the antecedent repealing of the current National Accountability Ordinance, 1999 (NAO) and promulgation of the Holder of Public Offices Act, 2009 (HPOA). It is important to ensure that this is not just a switch of acronyms but a substantive institutional restructuring and realignment of statutes as a step towards fostering accountability and transparency within the country—a core attribute of good governance. The news items in early January surprisingly generated very low level of interest from stakeholders in the political and governance arenas and the civil society, all of whom appear to hold institutional strengthening esteemed in rhetoric. It must be recognized however, that unless we actively and substantively engage in shaping institutional norms and structures, rhetorical commitments cannot come to fruition. It is therefore with a view to initiating...

The Global Financial downturn—imperatives for the health sector.

Nishtar S. Pablos-Mendez A. The Global Financial downturn—imperatives for the health sector. Lancet 2009;373:124. Download Attached file #...

Financial crisis, social unrest and reform

Published in The News International on January 05, 2009:  The December 22, 2008 issue of Newsweek featured an article on the downside of Chinese state reform. Entitled 'Why China is too scared to spend', the article drew attention to the weaknesses created in the Chinese health system with the advent of market reforms in the 1980's, which did away with the communes that funded the Chinese system of work-unit based welfare. The consequent negative impact on the Chinese social sector hit healthcare the worst, as bare foot doctors in villages and affordable hospitals in towns were replaced by privatized state enterprise. Currently, a majority of the population spends out-of-pocket to seek healthcare and as rightly pointed out in the article 'a serious illness can wipe out a family's savings'—a pattern labeled as catastrophic spending. The word 'catastrophic' in the present context denotes an economically dire outcome for a family. This pattern of spending in health comes to the spotlight in view of the recent financial crisis because of its implications for spending patterns, as Chinese families, unprotected in terms of their...

Global crises—imperatives for a just social order

Published in The News International on December 14, 2008: There is an apprehension within the development circles that the economic impact emanating from the crisis in international commodity markets and the affects of the global financial downturn coupled with constrained fiscal space in the country as a result of a number of factors inherent to Pakistan's domestic situation is likely to hit development budgetary allocations hard, over the coming months. Such a situation is indeed plausible. While the lack of full integration of Pakistan's financial markets with international markets, to some extent precludes the adverse impact getting imported into Pakistan as it has in the more integrated markets of East Asia, notwithstanding the synergistic effect of other factors will mean that the government will have fewer options to raise additional resources to support the social sector budget. Pakistan will, from now on have to comply with the stipulations of the International Monetary Fund; these ingrain fiscal discipline and should not be used as an excuse to limit social sector expenditures. On the contrary these times require strengthening of interventions that...

Scaling up research and learning for health systems: time to act.

Evans T, Nishtar S, Atun R, Etienne C. Scaling up research and learning for health systems: time to act. Lancet 2008;372(9649):1529-31. Download Attached file #...

A new war – against polio

Published in The News International on October 23, 2008: Pakistan's security situation and the war on terror has become a top priority for the government. While the need to prioritize issues is understandable, attention to some other matters of the state on a war footing is also warranted. In many ways, the case of polio eradication is analogous to the war on terror given the international context within which it is being waged and the gains at stake. Since 1998, a Global Program on Polio Eradication spearheaded by WHO and involving many other agencies aimed at eradicating a disease from this planet for the second time in the world's history since Small Pox eradication in 1979, has been ongoing. This initiative, involving 125 countries, more than 20 million health workers and vaccination of over 2 billion children worldwide has been able to achieve the polio eradication milestone in all except four countries of the world. The premise is simple: immunization is a right of every child, vaccination is the most cost effective health intervention and a few drops of polio...

NAB and related governance issues

Published in The News International on September 30, 2008: The government has decided to repeal the National Accountability Ordinance 1999, and has drafted a bill to legislate for an alternative accountability mechanism; with the promulgation of these statutes, the National Accountability Bureau (NAB), Pakistan's apex agency mandated in an anti-corruption role will be replaced by an alternative accountability body. The draft bill is not in the public domain and cannot be commented upon and the shortcomings of the earlier Ordinance have not been publicly debated. Notwithstanding, an opinion is offered as this clearly, can be an opportunity to address current weaknesses in the country's anti corruption institutional mechanisms and legal system. Within this context, the objective of this opinion is threefold: first to contextualize NAB's niche in the broader remit of institutional arrangements that are of relevance of anti corruption reform. Secondly, to comment on the need for other statutes that need to be promulgated in tandem with an accountability law. Thirdly and most importantly, to draw attention to other broader measures and sectoral approaches in public sector reform, which...

Democracy and governance – upstream determinants

Published in The News International on September 08, 2008: With the conclusion of presidential elections, the power configuration within the state has been defined. 'Majority rule' or 'a few ruling with the consent of many', described by the Greeks centuries ago, as a characteristic feature of democracy has been established within Pakistan and constitutional stipulations as articulated in Part III of the Constitution with reference to its Chapters on the President and Majlis-e-Shoora (Parliament) have been adhered to. At this stage, let us be reminded that while democracy, as understood conventionally is a necessary condition for a good government, it is certainly not a sufficient condition. This comment is intended to objectively draw attention to other characteristics that need to be woven into the equation in order to enable democratically elected governments to successfully navigate the ship of the state. Democracy is not just about 'majority rule'; it is an amalgamation of many attributes. First, it is a set of institutional arrangements or constitutional devices; by this measure, Pakistan has achieved a democratic milestone. However, there are other institutional democratic...

Independence Day – an ode to governance

Published in The News International on August 17, 2008: 14th of August is as august as a day can get, both for Pakistanis who have witnessed the perils of partition and experienced the anguish of being in a subservient role as well as those of us born after independence; the latter can be attributed largely to 'temporal depth' – the characteristic understanding in nations of the past forming part of the present – and our collective consciousness, both of which we hope, will cascade to the next generation. Most of us would like to believe that the 'nation', as a territorial community and 'patriotism', as a commitment to the well being of our country, constitute an important aspect of our lives. However, other than periods of intense enthusiasm witnessed during the wars and the more recent sentiments of solidarity exhibited in the aftermath of the devastating October 2005 earthquake, we are often not clearly mindful of what truly constitutes the nation's well being. Allow me to illustrate that point further. As government entities at various levels, businesses, NGOs, civil society,...