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Health Policy – chinks in the armor

Published in The News International on July 14, 2008:  In the midst of all the overarching challenges the country faces, sectoral policy and strategy appears to be relegated to the background; the latter cannot be mainstreamed in any case without sound institutional governance, which is also a determinant of the currently prevailing broader issues. Let's take the example of health where the government's initiative to formulate a new national health policy could be the starting point for the much needed reform within the health sector. Certain sound technical choices can be made and if evidenced-based strategies are adopted to synergize a technically robust and administratively feasible agenda, a viable basis for restructuring the health system can be made. However, the issue is not at the level of 'technical choices' but with the manner in which institutions govern policy change; there are two critical impediments at this level; first, the ability of state institutions to build on evidence and secondly, their ability to ensure that policy reforms introduced, are taken to fruition over the long term. A historial review demonstrates that health...

Romancing health insurance

Published in The News International on June 28, 2008: With all the four provincial budgets for the fiscal year 2008/09 tabled, the annual provincial development programs for the next year have been unveiled. Provincial development budgets range from 22.12-41.13% of the total outlays with Punjab spending the highest and Balochistan the lowest. 1.84-12.15% of the total provincial development budgets have been allocated for health with Sindh allocating the highest in relative terms. On the whole, provincial health allocations suffer from limitations that are somewhat similar to those described for the federal health budget in the author's editorial in The NEWS on June, 20. However, a consistent reference to health insurance as a potential means of financing health in budget speeches has prompted this opinion in an attempt to bring clarity to the potential therein. First of all, it is important to recognize that there are broadly two means of financing health – public and private; public sources, which include tax and pooling (social health insurance and exemptions are the two ways of pooling) are more equitable in protection against health...

Budget – five points under the health lens

Published in The News International on June 21, 2008:  Had it been conventional to place the budget in the public domain to solicit inputs of the civil society on the directions proposed therein, suggestions such as the one articulated in this opinion could have been more timely in terms of possible inclusion in the planning process. Given that this is not the scenario, the following five points are offered as policy inputs in relation to budgetary allocations for health, on the premise that some of these ideas will generate a discussion in the forthcoming parliamentary debates. First, it is important to recognize that the health status of populations has a direct correlation with the level of public spending on health. However, it is not just the aggregate level of spending, but the percentage of GDP allocated for health adjusted for inflation and population growth, and its translation into per capita public expenditures relative to private expenditures that gives a somewhat truer picture of the state's investments in health. Here it is acknowledged that Pakistan's aggregate level of allocation for health...

Pakistan’s Covert Cartels

Published in The News International on May 22, 2008: With economic, food and energy crises looming, criticism can be the most convenient past time. Such situations however, are also the litmus test for patriotism, given that a true commitment to the country warrants a look into the present and past for an objective empirical analysis only to develop insights for future planning and action. It is in an attempt to do the latter, that a viewpoint is offered. Crises illicit a knee jerk reaction to trouble shoot and inadvertently lead to fleeting short term solutions; however, it is equally important to explore their causal determinants for  long term sustainable action. Let's take the wheat crisis as a case in point, a crisis that affects the common man directly as opposed to many other crises in the spotlight, that don't. After a careful evaluation, it becomes evident that the crisis is just the tip of the iceberg and that its manifestations, price hike and shortages, are an indication of deep-seated systemic issues, just as fever indicates infection or unexplained rains herald climate...

Honing the 100-day agenda

Published in The News International on April 06, 2008:  Perceived as an effort aimed at planning strategically the Prime Minister's 100 day agenda is a step in the right direction. The points articulated therein are substantively valid if implemented in their true spirit. Their contents however, are a mix of long term aspirational goals, preferred policy choices, strategic administrative measures and a few immediate executive orders. Ideally the hundred day agenda should sift and separate the aspirational vision from the steps needed to implement the vision and subsequently cascade the latter into tangible processes that the government can pragmatically initialize within the stipulated period. It is hoped that the government will engage in such a strategic planning exercise to hone the agenda further and it is with the intent of contributing to this exercise that a neutral viewpoint is offered. To begin with, the overarching context of the agenda should be brought to bear; this clearly flags three imperatives: instituting mechanisms so that individual and group interests become subservient to state interest; strengthening institutional integrity; and making governance effective to enable...

Anti-corruption reform – strategic imperatives

Published in The News International on March 18, 2008: Elections 2008 will soon come to fruition with the formation of a new government. Regardless of who assumes office, being in the government is not going to be an enviable position if the ground reality is brought to bear, as it should. As practical action replaces rhetoric, limitations of the government to deliver on election catchphrases will become evident, particularly in serving the needs of the disadvantaged. The foreseen inevitable worsening of inflation is likely to put a tremendous pressure on the impoverished masses whereas the stalling macroeconomic situation will constrain the government's ability to allocate additional development budgets. Failure to improve social conditions will ultimately have implications for many deep seated issues we face today, such as violence and instability. In order to do something meaningful therefore, certain insightful policies will have to be pursued beyond quick actions demanded by political expediency. In the quest for a sustainable solution, the new government might want to consider a common determinant that has led to most of the maladies faced by the country...

The Social Sector – telling evidence

Published in The News International on January 30, 2008:  In its report entitled "The State of the World's Children, 2008" UNICEF's reiteration of Pakistan's stalling position to meet the targets stipulated in the Millennium Declaration particularly with reference to MDG 4 and 5 adds yet another set of predicaments to the ones that already exist in the country, on a range of fronts. Much of what has been articulated in the report is not new though; we have known about our poor maternal and child health indicators for a while through state-owned data that is in the public domain and many international peer reviewed publications; but perhaps a multi-lateral's technical weight might help to drive the nail home further. What has hurt our national pride this time around is to see our indicators being compared with countries such as Afghanistan with whom we have no comparison in macro economic terms and to see countries in a similar per-captia income category, with far better indicators on child mortality. Here it must be recognized that this is not just 'another report'; the data...

The new government’s option

Published in The News International on December 31, 2007: With the elections of 2008 forthcoming, and a change of hands on the governments reigns envisaged shortly, it is evident that any new government in Pakistan will have many issues to grapple with – from terrorism and conflict to the energy crisis and stalling fiscal indicators; inevitably and understandably, these will be the substrate of the new government's focus as a result of which certain critical systemic issues are likely to get relegated to the background – issues that ultimately tangle most governments in a vicious spiral over the long term. Balance dictates that the new government must accord high priority to these issues right at the very outset. Foremost amongst these issues is the complex maze of malpractices and corruption, which in its truest sense cannot be extricated from governance challenges, mismanagement and inefficiencies. Within the framework of governance, these terms are often used interchangeably; the connotation of corruption makes it distinctive though as the other three may be inadvertent and without the intent to benefit whereas the nuance...

Corruption: the need-greed equation

Published in The News International on December 09, 2007: Pakistan's ranking on the 7th position in the recently released Global Corruption Barometer by Transparency International should lend a serious impetus to address an issue, which is deeply ingrained in the institutional processes of the country, both in the public and private sectors and in many fiscal, ethical and moral shades. However it is important to recognize that corruption is not specific to Pakistan but is a systemic phenomenon, endemic to developing countries and prevalent in many in western nations. Corruption is also not a new occurrence in Pakistan but is a manifestation of a time long practice; this is evidenced by a reference made to the phenomenon by the Quaid on the occasion of his address to the Constituent Assembly of Pakistan on August 11, 1947. Corruption is also not a phenomenon for which a particular government can be blamed; notwithstanding, various governments have set precedence for ingraining different forms of corruption and have failed to pay due attention to the matter. Corrupt behaviors fall on a spectrum and although...

Integrating a new public health order

Nishtar S. Integrating a new public health order. Lancet...

Time for a global partnership on Non-Communicable Diseases.

Nishtar S. Time for a global partnership on Non-Communicable Diseases. Lancet...

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